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Gastroenterologische Symptomenkontrolle in der Palliativmedizin (Teil 1)

Gastrointestinal symptom control in palliative care (part 1)

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Zusammenfassung

Die Palliativmedizin gewinnt in Deutschland aus gesellschaftlichen, medizinischen und ökonomischen Gründen zunehmend an Bedeutung. Etwa 80% aller palliativmedizinischen Patienten leiden unter gastrointestinalen Symptomen, die zu teilweise extremer Beeinträchtung führen können.

In einem zweiteiligen Beitrag soll eine Übersicht über die Möglichkeiten der Symptomenkontrolle, insbesondere der medikamentösen Kontrolle im hausärztlichen bzw. ambulanten Bereich gegeben werden. Behandelt werden sollen im ersten Teil Beschwerden der Mundhöhle, Schluckauf, Übelkeit und Erbrechen, im zweiten Teil Obstipation, Diarrhö, Aszites, Ikterus und gastrointestinale Obstruktion. Ausgenommen sind an dieser Stelle die Anorexie-Kachexie-Problematik und die gastrointestinalen Blutungen, deren Erkennung zwar Aufgabe der im ambulanten Bereich tätigen Kollegen ist, deren Evaluation und Behandlung aber meistens eines stationären Aufenthaltes bedarf.

Anliegen dieser Übersichten ist es, dazu beizutragen, Schwerkranken in der Endphase eine Betreuung im häuslichen Umfeld zu ermöglichen und unnötige stationäre Aufenthalte zu vermeiden.

Abstract

Because of current medical and socioeconomic factors, palliative care is gaining increasing importance in Germany. Approximately 80% of all palliative care patients suffer from gastrointestinal symptoms, which can be heavily incapacitating.

The object of this two-part review is the control – especially the medical control – of these symptoms in the area of primary care. Complaints of the mouth as well as nausea and vomiting will be addressed in part 1, and constipation, diarrhoea, ascites, jaundice, and gastrointestinal obstruction will be addressed in part 2. Anorexia/cachexia and gastrointestinal bleeding have been omitted; although the primary care practitioner comes across these problems, their management usually requires hospitalization.

It is the purpose of this review to contribute to the ability of terminally ill patients to receive appropriate medical care at home, thereby avoiding unnecessary hospitalisations.

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Correspondence to PD Dr. M.H. Holtmann.

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Holtmann, M., Siepmann, U., Mahlkow, S. et al. Gastroenterologische Symptomenkontrolle in der Palliativmedizin (Teil 1). Gastroenterologe 4, 64 (2009). https://doi.org/10.1007/s11377-008-0253-3

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Schlüsselwörter

  • Palliativmedizin
  • Terminalphase
  • Gastroenterologie
  • Hausarzt
  • Symptomenkontrolle

Keywords

  • Palliative care
  • Terminal phase
  • Gastroenterology
  • Primary care
  • Symptom control