Role of CM in Determining a Cutaneous Opening Having a Blind Tract
The following notes are taken from one of the lectures during the 3rd midyear convention at Palawan last June 23-25, 2008. Although I was not able to attend, I was able to secure a copy from my colleague, Jerry Cabinan (Thanks, friend!)
This lecture was originally done through a power point presentation. If you like to have the original form of this lecture, kindly leave your e-mail address in the comment section and I?ll gladly provide you.
The Role of CM in Determining a Cutaneous Opening Having a Blind Tract
DEXTER R. RODELAS,RRT
DEXTER R. RODELAS,RRT
Fistula
Is an abnormal tunnel connecting two body cavities (such as the rectum and the vagina) or a body cavity to the skin (like the rectum to the outside of the body).* One way a fistula may form is from an abscess -- a pocket of pus in the body.
* The abscess may be constantly filling with body fluids such as stool or urine, which prevents healing.
* Eventually the fistula breaks through to the skin, another body cavity, or an organ.
A fistula can develop between:
* One of the tubes (ureter) leading from the kidney to the bladder and the vagina. The medical term is a ureterovaginal fistula
* A ureter and the bowel (uretero-colic fistula)
* The bladder and the vagina (vesicovaginal fistula)
* The bowel and the vagina (rectovaginal fistula)
* The bowel and the bladder (enterovesical fistula).
Types of Fistulas
1. Enterocutaneous:
* This type of fistula is from the intestine to the skin.
* An enterocutaneous fistula may be a complication of surgery.
* It can be described as a passageway that progresses from the intestine to the surgery site and then to the skin.
2. Enteroenteric or Enterocolic: This is a fistula that involves the large or small intestine.
3. Enterovaginal: This is a fistula that goes to the vagina.
4. Enterovesicular: This type of fistula goes to the bladder. These fistulas may result in frequent urinary tract infections, or the passage of gas from the urethra during urination.
Symptoms
* Symptoms of fistulas can include pain, fever, tenderness, itching, and generally feeling poorly.
* The fistula may also drain pus or a foul-smelling discharge.
* These symptoms vary based on the severity and location of the fistula.
Diagnosis
* Fistulas, depending on their location, can be diagnosed by some of the diagnostic tests often used in Barium enema, colonoscopy, sigmoidoscopy, or an upper endoscopy may be used.
Sinography
* The catheterization and contrast examination of a cutaneous opening having a blind tract.
Fistulography
* If there is communication to another
Procedure/Technique
* In this test, dye is injected into the fistula, and X-rays are taken.
* The dye helps the fistula to show up better on the X-rays.
* The dye is inserted into the rectum, similar to an enema, for fistulas that are in the rectum.
* The dye must be 'held' inside during the procedure.
* With a fistula that is to the outside of the body, the dye is put into the opening with a small tube.
* X-rays will be taken from several different angles, so a patient may have to change positions on the X-ray table.
* As with any other kind of X-ray, remaining still is important.
Complications
* A fistula may form an abscess when it closes, or if it becomes infected.
* An abscess is an infection inside a cavity in the body
Purpose
1. To delineate the tract.2. To show the presence of abscess cavity
3. To demonstrate the communication with the bowel, bladder or any other viscus , if any.
Treatment
* Treatments for fistulas vary depending on their location and severity of symptoms.
* Medicinal treatments include Flagyl (an antibiotic)
* An enteral diet may be prescribed for enterovaginal, enterocutaneous, and enterovesicular fistulas.
* An enteral diet is liquid nutrition that is taken by mouth or given through a feeding tube. These liquid nutrition formulas replace solid food and contain vital nutrients.
* With no solid food there is less stool passing through the anus, which helps the fistula heal and maybe even close.
* Fistulas that don't respond to any of the above therapies may require surgery.
* If the fistula is in a healthy part of the intestine, it may be removed without taking out any part of the intestine.
* If the fistula is in a very diseased part of the bowel, a resection may have to be performed.
* A resection may result in a temporary ileostomy.
* Stool is diverted through the ileostomy, giving the part of the intestine with the fistula time to heal.
* This type of surgery is most often done on rectovaginal or enterovesicular fistulas.
Prognosis
* The location and severity of the fistula play a major role in determining treatment.
* With proper care, a fistula can be treated and healed and should not re-occur.
 |
0 comments:
Post a Comment