Gastrointestinal fistula

Gastrointestinal fistulas if enteral nutrition cannot be provided above or below the fistula... 

Two other somatostatin analogs, lanreotide and vapreotide, have been studied. Lanreotide is indicated for patients with carcinoid tumors in a dose of 30 mg intramuscularly (as a depot) every 14 days. If necessary the dose can be increased to 30 mg intramuscular every 7 to 10 days. Vapreotide is an orphan drug that is indicated for pancreatic and gastrointestinal fistulas. 

Octreotide (Sandostatin) injection is commercially available in the United States for subcutaneous or intravenous administration. A long-acting intramuscular formulation of octreotide (Sandostatin EAR) is also available for monthly administration. In addition to the treatment of acromegaly, octreotide has many other therapeutic uses, including the treatment of carcinoid tumors, vasoactive intestinal peptide tumors (VIPomas), gastrointestinal fistulas, variceal bleeding, diarrheal states, and irritable bowel syndrome. 

Bevacizumab (Avastin) VEGF 2004 Not conducted ECG in monkey— no effect 6-month monkey Bone plate changes Non-gastrointestinal fistula formation, arterial thnunboembolic events (e.g., myocardial infarction, cerebral infarction), hypertension, revtasible posterior leukoencephalopathy syndnune (RPLS), proteinuria, infusion reactions... 

Gastrointestinal Patients may be at increased risk of fistulae when treated with bevacizumab [188, 200 ]. In clinical trials, gastrointestinal fistulae have been reported with an incidence of up to 2% in patients with metastatic colorectal cancer, but were also reported less commonly in patients with other types of cancers. 

Gastrointestinal losses (e.g., diarrhea, fistula, ileostomy, uretero sigmoido stomy)... 

Trace elements are essential cofactors for numerous biochemical processes. Trace elements that are added routinely to PN include zinc, selenium, copper, manganese, and chromium. There are various commercial parenteral trace element formulations that can be added to PN admixtures (e.g., MTE-5 ). Zinc is important for wound healing, and patients with high-output fistulas, diarrhea, burns, and large open wounds may require additional zinc supplementation. Patients may lose as much as 12 to 17 mg zinc per liter of gastrointestinal (GI) output (e.g., from diarrhea or enterocutaneous fistula losses) however, others have demonstrated that 12 mg/day may be adequate to maintain these patients in positive zinc balance.18 Patients with chronic diarrhea, malabsorption, and short-gut syndrome may have increased selenium losses and may require additional selenium supplementation. Patients with severe cholestasis should have copper and manganese... 

Severe hemodynamic instability Enterocutaneous fistulae Severe diarrhea Severe malabsorption Severe gastrointestinal hemorrhage Intractable vomiting... 

Intestinal clearance is henceforth defined as the ability of the small bowel to clear its lumen of bacteria. The known conditions of major clinical importance for intact intestinal clearance are (1) normal gastrointestinal anatomy, including the absence of intestinal diverticula and fistula, and (2) normal intestinal motility. 

Because it inhibits pancreatic secretion, octreotide may be of value in patients with pancreatic fistula. The role of octreotide in the treatment of pituitary tumors (eg, acromegaly) is discussed in Chapter 37. Octreotide is sometimes used in gastrointestinal bleeding (see below). 

A patient who received regional intrahepatic chemotherapy from a continuous infusion pump for 31 months developed a gastroduodenal artery-duodenal fistula, and presented with signs and symptoms of upper gastrointestinal bleeding. 

Thiry-Vella fistulas (19), prepared at various levels of the gastrointestinal tract, have been used in the conscious dog for determining motility by (l)placing an indigestible bolus in the oral end of the fistula and determining the traverse time before and after treatment with drugs (2) placing a balloon... 

Gastrointestinal fluid loss Severe diarrhea Pancreatitis Intestinal fistula Renal tubular acidoses (RTA) Proximal (type II) RTA Distal (type I) RTA Type IV RTA... 

Gastrointestinal water losses also can result in dehydration. We secrete approximately 8 to 10 L fluid per day into our intestinal lumen. Normally, more than 90% of this fluid is reabsorbed in the intestines. The percentage reabsorbed can be decreased by vomiting, diarrhea, tube drainage of gastric contents, or loss of water into tissues around the gut via bowel fistulas. 

Crohn s disease is a chronic inflammatory condition that may occur in any part of the gastrointestinal tract but commonly involves the terminal ileum or right colon frame. Gynecologic involvement with inflammation of the organs of the true pelvis or of the vulva is not uncommon. Another manifestation are fistulas between the vagina and the colon or rectum [5]. MRI is the method of choice for the diagnostic evaluation of pelvic fistulas. 

In clinical chemistry, the variations of the Na concentration level in the extracellular fluid are interpreted as follows [3] (1) The level of Na" is elevated in dehydration (water deficit), central nervous system trauma or disease, and hyperadrenocorticism with hyperaldosteronism or corticosterone of corticosteroid excess. (2) A decrement of the Na level is observed in adrenal insufficiency, in renal insufficiency (especially with inadequate Na intake), in renal tubular acidosis as a physiological response to trauma and bums (Na shifts into cells), in unusual losses via the gastrointestinal tract as in acute or chronic diarrhea or intestinal obstruction or fistula, and in unusual sweating with inadequate sodium replacement. In some patients with edema associated with cardiac or renal disease, seram Na concentration is low, even though total body sodium content is greater than normal water retention (excess antidiuretic hormone, ADH) and abnormal distribution of sodium between intracellular and extracellular fluid contribute to this paradoxical situation. Hyperglycemia occasionally results in a shift of intracellular water to the extracellular... 

Infected (mycotic) aneurysms can be identified by its lobulated contour, soft tissue infiltration, and periaortic abscesses or trapped air (Rakita et al. 2007). Primary aorto-enteric fistulas as a complication of an AAA are rare and can be identified by extraluminal periaortic trapped air or by the extravasation of the contrast agent into the gastrointestinal tract. 

Sfakianos GP, Numnum TM, Halverson CB, Panjeti D, Kendrick IV JE, Straughn Jr. JM. The risk of gastrointestinal perforation and/or fistula in patients with recurrent ovarian cancer receiving bevacizumab compared to standard chemotherapy a retrospective cohort study. Gynecol Oncol 2009 114 (3) 424-6. 

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