Symptom: Abdominal Bloating

Initial Grading Reminder

CTCAE grading of abdominal bloating:

• Grade 1: Mild symptoms; intervention not indicated
• Grade 2: Moderate symptoms; medical intervention indicated
• Grade 3: Severe symptoms; surgical intervention indicated

Assessment and Grading

Characterize the symptom (onset, pace)

Ask the patient:

Have you had any issues with bloating in your abdomen (belly) in the past? Any Crohn’s disease or cancer metastases to your bowel? Is this a new or worsening symptom? When did it start or get worse? Has it developed gradually or suddenly? Has your diet changed in the past day? What have done/taken to treat it thus far? Do you drink a lot of carbonated beverages? Are you passing gas?

“Suddenly” would be more consistent with peritoneal signs.

Grade the symptom

Ask the patient:

How would you rate your abdominal (belly) bloating (mild, moderate, or severe)? Is it affecting your ability to function?

Patient Query Regarding Other Symptoms/Red Flags

Ask the patient:

Do you have any changes in your bowel movements? Any abdominal pain/tenderness, nausea, fever, or change in appetite?

Do you have any yellowing of the skin or whites of your eyes, abdominal (belly) pain, sleepiness, or is your thinking foggy?

Do you have new or worsening shortness of breath, increased fatigue or chest pain? Does your heart feel like it is racing or skipping a beat?

Patient Factors to Consider That Affect the Approach to Intervention

Consider the following in individualizing the intervention: Is the patient a good or poor historian? Any language barriers or cognitive deficits? Is the patient reliable (able to carry out treatment recommendations)? Does this patient have alcohol/substance abuse issues? Does the patient have transportation? Is there sufficient caregiver support?