Case Study Gastro-Intestinal Fistula Nutritional Support
Journal Title: Biomedical Journal of Scientific & Technical Research (BJSTR) - Year 2018, Vol 5, Issue 4
Abstract
“When a fistula is developed the tendency is first not to do anything and see how serious it will get; and therefore, at the time the catastrophe’s total impact strikes, the patient is already septic, nutritionally depleted and presenting an extensive cutaneous destruction” Chapman [1]. Nutritional management is one of the most important factors when successfully treating gastro-intestinal fistulas Ellis H [2]. In 21 years of experience at the Caracas University Hospital’s (HUC) Nutritional Support Unit (NSU) Belloso R, Baptista GA [3]. It has been possible to confirm that employing exclusively nutritional support, there are more possibilities of fistulas closure that if employing combinations of nutritional support and surgery; or to the contrary, only surgery - of those fistulas that are not of surgical closing -, this being also proven by other authors [3]. As to the kind of nutritional support, in each of the above cited treatment modalities, Total Parenteral Nutrition (TPN) prevails upon Enteral (E) and mixed Nutrition (N) as nutritional therapeutic measure to achieve the closing of fistulas Fukuchi S et al. [4]. The use of this TPN nutritional support measure is more relevant in high grade fistulas difficult to access via catheter, as well as when fistulas are placed in the small Intestine complicated with dysfunctional gastro-intestinal tract Rombeau J Caldwell [5]. It is also important to notice that the Mortality Rate has significantly diminished from 40 – 65% down to 5 – 20%, knowing that the majority of deaths are associated to malnutrition and sepsis Tulsyan et al. [6]. a) Reanimation and skin protection; b) Instituting nutritional handling; c) Evaluation and treatment, and d) Sheldon’s Therapeutic Plan. And as for pharmacology managing, the use of somatostatine and analogues-octreotide-has been proposed in order to diminish fistulas output Alvarez et al. [8]. It is known that combining somatostatine therapy with TPN, allows 77% of fistulas closure within a 5 to 8 days time period Nubiola [9], facilitating high output fistulas’ management. Somatostatine must be suspended if in 48 hours there is no decrease in the fistula output, or if in the next two or three weeks of treatment, there is no response. Normally, treatment with somatostatine analogues is well tolerated by the patient; however, some authors describe some complications from employing analogues such as nausea, cramps, and diarrheas as secondary effects, mainly at the start of treatment or upon dose increase. Biliary lithiasys has also been described during lengthy treatments as a result of the gallbladder’s decrease motility [9].
Authors and Affiliations
Gertrudis Adrianza de Baptista
Keywords
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- EP ID EP585567
- DOI 10.26717/BJSTR.2018.05.001241
- Views 129
- Downloads 0
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