Hypoxia: prevention, treatment and features of monitoring. Symptomatic treatment of cancer patients

SYMPTOMATIC TREATMENT SYMPTOMATIC TREATMENT - is aimed at eliminating individual manifestations (symptoms) of the disease (eg, prescribing painkillers).

Big Encyclopedic Dictionary. 2000 .

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    Based on divinatory conclusions about internal reason disease and consisting in the treatment of individual symptoms of the disease, as opposed to rational. Dictionary of foreign words included in the Russian language. Chudinov A.N., 1910. ... ... Dictionary of foreign words of the Russian language

    It is aimed at eliminating individual manifestations (symptoms) of the disease (for example, the appointment of painkillers). * * * SYMPTOMATIC TREATMENT SYMPTOMATIC TREATMENT is aimed at eliminating individual manifestations (symptoms) of the disease ... ... encyclopedic Dictionary

    Aimed at eliminating manifestations (symptoms) of the disease (e.g. prescription of painkillers) … Natural science. encyclopedic Dictionary

    SYMPTOMATIC TREATMENT- a method of treatment aimed at eliminating the external signs (symptoms) of the disease, regardless of its causes and usually without eliminating the cause, and alleviating the suffering of the patient (getting rid of pain, asthma attacks and coughing, heart palpitations and ... ... Psychomotor: Dictionary Reference

    Treatment- (Old Slavonic "lek" medicine) any procedure (their complex), the purpose of which is to eliminate the pathological process or disease state or reduce their threat to health, social adaptation and well-being of patients. IN… …

    Treatment and prevention of senile dementia- Patients with senile dementia first of all need observation and care. It is necessary to provide patients with dietary nutrition, monitor the regularity of physiological functions, clean skin, achieve feasible physical activity and ... ... Encyclopedic Dictionary of Psychology and Pedagogy

    I Treatment (lat, curatio; Greek therapeia) is a system of measures aimed at restoring health, preventing complications of the disease and eliminating painful manifestations of the disease for the patient. Among them are activities aimed at ... ... Medical Encyclopedia

    Prevention and treatment of atherosclerosis of the cerebral arteries- For the prevention of atherosclerosis, in addition to the correct diet (restriction of food rich in cholesterol and fat) and the exclusion of such intoxications as alcoholism and smoking, the correct organization of work and rest is very important, ... ... Encyclopedic Dictionary of Psychology and Pedagogy

    POISONING- POISONING. Poisoning is understood as “disorders of animal functions. organism caused by exogenous or endogenous, chemically or physicochemically active ingredients, which are alien in terms of quality, quantity or concentration ... ... Big Medical Encyclopedia

    Pathological conditions caused by exposure to toxic substances (industrial poisons) in production conditions. Industrial poisons are a large group of toxic substances and compounds that are used in industry as a source ... ... Medical Encyclopedia

Books

  • Symptomatic treatment for malignant neoplasms, M.L. Gershanovich. The book describes a system of symptomatic therapy for patients with advanced forms of malignant neoplasms in case of impossibility or exhausted possibilities of special…

ov) without a targeted impact on the underlying cause and mechanisms of its development (in the latter cases, they speak of etiotropic or pathogenetic treatment, respectively). The purpose of S. t. is to alleviate the suffering of the patient, for example, the elimination of pain in case of neuralgia, trauma, debilitating cough with damage to the pleura, vomiting in myocardial infarction, etc. Often S. t. is used in cases of emergency treatment - until an accurate diagnosis is established (for example , infusion of blood or blood substitutes in acute anemia, artificial respiration and cardiac massage in a state of clinical death (See Clinical death)). Sometimes symptomatic relief is inappropriate (eg, administering pain medication for an acute abdomen (See Acute abdomen) makes subsequent diagnosis difficult).


Great Soviet Encyclopedia. - M.: Soviet Encyclopedia. 1969-1978 .

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    symptomatic therapy- Supportive therapy for terminally ill patients (cancer), aimed at relieving the symptoms of the disease or side effects, syn. palliative medicine Subjects of biotechnology Synonyms palliative ... ... Technical Translator's Handbook

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    Along with causal (causal, pathogenetic) psychotherapy, S. p. is an integral part of individual psychotherapeutic programs. S. p. include directions, methods, forms and techniques oriented ... ... Psychotherapeutic Encyclopedia

    T., aimed at eliminating or weakening individual manifestations of the disease ... Big Medical Dictionary

    Atropinocomatous therapy, abbreviated as ACT (or, otherwise, atropinoshock therapy, AST), often called simply “atropine” among psychiatrists, is one of the methods of intensive biological therapy in psychiatry, based on intramuscular ... ... Wikipedia

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    I Poisoning (acute) Poisoning diseases that develop as a result of exogenous exposure to the human or animal body of chemical compounds in quantities that cause violations of physiological functions and endanger life. IN … Medical Encyclopedia

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Books

  • Clinical semiotics and symptomatic therapy, A.I. Ignatovsky. Berlin, 1923 Medical publishing house "Doctor". Richly illustrated publishing house. Owner's binding. The safety is good. This publication has a utilitarian purpose - ...
  • ORZ. Guide for sane parents, Komarovsky Evgeny Olegovich. The new book by Dr. Komarovsky is not only a comprehensive guide on the most pressing topic of children's acute respiratory infections, but also a common sense textbook, a book whose main task is to make…

The goal of palliative care is to make life easier for the patient and their loved ones.”

Most solid tumors with metastases in adults are incurable, so the goal of treatment in such cases is to eliminate the painful symptoms of the disease and, if possible, make the life of the patient easier. After learning about their diagnosis, many patients experience fear of suffering and what they have to endure. To optimize treatment, it is necessary that from the moment of diagnosis, it should be carried out in a complex manner, with the participation of specialists of various profiles. The degree of participation of these specialists in the course of treatment varies.

However, the following goals of palliative care can be distinguished:

  • to ensure the maximum benefit for the patient from the participation of all specialists due to the provision of medical, psychological, social and spiritual assistance to him at all stages of oncological disease;
  • reduce, if possible, the negative psychological impact and experiences of the patient during the transition from "active" treatment to palliative;
  • help patients "come to terms with their illness" and be able to live as actively as possible until the end of their lives;
  • to support the patient and those caring for him during the period of treatment, and after death - to help the family cope with the loss.

"System"

Specialists assisting the patient are united in a group that has a complex organization and provides the entire process of diagnosis, clarification of the stage of the disease and treatment. However, it is precisely this circumstance that often perplexes the patient and his relatives, especially if the hospital is based in several buildings or it becomes necessary to transfer the patient to a specialized center or the diagnosis has not been finally established. The disadvantages associated with the relative autonomy of the departments, the need to make lengthy records in the medical history, and so on, have decreased with the advent of multidisciplinary teams and their composition of doctors of a new specialty - patient care. Thanks to this organization of work, continuity in the work of different specialists is improved, patients have less repetition when they are interviewed, they better understand the purpose of each visit to the doctor and know who to contact if they feel “lost in this system”.

Difficulties associated with the need to communicate sad news

The message of sad news always causes negative emotions and dissatisfaction in the patient and his family members. Many patients leave the doctor, not wanting to listen to their diagnosis and prognosis in more detail, not knowing what advances exist in the field of treating their disease, or, conversely, they want to get more information than they were told. There are few freemen who prefer to know less, trusting completely their doctor (perhaps less than 5%). Patients who are dissatisfied with the amount of information communicated to them have a harder time getting used to their diagnosis, are more likely to experience anxiety and depression. It is important to know how much information a patient needs at a particular stage of his illness. Information is dosed taking into account the characteristics of the patient and his disease.

