Fìstulas Flashcards
Qué es una fístula?
Es una conexión anormal entre dos órganos huecos o un órgano hueco y la piel
Cuales son los factores predisponentes y condicionantes de una fístula
El acrónimo “HIS FRIEND”:
High output fIstula (>500 cc/day) Intestinal destruction (>50% of circumference) Short segment fistula <2.5 cm Foreign body (e.g., G-tube) Radiation Infection Epithelization (e.g., colostomy) Neoplasm Distal obstruction
Que es una fístula enterocutanea?
Fístula del tracto gastrointestinal a la piel (entero-cutanea)
What are the causes of enterocutaneous fistulas?
Anastomotic leak, trauma/injury to the bowel/colon, Crohn’s disease, abscess, diverticulitis, infammation/infection, inadvertent suture through bowel
What is the workup of enterocutaneous fistulas?
- CT scan to rule out abscess/ inflammatory process
2. Fistulagram
What are the possible complications of enterocutaneous fistulas?
High-output f stulas, malnutrition, skin breakdown
What is the treatment of enterocutaneous fistulas?
NPO;  TPN; drain abscesses, rule out and correct underlying causes; may feed distally (or if fistula is distal, feed elemental diet proximally);half will close spontaneously, but the other half require operation and resection of the involved bowel segment
Which enterocutaneous  fistula closes faster: short or long?
Long fistula (may be counterintuitive—but true)
Que son las fístulas colonicas
Include colovesical, colocutaneous, colovaginal, and coloenteric fistulas
What are the most common causes of colonic fistulas?
Diverticulitis (most common cause), cancer, IBD, foreign body, and irradiation
What is the most common type of colonic fistulas?
Colovesical  fistula, which often presents with recurrent urinary tract infections; other signs include pneumaturia, dysuria, and fecaluria
How is the diagnosis made of colonic fistulas?
Via BE and cystoscopy
What is the treatment of colonic fistulas?
Surgery: segmental colon resection and primary anastomosis; repair/resection of the involved organ
What is a cholecystenteric fistula?
Connection between gallbladder and duodenum or other loop of small bowel due to large gallstone erosion,often resulting in SBO as the gallstone lodges in the ileocecal valve (gallstone ileus)
What are the common causes of a gastrocolic  fistula?
Penetrating ulcers, gastric or colonic cancer, and Crohn’s disease
What are the possible complications of gastrocolic
fistulas?
Malnutrition and severe enteritis due to reflux of colonic contents into the stomach and small bowel with subsequent bacterial overgrowth
What are the specific types of bladder fistula
Vesicoenteric (50% due to sigmoid diverticulitis); signs include pneumaturia, fecaluria
Vesicovaginal (most are secondary to gynecologic procedures); signs include urinary leak through vagina
Cuales son las fases de Chapman y Sheldon para el manejo médico y quirúrgico de los pacientes con fístulas enterocutáneas
Primera fase: (0-12 horas)
— Corregir déficit hidroelectrolítico
— Comenzar a controlar la sepsis al drenar quirúrgicamente abscesos accesibles y cobertura antibiótica
— Control de la fístula, proteger la piel y comenzar a cuantificar pérdidas de volumen y electrolíticas de la fístula
Segunda fase: (0-48 horas)
— Continuar con la corrección del equilibrio hidroelectrolítico
— Reponer los gastos hidroelectrolíticos de la fístula
— Comenzar el programa nutricional intravenoso
Tercera fase: (1-5 días)
- Intentar vía enteral de alimentación de ser posible (a través de sonda nasoyeyunal, sonda nasogástrica,
yeyunostomía, etc)
- Realizar estudios de imagen para delinear la fístula: fistulografía, colon por enema, serie esófago-gastro-duodenal, etc.
Cuarta fase: (después de 5 días)
- Mantener el aporte nutricional adecuado
- Cirugía para controlar la sepsis
- Cirugía en caso de que la fístula no cierre
