Differential Diagnosis for NGT Drain with Greenish Discharge

• Single Most Likely Diagnosis
  • Bilious aspiration or gastric contents: This is the most likely diagnosis because the greenish color of the discharge is indicative of bile, which is often associated with gastric secretions. The presence of bile in the NGT drain suggests that the tube is correctly placed in the stomach and is draining gastric contents, which can include bile that has entered the stomach from the duodenum.
• Other Likely Diagnoses
  • Infection or colonization of the NGT: Bacteria can colonize the NGT, potentially leading to infection. Certain bacteria can produce pigments that might cause a greenish discharge, although this is less common.
  • Partially digested food: If the patient has been fed through the NGT, partially digested food could cause a greenish appearance, especially if the food contained green vegetables or dyes.
• Do Not Miss Diagnoses
  • Pneumonia (aspiration pneumonia): While less likely to directly cause greenish discharge, aspiration of gastric contents into the lungs can lead to pneumonia. The greenish color might be seen if the patient has coughed up and then swallowed infected sputum, which is then drained through the NGT.
  • Intestinal obstruction or ileus: In cases where there is an obstruction or ileus, bile can accumulate and potentially be regurgitated into the stomach, leading to a greenish discharge through the NGT.
• Rare Diagnoses
  • Gastrointestinal bleeding: Although rare, if the bleeding is from the upper GI tract and involves a significant amount of bile, it could potentially cause a greenish tint to the discharge.
  • Certain medications or dyes: Some medications or dyes used in medical procedures can cause discoloration of bodily secretions, including a greenish hue, although this would be an uncommon cause of greenish discharge from an NGT.