Good news strengthens the patient's trust in the doctor, reduces uncertainty, and allows the patient and family to be better prepared practically, psychologically, and emotionally for treatment. In the case of sad news, the case is not limited to its message. This is a process in which the news is often repeated, the diagnosis is explained, the patient and his relatives are informed about the state of affairs in this area and, possibly, they are preparing them for the death of a person close to them.

Giving Sad News - Ten Steps

This approach can be used as a general framework and adapted to specific situations. Remember that the patient has the right, but not the obligation, to hear the sad news.

  • Training. Check out the facts. Make an appointment. Find out from the patient who he allows to be present. Take care that you are not disturbed (turn off your cell phone).
  • Find out what the patient already knows. Both the doctor and relatives of the patient usually underestimate the degree of his awareness.
  • Find out if the patient needs more information.
  • Do not prevent the patient from denying your news. Denial is a way to overcome. Let the patient control the amount of information.
  • Warn the patient that you are going to report bad news. This will give him time to collect his thoughts and see if he can listen to your information.
  • Explain the situation to the patient if he asks for it. Speak more simply and clearly. Avoid harsh statements and medical jargon. Check if the patient has understood you correctly. Be as optimistic as possible.
  • Listen to the concerned patient. Avoid premature encouragement.
  • Do not interfere with the outpouring of the patient's feelings.
  • Summarize what has been said and make a plan, this will avoid confusion and uncertainty.
  • Express your willingness to help the patient. Giving sad news is a process. Give the patient time to ask you questions; it is advisable to give him written information indicating the specialist caregiver to whom the patient can contact in the future. Specify the time, place and purpose of the next meeting with the patient or the next study.

Uncertainty

Uncertainty is one of the psychological states that a person experiences especially hard. This is a condition in which most patients with oncological pathology stay from the moment they develop dangerous symptoms and initiation of examinations before the end of treatment. The doctor also faces a dilemma when he tries to cheer up an anxious patient and inform him of his illness with an uncertain prognosis. This is especially difficult when it is necessary to obtain the informed consent of the patient for clinical researches or flow methods, the effectiveness of which is problematic.

In such cases, there are always fears of discomfort, disfigurement, disability, addiction, death.

Most patients who are told they have cancer have already had a similar disease in the past with relatives or friends. It is desirable that the physician be aware of how such an experience affected the patient. You can cheer him up. Misconceptions should be corrected. If there are justified concerns, they should be acknowledged and efforts should be made to eliminate the anxiety associated with them.

Psychological support in the long term

Paradoxically, patients often have a greater need for support after completion of treatment, when they need to re-evaluate their lives and overcome the upcoming difficulties associated with survival. They often receive psychological support through surveillance programs and may feel helpless when regular contact with specialists is cut off. This problem is exacerbated by the fact that there are only a few curable malignant tumors in adults, so patients have to live, overcoming the fear of recurrence.

Symptomatic treatment

Physicians and other healthcare professionals involved in the day-to-day care of cancer patients have a significant clinical responsibility for assessing symptoms and managing them.

Symptoms may vary:

  • directly associated with a malignant tumor;
  • manifestation of side or toxic effects of palliative therapy;
  • affecting the physical, psychosocial, emotional and spiritual sphere of the patient;
  • caused by another cause unrelated to the underlying disease.

Therefore, the symptoms detected in the patient require careful evaluation in order to draw up the best plan for their elimination.

Elimination of pain

Pain management is an important part of both palliative and curative cancer treatment. In approximately 80-90% of cases, pain can be eliminated by oral administration of conventional painkillers in combination with drugs from other groups in accordance with WHO recommendations. Ineffective pain management can exacerbate other symptoms, including fatigue, anorexia and nausea, constipation, depression, and feelings of hopelessness. Pain can also become an obstacle to regular chemotherapy and timely visits to the doctor. Relief of pain at the cost of increased side effects is unacceptable in most cases, so there is a need to develop effective measures.

The most common causes of intractable pain in cancer patients may be the following.

  • A simplified approach to the examination, which does not allow to establish the true cause of pain and its type, to identify and evaluate the general unfavorable background. lowering the pain threshold. If this background is not taken into account, the appointment of analgesics alone will not be able to eliminate pain. It is necessary to correct the psychological background.
  • Lack of a systematic approach to pain management, including a lack of understanding of the WHO three-step pain management regimen for cancer patients, the role of adjuvant analgesics, and opioid dose titration. "Panic prescription" of analgesics often leads to the development of side effects.

The ideal treatment for pain involves addressing its cause. Therefore, correctly selected palliative chemotherapy, radiation or hormonal therapy is in the first place. In palliative care, the use of analgesics is a generally accepted criterion for assessing response to therapy. However, even if the patient is prescribed a course of anticancer therapy, the use of analgesics does not lose its meaning, since the analgesic effect of therapy does not occur immediately and, moreover, is incomplete and short-lived.

Categories of cancer pain

The role of a carefully collected anamnesis in the treatment of pain cannot be overestimated, since it allows doctors to clarify its mechanism, and therefore, to select the optimal pain therapy.

Is the pain acute or chronic?

A malignant tumor in a patient does not always cause pain. Sudden pain may be due to acute complication both the tumor itself and anticancer therapy, and sometimes it is completely associated with other causes. Examples of such causes include a pathological fracture of the bone, leading to the need for orthopedic treatment, acute pathology of the abdominal organs, requiring urgent surgical examination, or mucositis that developed during or after radiation therapy.

On the other hand, chronic progressive pain may indicate tumor progression and infiltration of soft tissues and nerve roots.

What is the type of pain?

Somatic pain, for example, with bone metastases, phlegmon, is localized and permanent.

Visceral pain is usually vague, variable, and often accompanied by nausea and other symptoms (eg, liver or abdominal lymph node metastases).

Neuropathic pain, classically described as "shooting", is usually located in the zone of innervation of the affected nerve (for example, pain with pressure on the nerve root).

How does the patient interpret pain?

Pain has a pronounced emotional component and is significantly influenced by mood and morale. Understanding how the patient interprets their pain can help develop a more realistic plan for dealing with it. For example, whether the appearance of a “new” pain causes anxiety in the patient, whether it reduces his general activity, whether the patient considers it a harbinger of the terminal stage of his disease. Eliminating anger, fear or irritation contributes to more effective pain relief.

Medical treatment for pain

The principles of the three-stage pain management regimen are as follows.

  • The analgesic is selected depending on the intensity of pain, and not on the stage of the tumor process.
  • Analgesics with prolonged use are prescribed to prevent pain. It is also necessary to have analgesics at the ready to quickly relieve pain when it intensifies.
  • Prescribing a single pain medication is rarely sufficient.
  • Treatment should be started with a fast-acting analgesic and then switched to long-acting drugs and maintained at a stable dose.
  • Spioids are usually used in combination with non-narcotic analgesics.
  • Adjuvant analgesics are usually prescribed based on the cause and type of pain.

First stage. Analgesia with non-narcotic drugs

Paracetamol is a non-narcotic analgesic. It also serves as an antipyretic, but does not have an anti-inflammatory effect. Side effects when administered at a therapeutic dose are rare. Alternatively, NSAIDs, such as ibuprofen 400 mg three times a day, can be prescribed, although this leads to the need for simultaneous administration of gastroprotectors and control of renal excretory function. Paracetamol can be used in combination with NSAIDs without fear of serious complications.

Second step. Analgesia with weak opioids

Patients should continue treatment with non-narcotic analgesics. If the analgesic effect is insufficient, a weak opioid drug is prescribed. Subtherapeutic doses of codeine, in which it is often found in over-the-counter drugs, should be avoided.

