Gastrostomy
Gastrostomy is a medical procedure that creates an artificial opening in the abdominal wall to the stomach, commonly used when a patient is unable to swallow food. This inability to eat can arise from various conditions, including cancers, esophageal strictures, unconsciousness, or injuries, such as children ingesting caustic substances. The procedure involves inserting a gastrostomy tube, often referred to as a G-tube, which can be either permanent or removed after each feeding. The tube allows for the delivery of nutrients in a pureed form, which is essential as solid food is not suitable for these patients.
Careful management is required to prevent complications, such as infections, by ensuring that the tubes are sterilized and that the surrounding skin is protected from gastric juices. Psychological adjustments can also be significant, especially for those with long-term gastrostomies, as the experience of eating often holds social and cultural importance. Overall, gastrostomy serves as a vital solution for individuals who face challenges in meeting their nutritional needs due to medical conditions.
Gastrostomy
Anatomy or system affected: Abdomen, gastrointestinal system, stomach
Definition: The creation of a hole through the wall of the abdomen into the stomach to feed a patient who is unable to swallow
Indications and Procedures
Gastrostomies are carried out during situations in which a patient is unable to swallow food. This condition may result from cancer or strictures of the esophagus; when an esophageal fistula is present, causing the diversion of swallowed food; or when a patient is unconscious. In some cases, the patient is a child who has swallowed a caustic substance, causing damage to the esophagus. Gastrostomy is often used for children who are having trouble reaching their necessary caloric intake after all other options have been exhausted. Under such circumstances in which a gastrostomy is warranted, an artificial opening is prepared through the abdominal wall into the stomach, and a tube is inserted through the opening.
The gastrostomy tube, which is usually made of plastic or nylon, may be permanently inserted or removed after each feeding. The gastronomy tube is often referred to as a G-tube in the medical community. The development of the Barnes-Redo prosthesis has alleviated some of the problems associated with permanent gastrostomies. The device, which is permanently installed, has a cap placed over the opening between feedings. When it is time to eat, the cap is removed, and a catheter is placed through the tube into the stomach, allowing food or liquids to be fed to the patient. When the meal is finished, the catheter is removed, and the cap is replaced on the gastrostomy tube.
Food for gastrostomy patients cannot be solid. It is recommended that any food first be thoroughly cooked and then blended into a mushy consistency. Patients should smell and taste the food prior to feeding, both to minimize the difficulty in adjusting to the situation and to stimulate gastric secretions, which will aid in digestion.
Uses and Complications
Care must be taken with gastrostomy patients to minimize the chance of infection. Any tubes that will be inserted into the stomach must be sterilized prior to use. In addition, the skin around the gastrostomy tube must be protected from gastric juices, such as stomach acid, which could cause irritation. The major adjustment for these patients, however, is often psychological—particularly for those with permanent gastrostomies, since meals are often times for social gatherings.
Bibliography
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Breckman, Brigid, ed. Stoma Care and Rehabilitation. New York: Churchill Livingstone/Elsevier, 2005.
Broadwell, Debra C., and Bettie S. Jackson, eds. Principles of Ostomy Care. St. Louis, Mo.: Mosby, 1982.
Edwards-Jones, Valerie, and Anne Leahy-Gilmartin. "Gastrostomy Site Infections: Dealing with a Common Problem." British Journal of Community Nursing, supplement (May, 2012): S8–S13.
"Feeding Tube Insertion—Gastrostomy." MedlinePlus, May 16, 2012.
"Gastrostomy: Permanent and Temporary." Health Library, November 26, 2012.
Gauderer, Michael W. L., and Thomas A. Stellato. Gastrostomies: Evolution, Techniques, Indications, and Complications. Chicago: Year Book Medical, 1986.
Ponsky, Jeffrey L., ed. Techniques of Percutaneous Gastrostomy. New York: Igaku-Shoin, 1988.