Enteral feeding

Question 1

When is enteral feeding indicated?

Answer 1

In patients who have an inability to maintain oral intake with a functioning GI tract

Question 2

What are the consequences of malnutrition?

Answer 2

Physical decline
Impaired psychosocial function
Function decline
Reduced QoL
Poor clinical outcomes
More healthcare use

Question 3

What screening tool is used to identify patients who are malnourished, at risk of malnourishment or obese?

Answer 3

Malnutrition Universal Screening Tool (MUST)

Question 4

What is step 1 of MUST?

Answer 4

BMI score

Question 5

What is step 2 of MUST?

Answer 5

Weight loss score

Question 6

What is step 3 of MUST?

Answer 6

Acute disease effect score (eaten in the last 5 days)

Question 7

What equation is used for calorie estimation?

Answer 7

Schofield equation

Question 8

What is bolus feeding?

Answer 8

Give feed, supplements, water and medication as a bolus by syringe when required.
Only purple enteral syringed can be used with feeding tubes

Question 9

What is an alternative to bolus feeding?

Answer 9

Continuous method with an enteral feeding pump and a giving set

Question 10

What are absolute contraindications to enteral feeding?

Answer 10

Intestinal obstruction
Severe ileus
Intestinal perforation
Proximal GI fistula
Refusal in a competent patient

Question 11

How do you check the position of the NG tube?

Answer 11

Aspirating and testing the pH.
pH between 0 and 5 is in the stomach and safe to use

Question 12

What is NG tube used for?

Answer 12

Short term feeding only

Question 13

What are some examples of NG use?

Answer 13

Swallowing disorders
Head and neck cancers
CF
Anorexia nervosa

Question 14

What are absolute contraindications to NG use?

Answer 14

Basal skull fracture
Nasopharyngeal/ oropharyngeal pathology prevents passage of tube

Question 15

What are the relative contraindications to NG use?

Answer 15

Nasal problem
Previous traumatic insertion

Question 16

What are the risks of NG use?

Answer 16

Malposition into lungs or intracranially
Removal by patient
Tube blockage
Oesophageal/ gastric ulceration

Question 17

What is NJ feeding?

Answer 17

Nasojejunal
Tubes run through pylorus into jejunum to deliver post pyloric feeding
Inserted under direct vision in endoscopy

Question 18

What are some examples of NJ use?

Answer 18

Delayed gastric emptying
Reflux causing an aspiration risk
Upper GI surgery
Pancreatitis

Question 19

What are absolute contraindications to NJ use?

Answer 19

Basal skull fracture
Nasopharyngeal/ oropharyngeal pathology prevents passage of tube
Gastric outlet obstruction

Question 20

What are relative contraindications to NJ use?

Answer 20

Inability to pass endoscope

Question 21

What are the risks of NJ use?

Answer 21

Malposition into lungs or intracranially
Removal by patient
Tube blockage
Oesophageal/ gastric ulceration
Post-pyloric position not sustained

Question 22

What are the three types of gastrostomy?

Answer 22

PEG
RIG
Surgical

Question 23

What does PEG stand for?

Answer 23

Percutaneous Endoscopic Gastrostomy

Question 24

What does RIG stand for?

Answer 24

Radiologically Inserted Gastrostomy

Question 25

When is a gastrostomy indicated?

Answer 25

When enteral feeding will be required long term (>30 days)

Question 26

What are absolute contraindications to gastrostomy?

Answer 26

Inability to pass endoscope due to pathology Gastric Outflow Obstruction Planned curative oesophageal resection

Question 27

What are relative contraindications to gastrostomy?

Answer 27

Coagulopathies Peritoneal dialysis Gastroparesis Portal HTN Gastric ulcer Gastric malignancy Gastrectomy Severe obesity Oesophageal cancer Active infection

Question 28

What are the risks of gastrostomy?

Answer 28

Pain Haemorrhage Peritonitis Pneumoperitoneum Gastrocolic fistula Infection Blockage Over granulation

Question 29

What are the three types of jejunostomy?

Answer 29

PEJ PEG-J Surgical

Question 30

What is PEJ?

Answer 30

Percutaneous Endoscopic Jejunostomy

Question 31

What is PEG-J?

Answer 31

PEG with Jejunal extension

Question 32

What is the indication for Jejunostomy?

Answer 32

Patient requires long term feeding and post-0pyloric feeding

Question 33

What are absolute contraindications to jejunostomy?

Answer 33

Inability to pass endoscope Jejunal disease at insertion site Intestinal obstruction distal to site

Question 34

What are relative contraindications to jejunostomy?

Answer 34

Coagulopathies Portal HTN Ascites Peritoneal dialysis

Question 35

What are the risks of jejunostomy?

Answer 35

Pain Haemorrhage Peritonitis Infection Blockage Post pyloric position not sustained