Third step. Analgesia with potent opioids

If the pain does not stop, basic analgesic therapy with non-narcotic analgesics should be continued, but weak opioids should be replaced with potent ones. Treatment begins with a fast-acting drug given every 4 hours, doubling the dose at night. The analgesic effect occurs in approximately 30 minutes, reaches a maximum at the 60th minute and lasts 4 hours if the dose is chosen correctly. The dose prescribed "on demand" for increased pain should be one sixth daily dose drug. You should simultaneously prescribe laxatives and have antiemetics at the ready.

Morphine in solution or tablets (quick-acting drug):

  • 10 mg every 4 hours (for example, at 6 hours, 10 hours, 14 hours, 18 hours and 20 mg at 22 hours);
  • dose "on demand" - 10 mg;
  • the appointment inside is more preferable, although the drug can also be administered subcutaneously and intravenously;
  • morphine treatment is carried out against the background of simultaneous use of laxatives, if necessary, the patient is given antiemetics;
  • basic therapy also includes taking paracetamol in combination with NSAIDs or without them.

Dosing of opioids

The dose of morphine is adjusted every 24 hours until the optimal dose is found. The "on demand" dose received during the previous day should be included in the adjusted dose. For example, if over the past day the patient has received “on demand” 30 mg of morphine, in addition to 60 mg prescribed as basic therapy, the following correction is performed:

  • a single dose is increased to 15 mg;
  • the dose taken at night is adjusted to 30 mg;
  • the dose "on demand" is set to 15 mg.

After stabilization of the dose (i.e. when the patient receives the drug "on demand" no more than 1 time per day), morphine is prescribed, for example, at a dose of 10 mg every 4 hours and at a dose of 20 mg at 22 hours.

  • The total daily dose is 60 mg.
  • Long-acting morphine 30 mg twice daily.
  • "On demand" fast-acting morphine is prescribed at a dose of 10 mg. The oral bioavailability of morphine is approximately 30%.

A significant part of it is metabolized (the effect of the primary passage) and excreted along with metabolites by the kidneys. The dose of morphine is subject to considerable individual variation. Over time, it has to be increased somewhat. Morphine has an important feature - a proportional relationship between the total daily dose and the dose taken "on demand". Clinical experience and the results of clinical trials indicate that there is no pain that cannot be controlled with opioids, it is only a question of the dose of the drug. However, for some types of pain, this dose is too high and therefore unacceptable due to side effects, such as sedation. In such cases, for example in neuropathic pain, adjuvant analgesics play a particularly important role.

Opioid toxicity.

  • Nausea and vomiting: metoclopramide 10-20 mg 4 times a day or haloperidol 1.5-3 mg at night.
  • Constipation: regular use of co-danthramer or co-danthrusate.
  • Drowsiness: usually the severity of this effect decreases by the 3rd day after the next dose increase.
  • Dry mouth: unlimited ability to take liquids, oral care.
  • Hallucinations: Haloperidol at a dose of 1.5-3 mg orally or subcutaneously in an acute situation.
  • Respiratory depression occurs only when the dose of the drug exceeds the dose necessary to achieve analgesia, or when the drug accumulates, for example, due to impaired renal excretory function.
  • Addiction (physical and mental) and addiction.

Alternative drugs to potent opioids for chronic pain.

  • Diamorphine: used when parenteral administration of an analgesic is necessary.
  • Fentanyl: Patients with chronic persistent pain are prescribed a transdermal form of the drug (fentanyl patch), with increased pain, morphine is administered. The sedative effect and the ability to cause constipation are less pronounced. When the first patch is applied, an alternative opioid is administered simultaneously.
  • Methadone: can be used instead of morphine, administered orally, toxic effects are the same, although the analgesic is less predictable. If liver function is impaired, methadone treatment is safer.

Adjuvant analgesics

The need for adjuvant analgesics may arise at any stage of pain management. Understanding the mechanism of pain is important for optimal drug selection, but once a drug is prescribed, one must also be prepared to discontinue it if it is not effective enough. Otherwise, the patient will accumulate a lot of drugs, the appointment of which will be difficult to regulate, and the effectiveness of treatment will be low. Adjuvant analgesics include the following drugs.

  • Glucocorticoids. These drugs are advisable to use with increased intracranial pressure, compression of the nerve trunks and roots, overstretching of the Glisson capsule (with liver metastases), and soft tissue infiltration. Doses of up to 16 mg/day of dexamethasone are often given in acute situations, but should be adjusted frequently and reduced to maintenance if possible. Side effects include fluid retention, irritation of the gastric mucosa, hypomania, hyperglycemia, and iatrogenic Cushing's syndrome.
  • Tricyclic antidepressants are especially indicated in the treatment of neuropathic pain. Amitriptyline is prescribed at a dose of 2 mg at night and gradually increased depending on the effect. Side effects include sedation, dry mouth, constipation, dizziness, and urinary retention.
  • Anticonvulsants. Gabapentin is the only drug approved for use in all types of neuropathic pain. Carbamazepine is also effective, although it should only be used when tricyclic antidepressants have failed, as these drugs can cause serious side effects when administered concomitantly.
  • Anxiolytics. Benzodiazepines are indicated for anxiety, agitation, restlessness, and insomnia, conditions that increase pain. They also have sedative and antiemetic properties and can be used to prevent nausea.
  • Antipsychotics, such as haloperidol, have antiemetic and sedative effects. They are especially indicated for hallucinations caused by opioid analgesics.
  • Bisphosphonates. Double-blind controlled clinical trials have shown that bisphosphonates reduce the pain of bone metastases in patients with breast, lung, and prostate cancer and reduce the incidence of complications associated with bone metastases, such as pathological fractures. They are also used in myeloma. The analgesic effect begins to appear within 2 weeks. The role of these drugs in the treatment of other tumors is unclear. Bisphosphonates are currently given intravenously [eg, pamidronic acid (pamidronate medac) or zolendronate at 3–4 week intervals], although work is underway to develop dosage forms for internal use. When treating with bisphosphonates, it is necessary to monitor kidney function and serum calcium levels (risk of hypocalcemia).

Other treatments

Anesthesia methods

In some malignant tumors, such as pancreatic cancer, which grows into neighboring tissues, they resort to blockade of the celiac plexus. With tumor infiltration of the nerve trunks in the armpit, a blockade of the brachial plexus is performed to eliminate pain.

In pathological fractures, when it is impossible to perform surgical fixation of fragments, epidural anesthesia is indicated.

For intense pain that is not amenable to conventional methods of treatment, pain specialists should be involved.

Palliative radiotherapy

External beam radiation therapy can help with pain associated with local tumor infiltration, such as a metastatic lesion in the bone. However, it should be remembered that the maximum analgesic effect of radiation therapy is achieved within a few weeks. In addition, radiation may increase pain at first. Pain relief during and after radiation therapy should be given due attention.

The use of radioisotopes that accumulate in bones, such as strontium, is justified for diffuse pain associated with osteoblastic metastases, for which conventional painkillers are ineffective. Radioisotopes are especially actively absorbed in foci with intensive bone turnover. With this method of treatment, there is a risk of severe myelosuppression

Supportive care

There are also a number of other treatments that complement pain management.

These include the following:

  • transcutaneous electrical nerve stimulation;
  • occupational therapy;
  • physiotherapy;
  • acupuncture, aromatherapy and other methods of reflexology;
  • relaxation therapy, including massage and hypnosis;
  • psychotherapy and patient education.

Elimination of nausea and vomiting

Nausea and vomiting occur in approximately 70% of patients with advanced cancer. As with pain management, an understanding of their mechanisms is also required to address these symptoms.

