Question: The following enteral feeding device should not be placed into which of the following patients?
A. 16 year old female with anorexia nervosa
B. 44 year old female with generalized urticaria
C. 80 year old male with hemorrhagic stroke
D. 50 year old malnourished female with cirrhosis and ascites
Answer: The gastroenterologist or hepatologist is often called upon to place percutaneous enteral feeding tubes. It is important to know when to say no. To be certain, the presence of ascites should raise a red flag. It will impair the healing process and will be a setup for secondary bacterial peritonitis. Even if a cirrhotic patient is malnourished, the presence of ascites is your contraindication. This is the correct answer. In its place, you should recommend a nasogastric feeding tube.
Anorexia nervosa and hemorrhagic stroke are two situations that may call for special nutritional delivery. The presence of urticaria by itself is not a contraindication. G-tubes can be placed successfully. Nevertheless, if the case is severe you may want to delay the G-tube placement until the patient recovers, just to be safe. Don’t overthink this answer set: the buzzword of ascites is the main learning point!