Went to my GI doctor today. Everything is great. He used the stuff they use to freeze warts off to freeze the edges of my tube site to reduce scarring. It isn't exactly a comfortable thing to have done and I'm sure I was flexing my abdominal muscles and holding my breath a bit. Baby did NOT like having it done though. She kicked and kicked!
My doctor also emailed me a copy of the abstract they have (so far) for the case study they are submitting this fall on me. For anybody who care to read it:
The Use of Percutaneous Endoscopic Gastrostomy for Nutrition Support in Pregnancy Associated with Hyperemesis Gravidarum
Matthew Tsushima, MD, Deborah Anghesom, MD, Michael Walter, MD, Snorri Olafsson, MD
Loma Linda University Medical Center
Hyperemesis gravidarum is a severe form of nausea and vomiting that occurs during pregnancy. We report the use of percutaneous endoscopic gastrostomy for nutrition support in a patient with hyperemesis gravidarum.
A 25 year old G2P1 Caucasian female with a history of hyperemesis gravidarum presented at 7 6/7 weeks gestation with weight loss and persistent nausea and vomiting. Her first pregnancy was complicated by hyperemesis gravidarum, which required total parental nutrition (TPN) for 3 ½ months. After failing conservative management with ondansetron, pyridoxine, and a bland diet, the patient was admitted for persistent nausea and vomiting.
On admission, the patient was afebrile and in mild distress. She reported a weight loss from 128 lbs to 119 lbs since becoming pregnant, with a BMI of 21.1. Physical examination revealed dry oral mucous membranes. Laboratory examination revealed a transthyretin level of 19 mg/dL [11-53 mg/dL], white blood cell count of 6.84 x 103/μL [4.8-11.8 x 103/μL], hematocrit 37.6% [32-46%], glucose 57 mg/dL [70-185 mg/dL], BUN 12 mg/dL [7-20 mg/dL], creatinine 0.7 mg/dL [0.7-1.3 mg/dL], albumin 4.7 mg/dL [3.8-5.2 mg/dL]. Urinalysis revealed ketones >80 mg/dL.
The patient was managed conservatively with intravenous fluids and ondansetron. A nasojejunal feeding tube was placed and enteral nutrition was initiated with prompt relief of symptoms. Osmolite 1.2 at 60 mL/hour was tolerated at goal rate. However, three days after placement, the feeding tube became clogged and she again complained of nausea and vomiting. A second feeding tube was placed with the end coiled in the stomach and enteral nutrition was restarted. However, the patient was unable to tolerate gastric feedings and TPN was initiated. She continued to complain of nausea and vomiting on TPN and was unable to tolerate oral medications.
After discussion with the patient and OB/GYN and Nutrition services, a percutaneous endoscopic gastrostomy tube with a 12 Fr J (PEG-J) tube extension was placed without difficulty. The patient resumed enteral feedings with improvement of symptoms and TPN was discontinued. Three days later, she again complained of nausea and vomiting. An upper endoscopy was performed which revealed jejunostomy tube tip in the gastric fundus. Using a guidewire, the jejunostomy tube was advanced further into the jejunum. She was discharged home tolerating enteral nutrition near goal rate. At home, she did note occasional clogging of the jejunostomy tube which resolved with flushes. One month later, the PEG-J tube was removed and a larger 22 Fr, 45 cm transgastric jejunal feeding tube was placed over a guidewire.
Enteral feeding is the preferred route of nutrition for a patient with a functional gastrointestinal tract. It also appears to be a safe and highly effective means of providing symptom relief in hyperemesis gravidarum. If patients are unable to tolerate nasogastric or nasoduodenal tubes. PEG placement may be an alternative to TPN.
My doctor also emailed me a copy of the abstract they have (so far) for the case study they are submitting this fall on me. For anybody who care to read it:
The Use of Percutaneous Endoscopic Gastrostomy for Nutrition Support in Pregnancy Associated with Hyperemesis Gravidarum
Matthew Tsushima, MD, Deborah Anghesom, MD, Michael Walter, MD, Snorri Olafsson, MD
Loma Linda University Medical Center
Hyperemesis gravidarum is a severe form of nausea and vomiting that occurs during pregnancy. We report the use of percutaneous endoscopic gastrostomy for nutrition support in a patient with hyperemesis gravidarum.
A 25 year old G2P1 Caucasian female with a history of hyperemesis gravidarum presented at 7 6/7 weeks gestation with weight loss and persistent nausea and vomiting. Her first pregnancy was complicated by hyperemesis gravidarum, which required total parental nutrition (TPN) for 3 ½ months. After failing conservative management with ondansetron, pyridoxine, and a bland diet, the patient was admitted for persistent nausea and vomiting.
On admission, the patient was afebrile and in mild distress. She reported a weight loss from 128 lbs to 119 lbs since becoming pregnant, with a BMI of 21.1. Physical examination revealed dry oral mucous membranes. Laboratory examination revealed a transthyretin level of 19 mg/dL [11-53 mg/dL], white blood cell count of 6.84 x 103/μL [4.8-11.8 x 103/μL], hematocrit 37.6% [32-46%], glucose 57 mg/dL [70-185 mg/dL], BUN 12 mg/dL [7-20 mg/dL], creatinine 0.7 mg/dL [0.7-1.3 mg/dL], albumin 4.7 mg/dL [3.8-5.2 mg/dL]. Urinalysis revealed ketones >80 mg/dL.
The patient was managed conservatively with intravenous fluids and ondansetron. A nasojejunal feeding tube was placed and enteral nutrition was initiated with prompt relief of symptoms. Osmolite 1.2 at 60 mL/hour was tolerated at goal rate. However, three days after placement, the feeding tube became clogged and she again complained of nausea and vomiting. A second feeding tube was placed with the end coiled in the stomach and enteral nutrition was restarted. However, the patient was unable to tolerate gastric feedings and TPN was initiated. She continued to complain of nausea and vomiting on TPN and was unable to tolerate oral medications.
After discussion with the patient and OB/GYN and Nutrition services, a percutaneous endoscopic gastrostomy tube with a 12 Fr J (PEG-J) tube extension was placed without difficulty. The patient resumed enteral feedings with improvement of symptoms and TPN was discontinued. Three days later, she again complained of nausea and vomiting. An upper endoscopy was performed which revealed jejunostomy tube tip in the gastric fundus. Using a guidewire, the jejunostomy tube was advanced further into the jejunum. She was discharged home tolerating enteral nutrition near goal rate. At home, she did note occasional clogging of the jejunostomy tube which resolved with flushes. One month later, the PEG-J tube was removed and a larger 22 Fr, 45 cm transgastric jejunal feeding tube was placed over a guidewire.
Enteral feeding is the preferred route of nutrition for a patient with a functional gastrointestinal tract. It also appears to be a safe and highly effective means of providing symptom relief in hyperemesis gravidarum. If patients are unable to tolerate nasogastric or nasoduodenal tubes. PEG placement may be an alternative to TPN.
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