  • Iatrogenic. Prescribing opioids can cause nausea. Chemotherapy at the beginning of treatment or during it can cause nausea and vomiting. Radiation therapy, especially if the brain or small intestine may cause nausea.
  • Metabolic. An increase in serum calcium may be accompanied by dehydration, constipation, abdominal pain, and confusion. Some patients experience nausea and vomiting without associated symptoms. Uremia also causes nausea, often without any other symptoms. If a metabolic mechanism for the occurrence of nausea and vomiting is suspected, it is necessary to perform biochemical analysis blood with the determination of calcium in the serum and kidney function.
  • Increased intracranial pressure associated with metastatic lesions of the brain and its membranes. In the diagnosis, the anamnesis plays a role (change in the nature of the headache). It is necessary to examine the fundus to exclude edema of the optic discs.
  • Subacute or acute intestinal obstruction, especially if the patient is diagnosed with a malignant tumor of the abdominal organs. The presumptive level of obstruction can be established based on the history [time of onset of nausea and vomiting, contents of vomit (unchanged food, fecal vomit), presence of stool and gas, abdominal pain]. To clarify the diagnosis and the possibility of eliminating intestinal obstruction, CT of the abdomen and intubation enterography are performed.
  • Pseudo-obstruction of the intestine. If this pathology is suspected, along with other studies, a digital rectal examination should also be performed. If the patient notes the appearance of a watery stool against the background of symptoms of intestinal obstruction, then it is most likely due to the fact that the fluid in the dilated intestine flows around the stool in the area of ​​​​the blockage.
  • Pain. Insufficiently effective pain relief can cause nausea.

Many neurotransmitter receptors are involved in the development of nausea and vomiting. Most of them are located in different areas of the CNS. However, peripheral receptors and neural pathways also play a significant role. An understanding of the mechanisms of nausea and knowledge of the point of application of the drug is necessary for the optimal choice of antiemetic drug.

  • The antiemetic drug is selected taking into account the most probable cause and mean the most acceptable way.
  • If oral administration is not possible due to vomiting, it is administered sublingually, buccally, rectally, intravenously, intramuscularly or subcutaneously. Particularly effective is long-term subcutaneous administration of the drug using a perfusion pump.
  • Patients should take antiemetic drugs regularly.
  • If nausea and vomiting do not resolve within 24 hours, a second-line drug is given.
  • The elimination of nausea and vomiting includes measures aimed at correcting each of the causes of these symptoms (hypercalcemia, excretory function of the kidneys, treatment with drugs that can cause vomiting, intestinal obstruction).
  • Metoclopramide is classified as a prokinetic. It can be used with caution in violation of the evacuation of gastric contents or subacute intestinal obstruction, but with increased vomiting or colicky pain in the abdomen, the drug should be discontinued. With complete intestinal obstruction, metoclopramide cannot be prescribed. Cyclizine neutralizes the effect of metoclopramide, so both drugs should not be prescribed at once.
  • It should be remembered that there may be several reasons that cause nausea and vomiting in a cancer patient. If they are unknown or first-line therapy is ineffective, it is advisable to prescribe levomeprazine, which acts on several types of receptors at once. Due to its wide spectrum of pharmacological activity, this drug is often effective even in cases where combination therapy with selective antiemetics does not help. The anxiolytic properties of levomeprazine make it preferable to prescribe it in this category of patients, although when administered at a dose of more than 6.25 mg / day, it often has a pronounced sedative effect.

Constipation

Causes of constipation

There are many causes of constipation in cancer patients.

  • Drugs, especially opioid analgesics and some antiemetics, such as 5-HT3 receptor blockers.
  • Dehydration associated with insufficient fluid intake, frequent vomiting or diuretic therapy.
  • Anorexia: insufficient food intake and changes in its qualitative composition.
  • Reduced motor activity and general weakness.
  • Hypercalcemia, especially if it is combined with dehydration, nausea, abdominal pain, confusion, although these associated symptoms may not be present.
  • Spinal cord compression: constipation is usually a late manifestation.
  • Intestinal obstruction associated with adhesions due to tumor infiltration, surgery or radiation therapy, as well as obstruction by a tumor of the intestine or compression of the tumor of the pelvic organs.

Clinical manifestations

  • Delayed stool or its absence.
  • Nausea and vomiting.
  • Abdominal pain, usually colicky.
  • "Paradoxical diarrhea" (the appearance of watery stools against the background of constipation).
  • Urinary retention.
  • Acute psychosis.

Diagnostics

History: Questioning the patient is especially important to identify contributing factors and avoidable causes of constipation, such as those associated with difficulties in caring for the sick at home.

Digital rectal examination.

Radiography of the abdomen is indicated only in cases where it is necessary to differentiate intestinal obstruction from pseudo-obstruction.

Blood test: calcium content in blood serum.

Treatment

Non-drug.

  • Eating more fluids and foods rich in fiber.
  • Increased motor activity.
  • The possibility of privacy. Respect for the patient's self-esteem.

Medical.

  • Prevention. For example, when starting treatment with opioid analgesics, laxatives (usually emollients or stimulants) are always prescribed. The ability to cause constipation in the fentanyl patch is less pronounced than in morphine. When pain intensity stabilizes, it is desirable to switch to treatment with a transdermal form of fentanyl.
  • Osmotic laxatives. Hyperosmolar mixtures that are not absorbed in the gastrointestinal tract retain water in the intestinal lumen, thereby increasing the volume of intestinal contents and stimulating peristalsis. Side effects of this group of drugs include cramping abdominal pain, thirst, increased gas formation in the intestines (for example, when using magnesium sulfate or lactulose, a synthetic disaccharide that is not digested.
  • Stimulant laxatives. Senna preparations are most often prescribed from this group of laxatives. They act mainly on the transport of electrolytes in the intestinal mucosa and increase peristalsis. May cause cramping abdominal pain. Another stimulant laxative is danthrone, which is used only in palliative care. It is especially effective for constipation caused by opioid analgesics. When prescribing deuteron, patients should be warned about the appearance of a red tint of urine. The drug is used only in combination with softening laxatives, such as codanthamer or codanthrusate.
  • softening laxatives. Drugs in this group, such as docusate, reduce the surface tension of feces, facilitating the penetration of water into them.
  • Drugs that increase the volume of intestinal contents are indicated for patients with a relatively satisfactory condition, in whom the ability of normal nutrition is almost not impaired. When using these drugs (for example, psyllium flea seeds), you need to take up to 2-3 liters of fluid per day.
  • Rectal preparations: glycerol (suppositories with glycerin) soften the feces and serve as a lubricant for the fecal plug palpated in the rectum; peanut butter enemas to soften feces: given before bedtime, and in the morning a high phosphate-containing enema is given to stimulate the stool.

Treatment of cachexia and anorexia

cachexia

Cachexia is understood as an increase in energy consumption that does not depend on the will, leading to a sharp decrease in the mass of both muscle and adipose tissue.

  • Occurs in more than 85% of patients with advanced stage cancer.
  • Often associated with anorexia, but cachexia is different from fasting, as weight loss cannot be prevented by increasing nutrient intake alone.
  • Most often, cachexia develops in patients with advanced solid tumors, especially when lung cancer and organs of the gastrointestinal tract.
  • The mechanisms by which cachexia develops are unclear, although there is an obvious role for circulating cytokines such as tumor necrosis factor causing metabolic disturbances, in particular protein breakdown, lipolysis, and enhancing gluconeogenesis.
  • Cachexia is the main cause of symptoms that appear at the end of the disease and lead to physical impotence, psychological and social maladjustment. It is painful both for the patient and for his relatives.

