Fistulas

Question 1

What are fistulas?

Answer 1

Fistulas are abnormal connections/passageways that form between 2 structures that do not typically connect

Question 2

What are Fistulas involving airways are referred to?

Answer 2

• Tracheoesophageal fistula (TEF) if involving the trachea and esophagus
• Bronchopleural fistulas (BPF) if involving th bronchial tree and pleural space

Question 3

How do Tracheoesophageal Fistula (TEF) affect the airways?

Answer 3

Bc TEFs have a abnormal connection between the trachea and esophagus there is risk of:

• Aspiration into the airway (leading to choking/recurrent pneumonia)
• Airway obstruction due to swelling or inflammation
• Persistent infection or poor oxygenation

Question 4

When do Tracheoesophageal Fistula (TEF) occur?

Answer 4

Acquired from trauma, surgery, or malignancy. Otherwise, the only natural way would be congenitally.

Question 5

What is a Empyema?

Answer 5

An infection within the lung that can’t be coughed out.

• located in the pleural space
• needs to be drained by needle/surgery

Question 6

What are the effects on the airway from a Bronchopleural Fistula (BPF)?

Answer 6

Bronchial tree and pleural connection leave risk of air leaks from the lung into the pleural space leading to:

• pneumothorax risk
• Impaired ventilation and gas exchange due to air loss
• Increased WOB and reduced oxygenation
• Risk of infection in the pleural space (empyema)

Question 7

Management of Fistulas?

Answer 7

Often require surgical repair or international procedures (stents/sealents). Otherwise, supportive care:

• Maintain adequate ventilation
• Preventing/managing infections
• nutritional support to reduce aspiration risk (in TEF case)