Presented by
Holystic Group:Abeer Manea, Andrin Antony, Annamma Varghese, Bency Abraham, Jenitha Selvam, Neena Chacko
Thursday May 18th, 2017
Outline
Case presentation
Video
Description of the symptom
Classifications of diarrhea
Impact on patients quality of life
Pathophysiology underlying the symptom
Pharmacological therapies
Complementary therapies
Patient and family education
Case Presentation
CB is a 68 year old man with a history of small cell lung cancer with bony
metastasis.
He reports the symptom of diarrhea post chemotherapy with cisplatin and
etoposide along with radiation therapy and irinotecan a week ago.
He stated diarrhea started with in the past couple of days and has gotten
progressively worse, over past 12 hours 4 to 6 episode of explosive diarrhoea.
Sometimes, he passes small amount of stool, but the urge to go to the bathroom
comes quickly and strongly.
Video
https://www.youtube.com/watch?v=zhNGkXVsSEU
Describe the symptom
Describe the symptoms ? How common is this symptom in cancer patients? What is the impact of the
symptom on the quality of life?
Diarrhea is defined as an abnormal increase in both the liquidity and the frequency of stools
Diarrhea could be due to the general toxicity of chemotherapy.
Chemotherapy induced diarrhea is not only highly prevalent but also not tolerable and can be life
threatening, if left untreated.
Radiation induced diarrhea, can cause damage to intestinal mucosa, this damage induces
prostaglandin release and bile salt malabsorption which leads to increased intestinal peristalsis and
causes diarrhea.
About 1 out of every 10 people (10%) have diarrhoea during their illness
Diarrhea is a common symptom in cancer patients with chemotherapy
- 50-80% of patients treated with chemotherapy report diarrhea as a side effect
Mr. CB was on Irinotican which can cause acute diarrhea or delayed diarrhea.
The causes of the symptom experienced by CB is due to the side effects of chemotherapy with
cisplatin and etoposide along with radiation therapy and irinotecan treatment. CBs diarrhea is a
common side effect for patients with advanced cancer.
Chemotherapy causes damage to both cancer cells and to normal, rapidly dividing interstitial
crypt cells.
Thus, the epithelial lining of the intestinal tract is susceptible to damage from the chemotherapy.
Fluid reabsorption into the body from the GI tract decreases and fluid and electrolyte
secretion into stool increases resulting in watery bowel movement that can lead to severe
diarrhea.
An additional cause of diarrhea in the oncology population is colonization with
infectious agents. Patients receiving chemotherapy are at a higher risk of CDAD
(Clostridium deficile associated diarrhea) even without antibiotic therapy.
Diarrhea can be due to Irinotecan, which is unique. It is associated with early and
delayed phase diarrhea. Regardless of its schedule for administration ,myelosuppression
and delayed type diarrhea are the most common side effects.
(Muehlbauer & Lopez, 2014)
(Stein, Voigt, & Jordan, 2010)
Pathophysiology
Deodorised Tincture of Opium is another drug used for chemotherapy induced diarrhea. Opium
tincture contains morphine which is an opioid pain reliever and can reduce gastrointestinal
motility.
Patients who are not responding to Loperamide after 48 hours can use Octreotide as a
second line of treatment.
Diet modification
Probiotics
Probiotics
Probiotics are living microorganisms (Bacteria) used for diarrhea
management (nutritional supplements).
(Qi et al., 2010)
(Morturano, 2012)
What Should the Nurse Teach the Patient about
Managing Diarrhea?
Explain to CB and family that
diarrhea is a side effect of
chemotherapy and radiation. Record number of stools.