Anorexia

Decrease or lack of appetite.

May be associated with increased fatigue and cachexia in advanced tumor processes and have no other specific cause.

However, the examination should be aware of the possible avoidable causes of anorexia:

  • nausea;
  • constipation;
  • depression;
  • metabolic disorders, such as increased blood calcium levels, uremia;
  • infection, such as oral candidiasis;
  • intestinal obstruction, ascites.

Treatment

The cause should be eliminated if possible. The measures taken usually do not affect cachexia.

General measures

Power optimization. It is recommended to eat often, in small portions, to eat when there is a feeling of hunger. Food should be high-calorie, have a relatively small volume. To stimulate appetite, you can drink a small amount of alcohol.

It is necessary to make sure that the food gives the patient pleasure and does not cause negative emotions. Caregivers should not be overly assertive.

It is necessary, if possible, to stimulate the activity of the patient.

Medical treatment

Nutritional supplements. High-calorie protein blends (such as Ensure). Glucocorticoids (eg, prednisolone 25 mg once daily) may improve appetite and general state, reduce nausea, but do not increase muscle mass.

Progesterone improves appetite, although there is no conclusive evidence that it causes weight gain.

Sometimes, against the background of active antitumor therapy, enteral and parenteral nutrition, but with the progression of the tumor, it is not justified.

Elimination of respiratory symptoms

Causes of shortness of breath in cancer patients

There are many causes of shortness of breath in patients with malignant tumors with metastases. They can be removable, so patients should be carefully examined.

Pulmonary causes.

  • Tumor of the lung.
  • Pneumonia.
  • Effusion in the pleural cavity (with repeated accumulation of fluid, the feasibility of pleurodesis should be discussed).
  • Carcinomatous lymphangitis.
  • Large airway obstruction with lung collapse distal to the obstruction.
  • Associated chronic obstructive pulmonary disease.

Cardiovascular causes.

  • Effusion in the pericardial cavity.
  • Congestive heart failure.
  • Pulmonary embolism.
  • Obstruction of the superior vena cava.
  • Anemia.
  • Violation of the heart rhythm. Neuromuscular disorders.
  • Muscle weakness and rapid fatigue.
  • Carapaceous breast cancer (cancer en cuirasse) manifested by tumor infiltration of the chest wall.
  • Respiratory depression, such as that associated with opioids.
  • Damage to peripheral nerves, such as the phrenic.
  • Tumor infiltration vagus nerve: hoarse voice, sometimes "bovine" cough. An examination by an ENT specialist is indicated: palliative injection of a soft tissue filler into the vocal fold can help eliminate this symptom.

The psychological state of the patient.

  • Fear, anxiety.

Treatment

If possible, eliminate the cause of shortness of breath

An integrated approach is needed using non-pharmacological methods of treatment, such as breathing exercises, physiotherapy, relaxation therapy, massage. Patients need to be helped so that their expectations are realistic.

A number of drugs can be tried as a palliative measure to reduce shortness of breath.

  • Opioids. Morphine at a dose of 2.5 mg 4 times a day orally reduces the respiratory drive and weakens the response to hypoxia and hypercapnia. It reduces discomfort associated with shortness of breath and also suppresses coughing.
  • Benzodiazepines reduce anxiety, cause sedation, and possibly also relax muscles. Concerns about the possibility of respiratory depression are usually unfounded, in particular in the treatment of lorazepam at a dose of 1-2 mg orally on demand.

Oxygen therapy allows you to eliminate or reduce hypoxia. It may also reduce shortness of breath, which appears to be due to a refreshing effect on the face or a placebo effect. Caution should be exercised in patients with chronic obstructive pulmonary disease.

Lymphedema treatment

Impaired lymph flow leads to excessive accumulation of interstitial fluid, called lymphedema. Most often, lymphedema occurs on the extremities. It is a dense edema, in which, after pressing a finger on the tissue, the fossa does not form, limits the activity of the patient and is difficult to treat. The causes of lymphedema are:

  • tumor infiltration of lymphatic vessels;
  • breach of integrity lymphatic system associated with excision lymph nodes, and changes in it caused by radiation therapy.

Extremity lymphedema should be differentiated from edema associated with grombotic or neoplastic deep vein occlusion. It is very important to distinguish between these conditions, as their treatment is different.

Prevention of lymphedema

Prevention of lymphedema is more rational and effective than treatment. It is important to give the patient a correct understanding of this complication. If needed, see a lymphedema specialist. Massage and physical exercise.

It is important to avoid injury and infection of the affected limb (wearing protective gloves when working in the garden, protection from sunlight, performing venipuncture on a healthy limb). Vigorous treatment for skin infections.

Treatment

Daily skin care. Self-massage and exercise. Wearing elastic stockings.

With refractory edema, elastic bandaging of the limb may be necessary before picking up elastic stockings. There are no drugs to treat lymphedema.

Psychological support and correction of mental disorders

Assessment of the mental state, rendering psychological support and correction of mental disorders should be an integral part of the treatment of a cancer patient. Psychological problems may be associated with such emotions and conditions as:

  • denial and confusion;
  • anger;
  • anxiety;
  • sadness and depression;
  • feeling of loss;
  • alienation;
  • inadequate management of one's condition.

Physicians should be aware that the patient's psychological problems often go unaddressed and should take the time to examine the mental status. It is always necessary to be attentive to the problems of the patient and those caring for him. The mental state of the patient can be assessed using various rating scales and systems.

  • Hospital Anxiety and Depression Scale.
  • Functional assessment of the effectiveness of cancer treatment.
  • Functional vital sign in cancer patients.
  • European questionnaire for assessing the quality of life.

Treatment

Self help. Patients should be involved in monitoring treatment, helping them to set realistic goals and form a coping strategy.

formal support. Patients have the opportunity to seek help from an experienced consultant in the clinic or information center at the hospital. Palliative care professionals have the opportunity, if necessary, to seek help from a psychologist and psychiatrist.

Psychotherapy. With severe anxiety and depression in a patient, it is advisable to conduct behavioral and short-term psychotherapy.

Psychiatric treatment. The attending physician of an oncological patient must recognize in time mental disorders requiring psychiatric consultation and drug correction (for example, antidepressants or anxiolytics). Psychotropic drugs help approximately 25% of cancer patients suffering from anxiety and depression.

Help with terminal arousal

Assessment of the patient's condition

Even with approaching death, due attention should be paid to the mental state of the patient, since in some cases it is possible to alleviate suffering and reduce near-death excitement.

Additional suffering to the patient can cause the following factors:

  • insufficiently effective pain relief;
  • urinary or stool retention;
  • nausea;
  • dyspnea;
  • fear;
  • side effects of drugs.

However, the scope of the study of a dying patient should be limited so as not to cause him additional suffering. It is important to achieve an optimal state of physical and psychological comfort in order to ensure a dignified and peaceful end to life.

Treatment in the terminal stage of cancer

Cancel all drugs that are not essential for the patient. In fact, this means that only analgesics, anxiolytics and antiemetics are left. If the dying patient is unconscious, glucocorticoids are usually discontinued.

Oral medications should be avoided. Subcutaneous administration by means of an infusion pump is often preferred. This does not require hospitalization, although it may require significant effort from caregivers and relatives.

Intravenous administration of drugs is also undesirable (sometimes it is simply impossible). Cannulating a vein is painful and can cause additional distress.

Drugs should be administered on demand. Optimal subcutaneous infusion, which allows to eliminate painful symptoms without the need for additional doses. It is important that caregivers have free access to the drug to administer it as needed.

