Wad medani teaching hospitalPr: AHMED ALAMIN UNIT   By Dr:Adam Mohammed
Definition:it is an abnormalcommunication between two epithelialsurfaces .Congenital or acquired                          ...
PathophysiologyDepends on the involved structres   High out put fistula =malabsortionDehydrationElectrolytes abnormalities...
Causes:   Emergency surgery         Infections   Inflammatory bowel disease   Malignant diseases CAcolon   Intestinal anas...
Classification:  Amount of discharge;high out put;>1 L/day  Low out put;<1L/day  Anatomical ;simple , complex  Nature of d...
Clinical pictureIatrogenic fistula initial signs    fever    leukocytosis    prolonged ileus    abd tenderness    wound in...
Investigations:  Small bowel enema  Barium enema  Fistulogram  CTscan abdomen
Management: according to the type Low out put;spontaneous closure ranging from 4-6-8WK With TPN High out put;skin protecti...
Factors that prevent spontaneous closure Epithelialization             epithelialization Nature of the disease            ...
prognosisDepends on general condition of pt              the cause of fistula              the severity of fistula      mo...
Fistula
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Fistula

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Fistula

  1. 1. Wad medani teaching hospitalPr: AHMED ALAMIN UNIT By Dr:Adam Mohammed
  2. 2. Definition:it is an abnormalcommunication between two epithelialsurfaces .Congenital or acquired Entero-enteral fitulaEnterocutaniousF:an abnormal tractcommunicating viscous with the skinsurface
  3. 3. PathophysiologyDepends on the involved structres High out put fistula =malabsortionDehydrationElectrolytes abnormalitiesExcoriation of the skinEnterovesical fistula = recurrent UTI
  4. 4. Causes: Emergency surgery Infections Inflammatory bowel disease Malignant diseases CAcolon Intestinal anastomosis Radiation enteritis Trauma penetrating wounds 80 of entrocutaneous fistulas are IATROGENIC
  5. 5. Classification: Amount of discharge;high out put;>1 L/day Low out put;<1L/day Anatomical ;simple , complex Nature of discharge:bile stained severe skin excoriation Ileum or caecum; fluid faecal matter Pancreatic;enzymes rich Distal column solid or semisolid faeces
  6. 6. Clinical pictureIatrogenic fistula initial signs fever leukocytosis prolonged ileus abd tenderness wound infections drainge of entric material fromwound or drains
  7. 7. Investigations: Small bowel enema Barium enema Fistulogram CTscan abdomen
  8. 8. Management: according to the type Low out put;spontaneous closure ranging from 4-6-8WK With TPN High out put;skin protection ,rehydration,electrolytes balance,defunctioning stoma,drugs(somatostatine), operative repair
  9. 9. Factors that prevent spontaneous closure Epithelialization epithelialization Nature of the disease FRIEND Foreign body or necrotic tissue Distal obstruction Dense fibrosis Ischaemia Drugs Malnutrition Irradiation High out put,high pressure,inefficient drainage
  10. 10. prognosisDepends on general condition of pt the cause of fistula the severity of fistula mortality rate 10-15 due to sepsis –underline disease 50 close spontaneously more than 50 morbidity rate ifsurgery for fistula done including 10recurrence rate

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