A 55-year-old woman with advanced ovarian cancer on palliative care presents with intractable nausea, bilious vomiting, and abdominal distension. CT shows diffuse peritoneal carcinomatosis with multiple transition points in the small bowel. No single mechanical point of obstruction is identified. Which pharmacologic agent is most appropriate for symptom control?

• A Metoclopramide
• B Ondansetron
• C Hyoscine butylbromide
• D Octreotide ✓

Explanation

Octreotide is the drug of choice for symptom control in malignant bowel obstruction, particularly when surgery is not feasible. It reduces gastrointestinal secretions by inhibiting VIP-mediated intestinal fluid secretion and decreases peristalsis, thereby reducing vomiting and colicky pain. It is more effective than anticholinergics alone. Metoclopramide is contraindicated in mechanical obstruction.

Reference: Oxford Textbook of Palliative Medicine, 6th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.