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22 Cards in this Set
- Front
- Back
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What are the common reasons for PEG feeding? |
Stroke, chronic neurological conditions, head and neck malignancy and occasionally psychiatric conditions |
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What are the contraindications to PEG tubing? |
Absolute - Contraindications to OGD, cannot transilluminate Relative - Unable to survive >30 days, varices, coagulopathy, obesity, inflammatory disease of the stomach |
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What is a button-PEG? |
A button PEG is a key component of PEG, it is the component between the skin and stomach allowing feeding |
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How many forms of PEG exist? |
Surgical, percutaneous and radiographic |
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Before you remove a PEG tube, what should you do? |
Inset a foley catheter in |
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How can tube thrombosis, the most concerning complications, be managed? |
Warm water flush, wire brushes and enzyme solutions (sodium bicarb) can be used |
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What is the most common complication of PEG tubes? |
Aspiration, haemorrhage, peritonitis, ileus, peri-stomal infection, buried bumpers and inadvertent removal |
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How should an exit infection around the PEG tube be managed? |
Broad spectrum oral antibiotics, if frank pus obtain culture and sensitivity, improve wound care (betadine, peroxide solution) |
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A patient presents with a leaking PEG tube, what is the likely cause? |
Chronic low grade infection is the most common reason, occasionally incorrect tube fitting is the cause |
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How can a leaking PEG tube be managed? |
PPI to reduce acid, control local infections, improve stoma care, use a foam dressing and if critical remove the PEG tube |
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What is the definition of re-feeding syndrome? |
Severe electrolyte shifts following rapid re-feeding after a period of under-nutrition |
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A patient who is high risk of suffering from re-feeding typically has... |
- BMI <16 kg/m2 - >15% weight loss in past 6 months - no nutritional intake for more than 10 days - low levels of potassium, phosphate or magnesium prior to feeding |
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Which patient risk factors increase the risk of entering re-feeding syndrome? |
Oncology, chronic alcoholism, post-operative, anorexic, elderly, uncontrolled diabetes, absorptive syndromes |
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What is the pathological process by which re-feeding causes damage? |
Re-feeding increases blood glucose levels stimulating insulin resulting to glycogen, fat and protein synthesis which stimulates cellular uptake of potassium, phosphate and magnesium, thiamine may also be involved |
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What are the clinical findings in a patient with low phosphate? |
Muscle weakness |
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Why are low magnesium levels a concern? |
Low magnesium impairs cardiac function and causes neuromuscular dysfunction, if maintained it leads to hypokalaemia and subsequent cardiac arrythmia |
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B1 (Thiamine) deficiency causes... |
Beriberi - weight loss, Wernick's encephalopathy in time Korsakoff's, weakness in limbs (dificulty walking) and heart failure |
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B3 (Niacin) deficiency causes... |
Pellagra - aggresion, dermatitis, insomnia, weakness and diarrhoea, can lead to dementia and death (4 D's of Pellagra - dermatitis, diarrhoea, dementia, death) |
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B2 (Riboflavin) deficiency causes... |
Dermatitis, glossitis, cheilosis, anaemia, corneal vascularisation |
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How should B vitamin deficiencies be managed? |
Pabrinex (vitamin supplementation), involve dieticians early and monitor bloods carefully |
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What is the maintenance IV fluid amount? |
- 25-30ml/kg/d of fluid - 1mmol/kg (Na+/K+/Cl-) - 50-100g/day (e.g glucose 5% contains 5g/100ml) |
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A patient with a fever of 39 requires feeding, how much is his BMR raised compared to normal? |
Fever increases BMR by 10% per degree, (39 - 37 = 2 x 10% = 20%) Sepsis increases need to 60%, infection increases to 20% |
