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Crohn's Disease Forum » Support Forum » Support please! Fear of peritonitis!!!


12-10-2013, 01:11 AM   #1
iriechic
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Support please! Fear of peritonitis!!!

Ugh I am so worried or I'd be in bed by now, especially after the long day I had at the hospital getting a Mickey Button. Long story short (as possible) I was in 7 mos. colitis flare. I did not tolerate the side effects of steroids well. I tried Remicade and felt poorly on it. My GI convinced me to get a PEG tube for bowel rest and to get nutrients. I agreed. I just read online that you are supposed to receive antibiotics preventatively before the PEG procedure. My GI did not have me do any abx before getting PEG. The PEG somewhat helped, but not full remission. However, I have had an ever larger belly since getting it. Both my husband and I agree it is distended and rather firm. I feel like I look 5-6 mos pregnant. I have had fever and chills a few times in the 2.5 mos of having PEG. Chalked that up to hormones or a bug from my kids. I also started 6MP two weeks ago. I exchanged to low profile Mickey Button today bc more discreet. Anyway, discharge papers have me panicked. We texted pics of belly to GI weeks ago and she said gaseous distention...pretty vague. Well, the papers say "Gastrostomy tube should not be used if there are signs of peritonitis (abdominal pain, fever), increased abdominal discomfort (check), leakage around insertion site (check, small crusty amount in AM like crust from eyes after sleeping), vomiting, large residual volume greater than the volume of the previous feeding (went to local ER bc so much when I checked. Stopped checking bc my GI said if under 12 ounces she's not concerned). Report nausea, distention, diarrhea....I have but Nada. TMI: my BMs ALWAYS float too, won't sink at all even after many hours. My GI says not a concern but I feel it's abnormal.

Anyway, please help if you can. I have myself convinced about peritonitis which is life threatening if untreated. It's infection in abdominal area that can spread to blood and become septic/ cause organ failure. Please, am I overreacting? What would you do? I want to have peace of mind. God bless for reading this, if you have. Truly appreciate support.
12-10-2013, 02:21 AM   #2
Jennifer
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When you went to the ER did they do any blood work and imaging tests to check for infection? If your symptoms are getting worse or if you're really scared then I'd go back to the ER and make sure that they check to see if you do have peritonitis. If you do go to the ER make sure they do blood work to check for an increase in your white blood cell count and to check if there's any bacteria in your blood. They could also do imaging tests like an x-ray, ultrasound or CT scan.

When looking at the symptoms of peritonitis on Mayo Clinic's site the symptoms basically sound similar to a bowel obstruction. Its possible that you have a narrowing and the fluid entering the PEG tube may not be making its way through your system because its bottle necking at a narrowed section so its hard to say what the cause is.

If you start vomiting, have a fever, have extreme pain and/or cannot pass stool then go to the ER immediately.

I was just doing a search on EN and floating stools and found this (may or may not be related as its about Nutrition Support in Severe Acute Pancreatitis but the complications with EN feeding may apply):

Complications During Enteral Feeding
While some persistent abdominal pain is normal during pancreatitis, pain that worsens with EN feeding may be a sign that the jejunal feeding tube has migrated out of place, resulting in pancreatic stimulation. The previously described case of the patient who stopped his EN due to increased pain is an example of this. After radiologic evaluation of the tube location, it was apparent that the EN formula was infusing into the duodenum. The patient was able to tolerate EN again after the J tube was replaced with the feeding ports in the jejunum, beyond the LOT. Likewise, if a patient is vomiting and the emesis appears milky, similar in appearance to the EN formula, one can suspect that the J tube may have migrated out of place, allowing the flow of formula into the stomach. The caregiver should evaluate tube position to ensure that the end of it (as well as the feeding ports, which may be on the sides near the end of the tube) is beyond the LOT.7
http://www.todaysdietitian.com/newar...11110p36.shtml

The floating stools are called Steatorrhea which can be due to malabsorption, Pancreatitis, Celiac etc. Looking at the symptoms of Pancreatitis I'm wondering if you should be tested for that. Afidz had it and she said it was extremely painful so I'm not sure (all these symptoms can be caused by tons of other health problems).

Sorry if this isn't much help but I don't know much about PEG tube feeding. Hope you start feeling better soon. Keep us posted.
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12-10-2013, 04:03 AM   #3
DustyKat
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I too have not had personal experience with a PEG at home but have in my work:

- The ‘crustiness’ around the tube is normal.

- My daughter had peritonitis from a ruptured bowel and in her case it clear cut that something was amiss. Severe abdominal pain, fever, elevated white cell count. That is not to say that for those that have catheters/tubes inserted into the abdomen can’t have a more subtle presentation.
The GI tract is not a sterile environment so there would have to be some sort of breach of the bowel/stomach or of the tract from the skin to the stomach through which the tube passes to develop peritonitis.

