Small Intestine Part 2 fistula

Question 1

• The communication occurs between two parts of the GIT or adjacent organs in
• Ex. enterocolonic fistula or colovesicular fistula

Answer 1

INTERNAL FISTULA:

Question 2

• Involves the skin or another external surface epithelium.

* Ex: enterocutaneous fistula

Answer 2

EXTERNAL FISTULA:

Question 3

• :

* Those that drain less than 200 mL of fluid per day

Answer 3

LOW OUTPUT FISTULAS

Distal

Question 4

• :

* Those that drain more than 500 mL of fluid per day

Answer 4

HIGH OUTPUT FISTULAS

Proximal

Question 5

• More than 80% of enterocutaneous fistulas represent ___________ complications
• Occur as the result of enterotomies or intestinal anastomotic dehiscences.

Answer 5

IATROGENIC

Question 6

•Fistulas that arise __________ without antecedent iatrogenic injury are usually manifestations of progression of underlying Crohn’s disease or cancer.

Answer 6

SPONTANEOUSLY

Question 7

Enteroenteric fistulas, which allow luminal contents to bypass a significant proportion of the small intestine, may result in clinically significant malabsorption.

Answer 7

Malabsorption

Question 8

often cause recurrent urinary tract infections.

Answer 8

Enterovesicular fistulas

Question 9

3.

•Drainage emanating from enterocutaneous fistulas are irritating to the skin and cause excoriation.

Answer 9

SKIN EXCORIATION

Question 10

4. •The loss of enteric luminal contents, particularly from high-output fistulas originating from the proximal small intestine, results in dehydration, electrolyte abnormalities, and malnutrition.

Answer 10

DEHYDRATION, ELECTROLYTE ABNORMALITIES, MALNUTRITION

Question 11

•Iatrogenic enterocutaneous fistulas usually become clinically evident between the ____________ postoperative days.

Answer 11

fifth and tenth

Question 12

•Initial signs of iatrogenic entercutaneous fistula

Answer 12

Fever
•Leukocytosis
•Prolonged ileus
•Abdominal tenderness
•Wound infection

Question 13

• 1) is the most useful initial test.
• Leakage of contrast material from the intestinal lumen can be observed.
• Intra-abdominal abscesses should be sought and drained percutaneously.

Answer 13

CT SCANNING following the administration of enteral contrast

Question 14

• 2)
• Can be done if the anatomy of the fistula is not clear on CT scanning.
• Can demonstrate the fistula’s site of origin in the bowel.
• This study also is useful to rule out the presence of intestinal obstruction distal to the site of origin.

Answer 14

SMALL BOWEL SERIES or ENTEROCLYSIS

Question 15

•Can be used occasionally if contrast administered into the intestine does not demonstrate the fistula tract.
, in which contrast is injected under pressure through a catheter placed percutaneously into the fistula tract, may offer greater sensitivity in localizing the fistula origin.

Answer 15

•3) FISTULOGRAM

Question 16

Therapy

• Fluid and electrolyte resuscitation is begun.
• Nutrition is provided, usually through the parenteral route initially.
• Sepsis is controlled with antibiotics and drainage of abscesses.
• The skin is protected from the fistula effluent with ostomy appliances or fistula drains.

Answer 16

Stabilization

Question 17

Therapy

The anatomy of the fistula is defined using the studies described above in the Diagnosis section.

Answer 17

Investigation

Question 18

Therapy

The available TREATMENT OPTIONS are considered, and a timeline for conservative measures determined.

Answer 18

Decision

Question 19

Therapy

This entails the surgical procedure, and requires appropriate preoperative planning and surgical experience.

Answer 19

Definitive management

Question 20

Therapy

•The overall objectives are to increase the probability of

Answer 20

SPONTANEOUS CLOSURE.

Question 21

•Most patients will require TPN; however, a trial of oral or enteral nutrition should be attempted in patients with

Answer 21

low-output fistulas originating from the distal intestine.

Question 22

Therapy

• A useful adjunct esp. in patients with high-output fistulas
• It reduces the volume of fistula output, thereby facilitating fluid and electrolyte management.
• May accelerate the rate at which fistulas close
• However, it has not clearly been demonstrated to increase the probability of spontaneous closure.

Answer 22

Somatostatin analogue

Question 23

• This approach is based on evidence that:
• 90% of fistulas that are going to close, close within a 5-week interval
• and also surgical interventions after this time period are associated with better outcomes and lower morbidity

Answer 23

Conservative treatment for 2-3 months

Question 24

•If the fistula fails to resolve during this period, surgery may be required during which the fistula tract, together with the segment of intestine from which it originates, should be resected.

Answer 24

Conservative treatment for 2-3 months

Question 25

•A useful mnemonic designates factors that INHIBIT spontaneous closure of intestinal fistulas: “FRIEND” :

Answer 25

Foreign body within the fistula tract
•Radiation enteritis
•Infection/Inflammation at the fistula origin,
•Epithelialization of the fistula tract
•Neoplasm at the fistula origin
•Distal obstruction of the intestine

Question 26

• :

* An abnormal communication between two epithelialized surfaces.

Answer 26

FISTULA