MRCP2-3659

MRCP2-3659

A medical consultation was requested by the nursing staff regarding a 67-year-old man who was admitted with a urinary tract infection. He was diagnosed with terminal adenocarcinoma of the pancreas six months ago. The patient had been experiencing increasingly severe abdominal pain for the past few weeks, for which his GP prescribed and titrated morphine sulphate tablets (MST), achieving temporary pain relief with each dose increase. At the time of admission, he was taking 150mg BD and was unable to tolerate any further dose increases due to drowsiness.

The patient’s medication history included ciprofloxacin 250mg BD, which was started four days ago for the management of urinary tract infection, paracetamol 1g QDS, tramadol 100mg QDS, MST 150 mg BD, senna 2 tabs ON, and Movicol one sachet BD.

Due to the persistent abdominal pain, the inpatient team conducted investigations, which revealed the following results:

Hb 135 g/l
Platelets 224 * 109/l
WBC 11.2 * 109/l

Bilirubin 23 µmol/l
ALP 189 u/l
ALT 326 u/l
γGT 178 u/l
Albumin 34 g/l

Chest x-ray: Normal heart borders and lung fields, no evidence of subdiaphragmatic air.
Abdominal x-ray: presence of faeces, no evidence of dilatation.
USS abdomen: multiple hypoechoic lesions within the liver, nil else abnormal noted.

What is the most appropriate next step in managing this patient?