Gastro Intestinal Fistula

Gastro Intestinal Fistula

Definition

A fistula is tract connecting two epithelial surfaces one of which is a hollow organ.

Classifiaction of Fistulae

Internal Fistula:-

A fistula connecting any two digestive organs.

External Fistula:-

A fistula connecting  a digestive organ and skin.

Uncontrolled fistula:-

A fistula which contaminates the general peritoneal cavity is called  uncontrolled fistula.

Controlled fistula

If the effluent of a fistula is drained out using a Foley’s catheter, without contaminating the general peritoneal cavity, it is called  controlled fistula.

Based on the out put fistulae can be

Low output Fistula :– If the output is less than 200 ml/24 Hours

Moderate output Fistula:– If the output is between 200-500ml/24 Hours

High output Fistula:– If the output is more than 500ml/24 Hours

Causes of Gastro Intestinal Fistula

• Congenital
• Traumatic
• Inflammatory-Cohn’s Disease
• Neoplastic-Carcinoma colon
• Post operative-Post appendicectomy /Intestinal Anastomosis.

Complications of GI Fistula

• Sepsis
• Fluid and Electrolyte Imbalance
• Malnutrition
• Effluent Dermatitis-resulting in skin excoriations, ulcerations and infections.

Principles of Management of GI Fistula:-

• Correction of Fluid and Electrolyte Imbalance.
• Nil Per Oral and Bowel rest.
• Total Parenteral Nutrition.
• Conversion of an uncontrolled fistula into a controlled fistula.

Prevention of Effluent Dermatitis:-

By painting the skin with Zinc oxide paste.

MCQ

The commonest electrolyte abnormality associated with a GI Fistula is Hypokalemia.