What are the differences in signs and symptoms of a misplaced g-tube
and a disrupted stoma where the tube is correctly within the stomach?

Hello,

Firstly, its "gastrostomy" not "gastostomy."  The mispelling may be
the reason you're not finding the information you need. Below are some
sites that will be very helpful. Since I am not a doctor I can't give
you a direct answer to your question.I recommend accessing the "G-tube
Mailing List" and asking some other folks about their experience with
g-tubes. Nothing better than going directly to the source - people
with experience.


Muscular Dystrophy Campaign
Site about Gastrostomys
<http://www.muscular-dystrophy.org/information/Care/gast.html>

The G-tube Mailing List Faq-O-Matic (chat with other patients)
<http://www.gtube.org/>

Gtube - Gastrostomy Support Mailing List (probably your best bet)
Homepage:
<http://www.lsoft.com/scripts/wl.exe?SL1=GTUBE&H=MAELSTROM.STJOHNS.EDU>
Searchable archives and contact info; you can also post questions
here:
<http://maelstrom.stjohns.edu/archives/gtube.html>

G-tube support group sites:
<http://personal.nbnet.nb.ca/normap/gtube.htm>

Gastrostomy Information and Support Society
<http://www.giss.org/>




Google search keywords:

gastrostomy tube leak complications

gastrostomy listserv

gastrostomy support group


Good luck. Please submit a clarification request if you want
additional info or have any other related questions.

Thanks,

rapidreference-ga

---

Request for Answer Clarification by rosalima-ga on 24 Jul 2002 05:52 PDT

Thank you for the further info.  I am also new to this, so didn't know
how much to put into the question.  The subject is rather complex.  I
am a geriatric nurse.  The problems that I am dealing with do not have
to do with a g-tube migrating up to the esophagous, but the feeding
leaking through a disruption in the stoma itself into the peritoneal
cavity.  Anecdotal information tells me that the S&S of a disrupted
stoma are "slow onset" and the misplacement of a tube with direct
emptying of feeding into the peritoneal cavity causes "sudden onset"
of S&S.  For a court case I am looking for support for the anecdotal
info.  Thank you :-))

---

Clarification of Answer by rapidreference-ga on 24 Jul 2002 07:58 PDT

Hello,

I went back to PubMed (medline) after reading your clarification
request. I searched "stoma" "peritoneal" and "gastrostomy" using the
mesh browser search option. I highly recommend using the mesh browser
search if you're unfamilar with the medical subject headings used to
index medical literature. Here are four additional citations for you.
I cannot guarantee you will find exactly what you need. I do hope this
will add to your case.

PubMed 
Medline from the National Library of Medicine
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi>

Mesh Browser
<http://www.ncbi.nih.gov:80/entrez/meshbrowser.cgi>

Mesh Browser Help
<http://www.ncbi.nih.gov:80/entrez/meshbrowser_help.html#Browser>



Batoon SB, Vela AT, Dave D, Wahid Z, Arunacahalam M, Shatenfeld
G,Pavlovici S.
Percutaneous endoscopic gastrostomy and stomal bilious leakage in a
patient with a Billroth II gastrectomy. Am J Gastroenterol. 2000
Nov;95(11):3320-1.

A. Golden, C. Beber, R. Weber et al., Long-term survival of elderly
nursing home residents after percutaneous endoscopic gastrostomy for
nutritional support. Nurs Home Med 5 11(1997), pp. 382¯390.

M. Kaw and G. Sekas, Long-term follow-up of consequences of
percutaneous endoscopic gastrostomy (PEG) tubes in nursing home
patients. Dig Dis Sci 39 4 (1994), pp. 738¯743.

D.E. Larson, D.D. Burton, K.W. Schroeder et al., Percutaneous
endoscopic gastrostomy: Indications, success, complications, and
mortality in 314 consecutive patients. Gastroenterology 93 (1987), pp.
48¯52.

Good Luck,

rapidreference-ga

The answer was very superficial.  I can search and get what the
researcher found.  I am looking for "specific" signs and symptoms to
differentiate between the two medical situations -1) misplaced tube
and 2) disrupted stoma.  The mispelling of gastrostomy was just that a
typo.  I am a nurse looking for data for a trial

Sorry, I did not intent to sound superficial. Perhaps I should have
provided more information concerning my search on your question. I
went to PubMed and ran some searches. There was plenty of research
about gastrostomy but I couldn't find anything relating to your query.
I then did some web searching and gave you a list of sites I thought
would be helpful. I assumed you were a consumer, not a health
professional - my mistake. I leave you with one more site that does
not provide a direct answer but does touch on the information you
request.