- Have you looked into the type of feed you are using and/or how you are administering it as a cause of your symptoms?

Hope you get to the bottom of things and are soon feeling much more comfortable. Good luck!

Dusty. xxx
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12-10-2013, 09:42 AM   #4
Ihurt
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Oh if you had peritonitis you would know it. You would have very bad pain in the area as well as a high fever I would think. If the ER did blood work and it was ok in terms of your WBC count, then you probably are ok. It could even be the food you put through the PEG tube that is causing you to bloat up, I think this is common. I would just keep an eye on things( your temperature, pain levels etc..). You will know it if something is wrong.
12-10-2013, 07:38 PM   #5
iriechic
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Thanks so much for all the information and support. Y'all are great! Fortunately, today I spoke with the PA who saw me yesterday before my Mickey Button procedure. He assured me that I would have a fever (that doesn't go away) and be in intense pain. I also mentioned that I woke with a little ooze around the site and he said that's normal because PEG and Mickey sizes may vary; I may have more wiggle room now. He was very kind and did say to call back in a few days if I'd like to let him know how it's going.

Maybe the formula is causing the bloating, that's very possible. I am eating solids 50% of the time. I just had my trypsin serum, fecal elastase, hepatic function and CBC w/Diff done last Tues. I haven't received results as the trypsin test was a send out and is still pending. I would really hope my GI clinic would call if any of the other tests were abnormal. The receptionist at UF IBD clinic can't give me lab results but they are in, except the one. Are there other tests to get while on 6MP? I thought I read on here test for TGGN or some letters like that?

I don't have crohns so I don't think stricture. I have lymphocytic colitis and celiac. I avoid all gluten. I don't have awful pain they would indicate pancreatitis. The floating does drive me nuts because I want healthy stools. I wonder if it could be post infectious because it's happened since C.diff cleared in July w/abx and fecal transplant. I wondered if vanco would help them sink but my GI doesn't want to risk another C.diff bout from antibiotic use. I'm at a loss how to fix the floating. Thanks again for support!
12-10-2013, 07:57 PM   #6
Farmwife
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Hi,
I feel your worry, not because I have IBD but because my girl does.
She has a AMT1 button. It's comparable to your Mickey but has an even lower profile (bragging of course).
The crustiness is normal. If you think about it, they've punch a hole in a place that should have none. Some leakage is normal.
The color and smell is what you have to look for. If it stinks.....call the doc.
If the color changes....call the doc.
If swelling happens a few inches around your button...call the doc.

Also do you do continual feeds or bullous?
We took my DD for a second opinion at Mayo and she said that some people (not many) can NOT take continual feeds. They (Mayo) believe that's what was causing pancreas problems for Grace. We've switched her back to bullous and are waiting to see if it helps.

HUGS
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12-10-2013, 08:01 PM   #7
Farmwife
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Also if you look under my advatar you'll see a support groug for NG Tube. This group also includes G-Tubes.
12-10-2013, 10:01 PM   #8
iriechic
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Thanks Farmwife

Oh my, I do wish I had Grace's lower profile button! How nice!!!

I was primarily doing feeds at night. It was darn near impossible to do continuous feeds during the day as I take care of my 6 yr old (after Kindergarten) and my two year old. I do bollus feeds sometimes during the day if I don't know what to eat or don't have anything SCD prepared to eat.

I just ran to the bathroom with awful diarrhea. Sorry so gross. I just feel like giving up sometimes because I don't know how to fix this problem. I am so tired of being sick for so long. It's always something to worry about too, like is this C.diff again or diarrhea from my IBD?! It all spiraled out of control for me during my prgnancy with my youngest. I hurt and pray to get better.

Wishing Grace the best! My GI was sending my slides to Mayo in MN for pathology to review there. I guess I am a complicated case.
12-10-2013, 10:15 PM   #9
Farmwife
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Well then you and Grace should meet. lol
Is your stool green and does it have that Horrible smell of c diff that will haunt me forever (Grace had it too).
12-10-2013, 10:43 PM   #10
iriechic
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It's not green but hurt so bad just now and does smell horrible. I really need a break. Nobody should have to feel this way. :'(
12-11-2013, 12:24 AM   #11
iriechic
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Updated GI on situation and she has offered to Rx oral vanco. I'm thinking that could help but definitely don't want to do harm. Did Grace take that antibiotic w/C.Diff?
12-11-2013, 02:09 AM   #12
Jennifer
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Are there other tests to get while on 6MP? I thought I read on here test for TGGN or some letters like that?
That would be 6-thioguanine (6-TGN).
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