Opioids. Treatment with these drugs, if previously given, should be continued, but the doses of the drug should be reviewed for subcutaneous injection. The dose on demand is 1/6 of the daily dose. If opioids have not been administered to the patient before, but it is necessary to eliminate intense pain, a small dose of diamorphine is administered, for example, 5-10 mg subcutaneously for 24 hours, and with increased pain, an additional 2.5 mg subcutaneously. Observe the effect and, if necessary, increase the dose.

Anxiolytics, such as midazolam, are administered at a dose of 10 mg/day subcutaneously and 2.5-5 mg as required. The effect of the drug should be carefully monitored, since it is often necessary to significantly increase the dose. The drug also has antiemetic properties. Sometimes, despite an increase in the dose of midazolam, arousal increases. In such cases, levomeprazine is additionally prescribed, which has a sedative property. First, 25 mg is administered subcutaneously immediately, then an additional 50 mg over 24 hours. Depending on the effect, the dose can be increased. Haloperidol is also effective. administered at a dose of 5 mg subcutaneously on demand.

Antiemetics are added to treatment at the same time as opioids.

Increased bronchial secretion is often more burdensome for the relatives of the patient than for himself. A conscious patient is more concerned about dry mouth, an inevitable side effect of drug suppression of bronchial secretion. If the patient is unconscious, then it is usually enough to change the position of his body or carefully evacuate the mucus with the help of suction. Usually, hyoscine hydrobromide is administered immediately subcutaneously at a dose of 400 μg or the drug is added to the perfusion pump syringe. Instead of hyoscine hydrobromide, glycopyrronium can also be prescribed. Side effects of these drugs are the same as those of M-anticholinergics.

Explanatory work. It is necessary that the relatives of the patient (and the patient himself, if he is conscious) know what purpose this or that doctor's appointment pursues. It should be explained how important it is to achieve adequate pain relief and avoid severe sedation. Caregivers should be aware of the drugs contained in the subcutaneous infusion solution, observe their effect and adjust the dose if necessary. Time spent at the bedside of a dying patient will allow relatives to experience the loss with greater understanding and without anger and suspicion, and will leave them with fewer questions regarding the last hours of his life.

Contacting an outpatient or inpatient palliative care service for advice or care for refractory symptoms or other care before or after death.

Complex symptomatic treatment

The care of a dying patient in a hospital is increasingly becoming formalized with the participation of teams from different specialists. This is in line with NICE guidelines covering the physical, social, psychological and spiritual aspects of such care.

Symptomatic therapy - Symptomatic therapy neuropsychiatric disorders in acute poisoning is carried out against the background of antidote and detoxification treatment. The main principle of the treatment of toxic coma is to maintain the function of the respiratory and cardiovascular system. The use of analeptics for this purpose (bemegride, corazol, strychnine, lobelin, etc.) often leads to deterioration clinical condition due to the development of cardiac arrhythmia, convulsions, psychosis, hallucinations, irreversible transcendental coma. It is possible to improve the function of vital centers in this situation only with the help of measures aimed at preventing cerebral edema: dehydration with osmodiuretics (mannitol, urea, mannitol), the introduction of glycerol (50 - 100 ml) into the stomach through a tube after preliminary rinsing, cryopypothermia with the Cold2 apparatus ".

Symptomatic therapy is divided according to the type and localization of symptoms:

With delirium and intoxication psychoses, the differentiated use of various sedative and neuroleptic drugs at the earliest possible stages is of great importance.

In case of convulsive syndrome caused by poisoning with tubazid, strychnine, camphor, ethylene glycol and other toxic substances of convulsive action, along with measures aimed at preventing cerebral edema, 4–5 mg of a 2.5% solution of hexenal or sodium thiopeptal are administered repeatedly at intervals of 30–40 min, and in severe cases with convulsive status, endotracheal anesthesia with muscle relaxants is indicated. Convulsive conditions are often complicated by hyperthermic syndrome, which should be clearly differentiated from febrile conditions caused by infectious complications. At a body temperature above 39°C, hypothermic measures are indicated (ice on the area of ​​passage of large vessels, wet wrapping with a wet sheet, crapiohypothermia, the introduction of lytic mixtures).

Treatment of toxic polyneuritis requires long-term use of injections of B vitamins, ATP, proserip. The most effective sorption methods of detoxification.

The syndrome of respiratory failure can be associated with damage to the mechanism of the act of breathing, obstructive and aspiration obstructions, pathological processes in the lungs, and a violation of oxygen transport by the blood. Violation of the mechanism of the act of breathing can be manifested by inhibition of the activity of the respiratory center, impaired innervation of the respiratory muscles, disorganization of the respiratory rhythm due to clinical convulsions. Inhibition of the activity of the respiratory center is most often found in case of poisoning with hypnotic and narcotic substances; in case of scrap, respiratory paralysis corresponds to the depth of the coma. The exception is poisoning with narcotic drugs (codeine, morphine), in which the degree of respiratory depression prevails over the depth of the coma and central respiratory paralysis can be observed even with the patient's consciousness preserved. Inhibition of the activity of the respiratory center can occur due to hypoxia and cerebral edema caused by toxic damage.

The success of treatment of central respiratory paralysis depends on the effectiveness of detoxification measures and antidote therapy. With a pronounced decrease in the minute volume of breathing and the development of respiratory acidosis, artificial lung ventilation (ALV) is indicated. Late transfer of patients to mechanical ventilation and an attempt to replace it with oxygen inhalation are unacceptable; in this case, the respiratory center loses its sensitivity to hypercapnia.

In case of poisoning with chlorinated hydrocarbons, IVL significantly enhances the removal of poison with exhaled air.

Respiratory disorders caused by damage to the respiratory muscles are primarily due to impaired nerve conduction in the autonomic ganglia and postganglionic fiber. In case of poisoning with organophosphorus compounds, the cause of respiratory distress is inhibition of cholinesterase activity; in case of poisoning with pachycarpine, acetylcholine is displaced from choline-reactive systems, causing ganglionic and neuromuscular blockade.

To eliminate this type of respiratory disorder, along with mechanical ventilation, active specific therapy is necessary: ​​the introduction of cholinesterase reactivators (dipyroxine) in case of poisoning with organophosphorus compounds, anticholinesterase drugs (prozerin) in case of pachycarpine poisoning.

Obturation-aspiration form of respiratory disorders occurs due to retraction of the tongue, hypersalivation, aspiration in Airways, laryngobronchospasm and bronchorrhea. In its treatment, the most important preventive and therapeutic measure is timely intubation or tracheostomy. In order to stop hyperejaculation and bronchorrhea, fractional administration of anticholinergics is necessary.

In case of poisoning with chemicals, as well as in the most advanced stages of treatment of poisoning, toxic pulmonary edema, acute pneumonia, massive purulent tracheobropchitis may occur. The treatment of these disorders is aimed at improving lung ventilation, normalizing the permeability of the vascular wall, reducing inflammation and dehydration therapy.

The hypoxic form of respiratory disorders (hemic hypoxia) is associated with impaired oxygen transport by the blood, which is caused by hemolytic and methemoglobin-forming poisons.

The syndrome of circulatory disorders, as a rule, accompanies poisoning and is manifested by heart or vascular insufficiency, or a combination of them. In the pathogenesis of these disorders, inhibition of the vascular center, ganglionic blockade, toxic effects on the vascular wall, dehydration and plasma loss (increased permeability of the vascular walls, profuse repeated vomiting, diarrhea, improper forcing of diuresis), acute adrenal insufficiency, hypoxia, and acidosis play a role. Hypovolemia leads to a decrease in the minute volume of blood circulation and the development of circulatory hypoxia. Treatment is reduced to the restoration of BCC.

