厌食和恶病质综合征的处理课件

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1、厌食和恶病质综合征的处理ManagementofAnorexiaandCachexiaRobertTwycrossApril2005症状处理的学问：EEMMATheScienceofSymptomManagement:EEMMAEvaluation[assessment]评估Explanation解释Management[treatment]治疗Monitoring监护Attentiontodetail注意细节2症状处理SymptomManagement敬告！并不总是能完全缓解症状Warning!Cannota

2、lwaysrelievesymptomscompletely替代目标：帮助患者更多地感觉到症状受到控制从而更少地感到被疾病所压倒Alternativeaim:helpingapatienttofeelmoreincontrolandthereforelessoverwhelmed3癌症衰弱cancerdebility治疗并发疾病treatmentconcurrentdisorder症状的原因CausesofSymptoms在癌症晚期，症状常常由多种原因引起Inadvancedcancer,symptomsoften

3、havemultiplecauses4症状的原因CausesofSymptoms临床诊断基于：Clinicaldiagnosisbasedon:可能性probability对病程的认识patternrecognition5“我没有胃口”‘Ihavenoappetite’鉴别诊断Differentialdiagnosis:1.厌食（对食物不感兴趣）或只有早饱感（觉得食物诱人但患者在吃了几口以后就觉得饱胀）2.原发性厌食（恶病质综合征）或继发性厌食3.躯体的（例如，引起呕吐）或精神心理的（例如,感到抑郁）1.Anore

4、xia(notinterestedinfood)orearlysatietyalone(thethoughtoffoodisappealingbutthepersonfeelsfullafterafewmouthfuls)2.Primaryanorexia(cachexiasyndrome)orsecondaryanorexia3.Physical(e.g.nauseated)orpsychological(e.g.depressed)6继发性厌食SecondaryAnorexiaFatigue疲劳Nausea恶心

5、Malodour恶臭Alteredtaste味觉改变Gastricstasis,e.g.constipation胃停滞，例如便秘Oropharyngealpathology口咽部疾病Pain疼痛7早饱感EarlySatietyGastricstasis胃停滞Post-gastrectomy胃切除术后Massivehepatomegaly巨大型肝肿大Massiveascites大量腹水8胃停滞（胃排空延迟）GastricStasis(DelayedGastricEmptying)在晚期癌症中常见:症状：早饱+/-,

6、上腹饱胀，返酸，呃逆，嗳气，恶心，呕吐体征：振水音？Commoninadvancedcancer:Symptoms:earlysatiety+/-,epigastricfullness,acidreflux,hiccup,belching,nausea,vomitingSigns:succussionsplash?9胃停滞的原因CausesofGastricStasis失动力型消化不良Dysmotilitydyspepsia便秘Constipation药物，例如阿片类，抗毒蕈碱类药Drugs,e.g.opioids

7、,antimuscarinics胰头癌Cancerofheadofpancreas引起神经病变的腹膜后癌Retroperitonealcancercausingneuropathy瘤旁自主性神经病变Paraneoplasticautonomicneuropathy脊髓压迫综合征Spinalcordcompression10评估Evaluation这是谁的问题？患者的还是亲属的？聆听患者的和亲属的忧虑Whoseproblemisit?Thepatient’sorthefamily’s?Listentothepatie

8、nt’sandthefamily’sfears11解释Explanation对亲属的解释Explaintothefamily:一个濒死的病人对食物丧失兴趣是正常的itisnormalforadyingpatienttoloseinterestinfood如果可能，在需要时才提供食物（使用微波炉？）ifpossible,providefoodwhenreque