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Malignant Bowel Obstruction — RACP Adult Medicine MCQ

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ModerateGastroenterologyMalignant Bowel ObstructionRACP Adult Medicine

A 65-year-old woman with advanced lung cancer has malignant bowel obstruction. She has nausea and vomiting. She is not a surgical candidate. She has a syringe driver with morphine and haloperidol. She continues to vomit. An NG tube has been declined. What is the most appropriate additional antiemetic?

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Correct answer: B — Hyoscine butylbromide (Buscopan)

In inoperable malignant bowel obstruction (MBO) with vomiting, hyoscine butylbromide (antisecretory) reduces intestinal secretions and colic. Metoclopramide is CONTRAINDICATED in complete bowel obstruction (prokinetic action worsens colic and perforation risk). Octreotide (antisecretory) is an alternative. Dexamethasone may reduce peri-tumoural oedema and partially relieve obstruction.

Reference: PCA – 2024 – MBO; eTG Palliative Care 2024