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24 Cards in this Set
- Front
- Back
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What is a fistula? |
Abnormal communication between two hollow organs or a hollow organ and the skin (ie, two epithelial cell layers) |
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What are the predisposing factors and conditions that maintain patency of a fistula? |
The acronym "HIS FRIEND": - High output fistula (>500 cc/day) - Intestinal destruction (>50% of circumference) - Short segment fistula (<2.5 cm)
- Foreign body (eg, G tube) - Radiation - Infection - Epithelialization (eg, colostomy) - Neoplasm - Distal obstruction |
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What is a enterocutaneous fistula? |
Fistula from GI tract to skin (enter-cutaneous = bowel to skin) |
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What are the causes of enterocutaneous fistula? |
- Anastomotic leak - Trauma / injury to the bowel / colon - Crohn's disease - Abscess - Diverticulities - Inflammation / infection - Inadvertant suture through bowel |
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What is the workup for entercutaneous fistula? |
1. CT scan to rule out abscess / inflammatory process 2. Fistulagram |
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What are the possible complciations of enterocutaneous fistula? |
- High-output fistulas - Malnutrition - Skin breakdown |
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What is the treatment for an enterocutaneous fistula? |
- 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 |
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Which enterocutaneous fistula closes faster: short or long? |
Long fistula (may be counterintuitive, but true) |
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What are the types of colonic fistulas? |
Includes: - Colovesical - Colocutaneous - Colovaginal - Coloenteric |
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What are the most common causes of colonic fistulas? |
- Diverticulitis (most common) - Cancer - IBD - Foreign body - Irradiation |
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What is the most common type of colonic fistula? Symptoms? |
Colovesical fistula, which often presents with recurrent UTIs
Other signs include pneumaturia, dysuria, and fecaluria |
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How do you diagnose colonic fistulas? |
Via BE and cystoscopy |
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What is the treatment of colonic fistulas? |
- Surgery - Segmental colon resection and primary anastomosis - Repair / resection of the involved organ |
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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) |
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What are the common causes of a gastrocolic fistula? |
- Penetrating ulcers - Gastric or colonic cancer - Crohn's disease |
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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 |
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What is a pancreatic enteric fistula? |
Decompression of a pseudocyst or abscess into an adjacent organ (a rare complication); usually done surgically or endoscopically to treat a pancreatic pseudocyst |
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What is an external pancreatic fistula? |
Pancreatico-cutaneous fistula; drainage of pancreatic exocrine secretions through to abdominal skin (usually through drain tract / wound) |
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What is the treatment of an external pancreatic fistula? |
- NPO - TPN - Skin protection - Octreotide |
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What is a "refractory" pancreatic fistula? |
Pancreatico-cutaneous fistula that does not resolve with conservative medical management (the minority of cases) |
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What is the diagnostic test for "refractory" pancreatic fistulas? |
ERCP to define site of fistula tract (ie, tail vs head of pancreas) |
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How is refractory tail of a pancreas fistula treated? |
Resection of the tail of the pancreas and the fistula |
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How is refractory head of a pancreas fistula treated? |
Pancreatico-jejunostomy |
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What are the specific types of bladder fistulas? |
- Vesicoenteric (50% d/t sigmoid diverticulitis); signs include pneumaturia, fecaluria - Vesicovaginal (most are secondary to gynecologic procedures); signs include urinary leak through vagina |
