ABSTRACT
Skin level gastrostomies and jejunostomies were used in 17 patients for long-term enteral feeding. These devices offer greater comfort to the patient and less potential complications and dysfunction compared to tube gastrostomies and jejunostomies. Placement of the skin level devices requires "mature" gastrocutaneous and jejunocutaneous fistulas. These fistulas can be created by initial placement of percutaneous endoscopic gastrostomies and jejunostomies.
Subject(s)
Enteral Nutrition/instrumentation , Gastrostomy/instrumentation , Jejunostomy/instrumentation , Adult , Aged , Humans , Long-Term Care , Middle AgedABSTRACT
By creating motility disorders, functional pancreatic insufficiency, inadequate bowel absorptive surface, bacterial overgrowth, or mucosal changes, several disease states and treatments have an adverse impact on the body's ability to digest and/or absorb nutrients adequately. The subjective and objective observations associated with the malabsorption syndrome--fatigue, paresthesia, weight change, alterations in bowel movements, and laboratory abnormalities--are caused by losses of macronutrients, electrolytes, minerals, and vitamins in the stool. The absorption workup consists of tests for fat absorption, bowel integrity, pancreatic function, and bacterial overgrowth, which may be performed alone or in combination to aid in identifying specific absorptive defects. Other diagnostic procedures include abdominal x-rays and CAT scans and intestinal biopsy. A logical, well-planned workup is essential in order to avoid unnecessary and/or costly testing. Nutrition management utilizes parenteral, enteral, and oral feeding in combination with adjunct medical measures for maximizing nutrient absorption and minimizing nutrient losses.
