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MCQ 9: Malignant Bowel ObstructionA 62-year-old woman with advanced ovarian cancer presents with abdominal pain, distension, and vomiting. CT scan confirms malignant bowel obstruction. What is the most appropriate initial pharmacological management?A. MetoclopramideB. OndansetronC. Dexamethasone and octreotideD. LactuloseE. ErythromycinAnswer: Dexamethasone and octreotideExplanation: In malignant bowel obstruction, the combination of dexamethasone and octreotide is often the first-line pharmacological management. Dexamethasone reduces peritumoral edema, potentially relieving the obstruction, while octreotide reduces gastrointestinal secretions and motility, decreasing nausea and vomiting. Metoclopramide is contraindicated in complete bowel obstruction. Ondansetron alone doesn't address the underlying problem. Lactulose could worsen symptoms. Erythromycin, a prokinetic, is not appropriate in obstruction.