ANOREXIA: A FEEDING TUBE COULD BE IN YOUR FUTURE...

Anorexic girl with PEG tube

The ins and outs of PEG (Percutaneous Endoscopic Gastrostomy) and NG (nasogastric) feeding tubes...

So, what are NG and PEG feeding tubes?

They are medical devices used to provide nutrition to those who cannot obtain nutrition by swallowing. Feeding tubes are often a last resort for chronic anorexics.

An NG tube is passed through the nose, down the esophagus and into the stomach, and a PEG tube is inserted through a small incision in the abdomen into the stomach.

This video shows the NG insertion technique:

PEG tube insertion has a high risk of serious complications. Placement of PEG tubes requires an invasive surgical procedure, and is usually done by a surgeon and a gastroenterologist working together.

"An endoscope (a long, thin fiberoptic tube with a tiny video camera on its end) is inserted through the mouth and down the esophagus into the stomach. The endoscopic camera is used to produce pictures of the inside of the stomach on a video monitor so that the proper spot for insertion of the PEG feeding tube can be located.

The surgeon inserts a needle into the stomach at the spot where the PEG tube will be located. Using the endoscope, the gastroenterologist locates the end of the needle inside the body, and encircles it with a wire snare. A thin wire is then passed from the outside of the body, through this needle and into the abdomen. This wire is then grasped with the snare and pulled out through the mouth. Now, there is a thin wire entering the front of the abdomen into the stomach and continuing upward and out the mouth. The PEG feeding tube is attached to this wire outside of the mouth. The surgeon then pulls the wire back out from the abdomen, which pulls the PEG down into the body through the mouth and esophagus. The tube is pulled until the tip of the PEG comes out of the incision in the stomach. There is a soft, round "bumper" attached to the portion of the PEG that remains inside the body, this bumper secures the tube on the inside of the body. The outer portion of the tube is secured with a bumper as well. Sterile gauze is placed around the incision site and the PEG tube is secured to your abdomen with tape."

Feeding tube system

While the operative procedure is usually safe, there can be serious complications:

(1) migration of the tube out of the stomach

(2) necrotizing fasciitis (“flesh eating disease”). Mortality rates for those with necrotizing fasciitis are as high as 73 percent

Necrotizing fasciitis of the abdomen

(3) fluid overload which causes an increase in weight, swelling in the legs and arms, and/or fluid in the abdomen, and breathing difficulties

(4) aspiration pneumonia (caused by inhaling food, liquids, vomit, or secretions from the mout) into the lungs, which can lead to an inflammatory reaction, a lung infection (pneumonia), or a collection of pus in the lungs (lung abscess)

(5) peritonitis, an inflammation of the thin membrane lining, called the peritoneum, that covers the intestinal tract and surrounds the organs in the stomach

(6) abdominal abscess, an infected pocket of fluid and pus located inside the abdominal cavity

Abdominal abscess

(7) bowel obstructions, which prevent the normal transit of the products of digestion. A bowel obstruction is a medical emergency

(8) gastric perforation, a complete penetration of the wall of the stomach, small intestine or large bowel, resulting in intestinal contents flowing into the abdominal cavity

(9) Gastrointestinal bleeding, which is any bleeding that starts in the gastrointestinal tract, which extends from the mouth to the large bowel. GI bleeding can be life threatening

(10) pain at the tube site

(11) tube malfunction

(12) stenosis of the opening (abnormal narrowing)

(13) local bleeding

(14) skin excoriation (traumatized or abraded skin caused by rubbing)

(15) wound dehiscence (the premature "bursting" open of a wound)

(16) cellulitis (diffuse infection of connective tissue with severe inflammation of dermal and subcutaneous layers of the skin)

Abdominal cellulitis

(17) gastroesophageal reflux, which occurs when the lower esophageal sphincter (LES) opens spontaneously, or does not close properly and stomach contents rise up into the esophagus

(18) diarrhea, and

(19) nausea

Feeding tubes do not come without the possibility of serious medical problems. If you are anorexic and presently on a feeding tube, please notify your doctor if you are feeling any discomfort whatsoever. It could save your life.


Links:
http://en.wikipedia.org/wiki/Feeding_tube
http://www.mda.org.au/PEG/peg.asp
http://flickr.com/photos/11374644@N06/2110312729
http://www.ispub.com/ostia/index.php?xmlFilePath=journals/ijps/vol2n2/abdominal.xml
http://pennacademicassociate.com/img/Slideshow/2.JPG
http://www.suile.com/casestudies/index.html
http://www.mrsanotes.com/cellulitis-general-information/

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