Acute heart failure can develop with many poisonings due to the direct effect of the poison on the heart and as a result of hypoxia, while myocardial contractility is disturbed, changes in excitability, conductivity and automatism are possible.

Liver dysfunction in acute poisoning can be associated both with the direct effect of hepatotoxins on the liver parenchyma, and with secondary damage to the organ as a result of changes in homeostasis. In turn, the loss of numerous liver functions leads to gross metabolic disorders and increased homeostasis disorders. Clinically, violations are manifested by liver failure. In this case, the following syndromes are distinguished: cytolytic, mesenchymal-inflammatory, hepatorenal, jaundice, hepatomegaly, cholestasis, portal hypertension. Disorders of mental activity - one of the constant signs of severe disorders of the antitoxic function of the liver - in acute poisoning can develop not only as a result of impaired hepatic function, but also due to the direct psychotropic narcotic effect of many hepatokeic substances. The most constant laboratory indicators of toxic hepatopathy are: hypo and dysproteinemia, hyperbilirubinemia, an increase in the content of enzymes.

Treatment of liver failure consists of three main types: etiological treatment, pathogenetic and symptomatic therapy. Etiological treatment, including antidote therapy, accelerated elimination of poison from the body, is most effective in the first hours of the disease. Pathogenetic therapy is also more effective when applied as early as possible. A special place is occupied by hepato-lipotropic substances, which can reduce the developing fatty infiltration of the liver damaged by toxins. These are B vitamins, potassium preparations, lipocaine, methionine, choline chloride, vitogepat.

Detoxification processes in various pathological conditions are largely determined by the efficiency of transport of metabolic products and xenobiotics from tissues to detoxification organs. All methods of treatment of this pathology, aimed at detoxification, should improve the transport function of the body.

It is possible to change the physicochemical characteristics of the body's transport medium: by transfusion of albumin preparations, by the introduction of artificial carriers of hemodez, neocompensan, etc., as well as by improving the transport function of one's own serum albumin. The latter became possible due to the wide development and introduction into clinical practice of sorption methods of detoxification, since one of the leading mechanisms for the positive effect of these methods of treatment is the improvement of the transport function of the body due to the sorption of hydrophobic metabolites from the albumin molecule. In addition, in patients with various intoxications, the activity of proteases significantly increases, leading to the accumulation in the body of products of limited proteolysis - peptides with an average molecular weight that have a pronounced pathophysiological effect. Esterase activity can be reduced by introducing inhibitors of protsolytic enzymes (trasilol, contrical) and using sorption detoxification methods.

The effectiveness of pathogenetic therapy acute poisoning significantly increases with the intraumbilical administration of medicinal substances, which can significantly increase their concentration in the liver tissue.

Complex of events symptomatic therapy It is aimed at maintaining homeostasis, which is of great importance in conditions of developing insufficiency of liver function.

Water-electrolyte balance is maintained taking into account the dynamics of the content of electrolytes in the blood serum and urine, and acid-base balance disorders (ACH) are corrected with potassium preparations (up to 10-12 r / day) with metabolic alkalosis or sodium bicarbonate with acidosis.

Kidney damage. Functional and destructive changes in the kidneys, which are noted in more than 1/3 of cases of various acute poisonings, are usually combined with the term "toxic nephropathy".

From a pathogenetic point of view, 3 main groups of toxic substances can be distinguished, in which the same type of pathological signs are observed. These primarily include nephrotoxic chemicals (ethylene glycol, compounds of many heavy metals, etc.) that cause toxic nephronecrosis. The second group of nephrotropic substances consists of hemolytic drugs, poisoning with which develops severe hemolysis, microcirculation disorders in the kidneys and liver. The third group includes hepatotoxic compounds, in case of poisoning by which the degree of kidney damage is largely determined by impaired liver function. Poisoning with almost any chemical substance can lead to toxic nephropathy, especially with an unfavorable combination of homeostasis disorders, which are of primary importance in the pathogenesis of liver dysfunctions, namely: a sharp decrease in LD with impaired regional blood circulation in the kidneys and liver, impaired water and electrolyte balance in the body, uncompensated metabolic acidosis, hypoprotsinemia, blood loss, etc.

In the pathogenesis of the development of toxic nephropathy, the leading army is played by excessive concentrations of peptides with an average molecular weight. It should be noted that it is the accumulation of abnormally high amounts of peptide bioregulators as a result of intensive proteolysis and insufficient function of exopeptidases that leads to impaired excretory and secretory functions of the kidneys, i.e., hyperoligopeptidemia is primary.

The main attention in the diagnosis of toxic nephropathy is given to the measurement of daily and hourly diuresis. A decrease in diuresis to 700 - 500 ml / day (20 ml / h) indicates the development of oliguria, and up to 100 ml / day (4 - 5 ml / h) - anuria.

One of the simplest indicators of the concentration ability of the kidneys is the specific gravity of urine. High rates of relative density of urine are observed in toxic nephropathy caused by the action of hemolytic substances, such as acetic essence, and serve as a poor prognostic sign. A decrease in the relative density of urine with oliguria also indicates severe renal dysfunction.

Modern methods for determining kidney function include: measuring the osmotic pressure of plasma and urine, studying the relationship between the electrolyte composition of blood plasma and urine, acid-base balance (ACH), glomerular filtration and tubular reabsorption, toxicological studies on the quantitative content of toxic substances in blood and urine, and also methods of radioisotope diagnostics of renal functions. Usually, acute poisoning is characterized by a combined violation of the functions of the liver and kidneys, manifested by hepatic-renal insufficiency.

Recent advances in the treatment of acute kidney failure largely due to complex application such methods of detoxification as forced diuresis, hemodialysis, hemo, lymph and plasma sorption, which allow correcting violations of the water-salt and acid-base state, removing end and intermediate metabolic products from the body.
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As a rule, doctors manage to detect the causal factor in the occurrence and development of any disease by the symptoms. Meanwhile, the signs of pathology sometimes cause no less suffering to the patient than the main ailment. Symptomatic treatment is a set of measures that affect precisely such manifestations.

When is symptomatic therapy used?

The most common examples of such therapy are the appointment of painkillers, antipyretics and expectorants. Symptomatic treatment can be independent (for example, with or included in a complex of therapeutic measures (for severe clinical pictures oncological pathologies). In one case or another, it has characteristic features that need to be considered in more detail.

How to treat cough symptomatically?

Symptomatic treatment of cough various etiologies is traditional because it is not a separate disease that occurs on its own. The main thing is to identify the underlying cause of this manifestation. Having determined the etiology of the sign of the disease, the therapist will be able to prescribe a symptomatic treatment plan.

Further actions and recommendations of a specialist will be aimed at finding out the productivity of the symptom. As you know, this criterion determines the presence or absence of sputum. It is known that a wet cough appears when sputum descends into the respiratory organs. With colds, this is a common process.

What can be a cough and what is the nature of its origin?

The beginning of symptomatic treatment is the appointment of drugs that thin the sputum and contribute to its rapid removal from the bronchi or lungs. A wet productive cough is often difficult to treat without the use of anti-inflammatory drugs. In parallel with such drugs, antibiotics or antiviral agents are prescribed. They are especially needed in the case when the cough was provoked by an infection.

Antibiotics are rarely used. When symptomatic therapy fails and antiviral drugs do not work, antibiotics are prescribed to relieve inflammation.

Speaking of unproductive dry cough, it should be understood that it most often occurs in the first stage of the disease. The patient is prescribed anti-inflammatory and cough-stopping drugs or mucolytic agents. An allergic reaction can be the cause of a dry cough. In any case, therapy should be prescribed by a doctor.

