Pleurisy and Pancreatitis from Surgery?

[GreywolfAV]

My 9 year old daughter had a G-tube placed a month ago by open surgery. After the surgery we noticed she was still having pain. We took her in for an Upper GI series and it turned out she had GERD, assumed to be from the G-Tube placement. The doctor put her on Previcid, and Reglan and told us to keep an eye on her. She went back later for a checkup and during an X-ray they saw a “shadow” on her lung. The “shadow” was quickly diagnosed as Pneumonia. It was decided that she had GERD with Aspiration and that had caused her Pneumonia. She was given Omnicef, Openex, and Orapred and again we were told to keep an eye on her. Two weeks after starting this treatment she still seemed to be having pain when she breathed. She was sent back to the hospital for low oxygen levels (85-90%). They performed a Bronchoscope. During the Bronchoscope they found some small amounts of clear fluid but nothing that suggested Aspiration they also found that she had Pleurisy. They performed an ultrasound guided procedure to drain the fluid from aound her lungs. They removed 350cc of fluid. The next morning the fluid came back worse than before. The doctor started an antibiotic, and ordered a CT scan. The CT scan has found she has Pancreatitis - Enlarged Pancreas. Could the Pancreatitis have come from the Steroid prescribed for the Pneumonia or the multiple scopes she has had recently? Is it possible that what they were actually seeing on the x-rays was the Pleurisy, not fluid IN the lung but AROUND it, and that she never had Pneumonia at all? It seems the decisions being made are making things worse

[National Jewish]

My first question about this young lady is what is her underlying medical issues requiring her to need a G-tube at this age.  Commonly with an evaluation for a G-tube, an upper GI is done prior to assess for reflux and possible aspiration risk.  It is not clear whether this young lady had reflux before the G-tube rather than after based on her upper GI series.  I am not clear that this was done.  Additionally, a pH probe may have helped the diagnosis of reflux prior to the G-tube placement.  Not knowing any underlying conditions warranting the need for the G-tube, I cannot provide additional information as to the cause of the etiology.  While the CT scan was suspicious for pancreatitis were blood tests such as amylase and lipase also performed.  These levels are commonly elevated if a clinical diagnosis of pancreatitis is confirmed.  It is unlikely that the steroids or the procedures were the cause of the pancreatitis.  Furthermore, without the actual radiographs, I cannot comment on the location of the fluid and the association with pneumonia.  I am also not clear that a CT scan of her chest was done to help identify the issues of the fluid.  This may be more helpful than the x-rays.  Finally, an acute aspiration event can cause a "shadow" on the lung and then clear unless a patient is chronically aspirating.  The bronchoscopy may miss an acute aspiration if it is done over 5 days after the initial aspiration event.

[myproblem]

What is the underlying problem that caused the need for the G-tube?

[GreywolfAV]

She is handicapped and has had eating problems.