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