From 1998 Nursing CE Handbook
When Your Patient Needs Tube Feedings 
<http://www.gi-guy.com/tubefRN.htm>

rapidreference

I did find this nursing document that may be of some use.
http://medicine.ucsd.edu/peds/Pediatric%20Links/Links/GI/Pediatric%20Stomas,%20Tubes,%20and%20Appliances%20Ped%20Clin%20of%20NA%20Dec%201998.htm

Google search terms:
Mic-Key+placement+stoma

Will keep looking,
V

Dear Rosalima,

The Medical Faculty of the University of California, San Diego had a
good description of the symptoms of g-tube migration and also various
stoma complications. My layman's understanding leads me to conclude
that stoma complications would generally tend to be more localised
(around the stoma), whereas the blockages caused by tube migration
would result in more generalised symptoms depending upon the site of
the blockage:

"....Migration 

Migration of the GT results from inadequate stabilization. The tube
may migrate upward toward the esophagus, causing vomiting and
potential aspiration. Downward migration to the pylorus will cause
gastric outlet obstruction. Signs and symptoms may include abdominal
distention, vomiting, pain, or discomfort. Migration to the small
intestine may cause the "dumping syndrome." Signs and symptoms of the
dumping syndrome include bloating, nausea, colic, explosive diarrhea,
and systemic symptoms of weakness, diaphoresis, and pallor. [2] If a
balloon catheter is being used and migration is not recognized,
inflation of the balloon may result in esophageal, duodenal, or small
bowel perforation. "

http://medicine.ucsd.edu/peds/Pediatric%20Links/Links/GI/Pediatric%20Stomas,%20Tubes,%20and%20Appliances%20Ped%20Clin%20of%20NA%20Dec%201998.htm

I hope this helps. In general, google researchers will respond very
well to a clarification request...
________

Another link that may be of interest.

http://staff.washington.edu/growing/Nourish/Tubecomp.htm

_______

Search strategy: "gastrostomy tube" stoma complications gave many more
links.

Rosalima,

I really didn't find that many articles at PubMed but I hope there's
something in this abstract.
http://www.ncbi.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11400925&dopt=Abstract

Also, this is a study done at the Singapore General Hospital between
1995-2000 that hopefully will have some stats you can use.
http://216.239.51.100/search?q=cache:kg2bb14gjfIC:www.sma.org.sg/smj/4210/4210a3.pdf+%22PEG+tube%22+%22misplacement%22+%22stoma%22+%22disruption%22&hl=en&ie=UTF-8

That link looks a bit hinky so here are my Google search words:  
PEG tube+misplacement+stoma+disruption

Will try for more this weekend,
V

Google should make it impossible to give a one- or two-star rating
without posting a clarification first.

Dear Rosalima,

Before I get too off the beaten path here, let me welcome you to
Google Answers.  While I don't think we've done justice on your
question, I think it has to do with the difficulty of the research
topic.

As rapidreference explained the MeSH method at PubMed is your best
approach, although I hope you've had better luck with your search
words than mine.  Quite a number of the nursing journals are by
subscription only and most researchers here don't have access to them.

I should have clarified first on your demographic before going off on
that peds tangent.  Generally, the researchers like to get as much
information as the customer is willing to give in the initial
question.  It saves time and confusion and I think the querant is more
satisfied with the results.  I do hope you'll GA another spin in the
future.  We'd love to have you back.

Now to your situation. I wonder about enlisting the support of your
colleagues with your research.  There are also LNCs/nurse paralegals
who could help you with the nuances of the case.  The GA researchers
help one another with especially difficult question, and I know nurses
have that same espirit d'corps.  If you don't already belong to a
nursing bulletin board, here are a few possibilities and a few links
that might be of interest.

nursing resouces:
http://www.careplans.com/pages/link_detail.asp?id=1&title=General%20Links
http://www.ntpr.org/menu
http://www.rncentral.com
http://www.rnweb.com/be_core/r/index.jsp
http://www.nursewebsearch.com

links to journal articles/nursing chapters
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11928047&dopt=Abstract
http://www.intellinurse.org/cfc/callofmonth/assessing%20problems%20with%20permanent%20feeding%20tubes.htm
http://www.mdchoice.com/searchframes.asp?sURL=http://www.merck.com/pubs/mmanual/section3/chapter25/25a.htm&rURL=http://www.mdchoice.com/SearchResults.asp?DoSearch=1&vreviewed=1
(you'll have to register for access here)

Lastly, I did found this paragraph from a nursing rationale
questionnaire form although I couldn't access the entire document. 
Forgive me if I don't know the exact terms; I probably only know
enough about medicine to be a danger to myself and others, but are we
talking about "dumping syndrome?" This paragraph would lend credence
to your gut {sorry medical humor there} feeling about "sudden onset."
 
"Common problem after partial gastrectomy with duodenal anasomosis.
Dumping syndrome is the rapid entry of a hypertonic, undigested food
bolus into the duodenum or jejunum.  Water is pulled into the
intestine causing decreased blood volume and increased intestinal
dilation.  Peristalisis is stimulated and motility increases. 
Symptoms occur in 5 - 30 minutes and include nausea, epigastric pain,
cramping, borborygmi, and diarrhea.  Systemic symptoms include
tachycardia, orthostatic hypotension, dizziness, flushing and
diaphoresis.
The hyperosmolar chyme causes a rise in blood glucose, the stimulates
the release of insulin, leading to hypoglycemic symptoms 2-3 hours
after the meal."
{http://www2.kumc.edu/instruction/nursing/nurs302/GIprocedure/rationquestions.htm}

Also, would this not present as an "acute abdomen" with rigidity and
rebound tenderness?  Again, not knowing nurse protocol, I'm wondering
if I've researched on the very best search terms.

I do hope we've given you something to go on and wish you very much
luck with your trial.  Please do come back.

search criteria:
gastrostomy tube displacement
acute abdomen
stoma disruption
parenteral feeding
PEG tube + peritonitis
G-tube+peritonitis
PEG tube+leakage
PEG tube complications
dumping syndrome
{any combination of the above}

Best regards,
V