The goals of symptomatic therapy for cough, SARS and oncology

Symptomatic treatment of influenza and SARS often has a high probability of complications. Taking medications that relieve symptoms does not give a deep result and a chance for a full recovery. Cough, runny nose, fever are signs of a respiratory or viral disease, which can only be eliminated with the help of complex treatment based on antiviral drugs and antibiotics.

If the symptomatic treatment of cough is aimed at complete recovery, then this treatment option for oncological diseases pursues a completely different goal. The need for this in cancer patients does not depend on the course of the disease and its stage. For example, when initial stage diseases, when the tumor has already been found in the body, but does not manifest itself in any way, the patient may become depressed or suffer from psycho-emotional disorders.

This condition is a symptom, which means that the treatment regimen needs to be adjusted.

Benefits of symptomatic cancer treatment

With the radical removal of cancer, symptomatic therapy is also necessary, since any intervention in the body is fraught with the most unforeseen responses. At the stage of postoperative recovery with weakened immunity, the rehabilitation of vital functions of the whole organism is necessary.

Symptomatic treatment of cancer patients sets itself the following tasks:

  • correction and weakening of hard-tolerated manifestations of a malignant tumor;
  • increasing the patient's life expectancy and improving its quality.

The symptomatic course becomes the only and main method of therapy for cancer patients in the fourth stage of cancer.

What is symptomatic therapy for malignant tumors?

Symptomatic treatment can be of two types:

  1. Surgical. It is also called non-specific; it is used when an increase in the size of a malignant neoplasm provokes bleeding, affects the vessels, preventing proper blood circulation and causes stenosis of the organs of any of the systems: digestive, genitourinary, respiratory.
  2. Medical. What does symptomatic treatment mean, one can understand by a set of procedures (a course of radiation and chemotherapy, sanitation of education, cytostatic therapy) and prescribing appropriate drugs, thanks to which doctors manage to save the patient from severe pain, discomfort and stop the intense inflammatory process.

Meanwhile, most experts believe that the use of symptomatic treatment should be justified, since it can significantly affect the further course of anticancer therapy.

The diagnosis and prognosis for the prospect of recovery play a decisive role here.

Indications for the appointment of symptomatic treatment

Maximum reduction of discomfort and pain This is the main goal of the symptomatic treatment of cancer patients. However, it should be understood that the impact of drugs on other organs and systems entails serious consequences. and incredible amounts of potent medicines- unthinkable burden on the body. You can understand what symptomatic treatment for oncology means based on the painful manifestations of the disease that patients often experience (at all stages of cancer):

  • disorders of the gastrointestinal tract (diarrhea, constipation);
  • rapid weight loss (anorexia, cachexia);
  • vomiting and nausea;
  • unbearable pain and dysfunction of the affected organ;
  • violations of metabolic processes;
  • kidney or liver failure;
  • neurosis, hysteria.

Manifestations of cancer in the last stages

In the third and fourth stages of cancer with complex forms of the pathology, doctors often resort to surgical intervention and complete removal of the tumor.

On the early stages surgery is also possible in the case when a malignant neoplasm has a significant impact on the patient's life, and sparing drug therapy does not give any result.

In the last stages of oncology, symptomatic treatment is prescribed, as a rule, due to the presence of such manifestations:

  1. Intolerable pain syndrome (non-passing, constant, unresponsive to traditional painkillers). In the last stages, pain increases, since often its source is not the tumor itself, but an organ that cannot be removed.
  2. Vomiting and persistent nausea are standard signs of a cancerous process in the body. In the first stages of the disease, they occur due to radiation and chemotherapy, and in the latter - most often due to the germination of the liver, circulatory organs.
  3. High body temperature. Feverish patients often perceive the symptom as a sign of SARS or respiratory disease and much later - as a symptom of oncology. Basically, a characteristic increase in body temperature is with and metastases in the liver.
  4. Defecation disorders. Problems with the stool, as a rule, occur with tumors of the digestive system.

Symptomatic treatment with surgery

Regardless of the country in which symptomatic treatment of cancer patients is used, its schemes will be almost identical, differing only in the method of surgical or medical treatment.

Surgical intervention is recommended to the patient in the event that its result will significantly affect the patient's quality of life. For tumors of the intestines, stomach, pancreas, doctors use gastrostomy, colostomy and anastomoses.

Irradiation for cancer

Among the methods of symptomatic therapy, radiation is considered the most common. Radiotherapy is applied both externally and internally, concentrating on the affected organ. The first option involves irradiating the entire area affected by malignancy. In the second situation, the therapeutic radiation dose is directed exactly to the tumor, having the maximum effect on it and practically without causing harm to other organs and systems with high toxicity. Radiotherapy allows you to stop the growth of cancer cells and the rate of progression of the disease, providing the patient with long-term pain relief.

Chemotherapy - an element of symptomatic treatment

It is also impossible to say with absolute certainty that the symptomatic treatment itself does not pose a threat to the patient's health. Side effects chemotherapy, for example, cannot be predicted, but most often they are caused by the individual characteristics of the body and its anaphylactic reaction to medications.

Despite all sorts of risks, chemotherapy generally has a positive effect on the condition of cancer patients, contributing to an increase in life expectancy.

Treating symptoms with medication

Separately, it is worth highlighting a group of medications that are actively aimed at eliminating symptoms. To alleviate the pain and suffering of patients with oncology, the following drugs are used:

  • anesthetics (depending on the degree of pain and its intensity; they can be narcotic and non-narcotic painkillers);
  • antiemetic (to eliminate the corresponding symptom);
  • antipyretic (to combat sudden temperature fluctuations);
  • antibiotics (to prevent the development of inflammatory and infectious processes);
  • hormonal (with tumors of the brain, thyroid gland).

Cancer treatment is easy to imagine by the example of prescribing drugs that increase appetite in patients. After all, the problem of eating food in patients with oncology is the most common. At the same time, the effectiveness and final result of symptomatic therapy largely depends on how the patient eats.

Side effects from symptomatic cancer treatment

It is worth noting that the treatment of manifestations has its negative consequences. In the fourth stage of cancer, when the patient is no longer helped by relatively weak painkillers, he is prescribed stronger drugs, which are characterized by such side effects:

  • vomiting and nausea;
  • weakness and drowsiness;
  • loss of appetite;
  • dizziness and hallucinations;
  • constipation.

In patients, a pronounced constriction of the pupils is noted against the background of the use of opiates. In addition, not only drugs are dangerous. Analgesics and non-steroidal anti-inflammatory drugs can cause erosion of the mucous membranes internal organs, hemorrhagic changes. Separately, it is worth considering the presence allergic reaction in a patient, which is not widespread, but manifests itself exclusively in special cases.

What problems do oncologists face while treating patients?

Symptomatic treatment of cancer patients at complex stages of the disease, where the chances of recovery are practically reduced to zero, is also associated with other difficulties. In particular:

  • drugs are not prescribed for systematic use;
  • biased assessment by the patient of the degree of pain intensity;
  • standard dosages or too weak an anesthetic in an individual case;
  • fear of drug addiction.

Not only patients, but also their relatives are often obstacles for the doctor to fully realize his potential.

The oncologist will not be able to help and alleviate the suffering of the patient if the following myths interfere with the treatment:

  • cancer cannot be cured;
  • analgesic drugs should be taken only when urgently needed;
  • fear of developing drug dependence.

Psychological qualification assistance of medical staff in the oncology clinic will help to avoid such difficulties. The patient himself and his relatives need regular consultations that can correctly set up the family for symptomatic treatment.