ULCER FISTULA SINUS/BASIC KNWOLEDGE.ppt

ULCER FISTULA SINUS/BASIC KNWOLEDGE ABOUT TYPES/CAUSES ND MANAGEMENT

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ULCER SINUS FISTULAE
DR.MUJEEB REHMAN
MBBS,FCPS
SENIOR REGISTRAR SURGERY

2. ABNORAL COMNUCATION BTW
LUMEN OF ONE VISCUS AND LUEMN OF OTHER VISCUS
OR
ITS COMUNICATION BTW TWO DIFERENT EPITHELIAL SURFACE
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FISTULA

3. LATIN; WORD
FLUTE MEANING TUBE/ PIPE
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4. CAUSES
CONGINITAL
 BRANCHAIL FISTULAE
 TRECHEO ESOPHAGAL FISTULAE
 UMBLICAL FISTULAE
 CONGENITAL A.V FISTULAE
 THYROGLOSAL FISTULAE
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5. BRANCHAIL FISTULAE
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6. UMBLICAL FISTULAE
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7. AQUIRED CAUSE
TRUMATIC
INFLAMATERY
MALIGNANT
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8. AQUIRED..
1-Trraumatic
a-following surgery i.e. intestinal fistula (fecal,biliary,pancreatic)
b-following instrumental delivery or difficult labor i.e. vasicovaginal
fistula, rectovaginal fistula
2-Inflammatory
 Intestinal actinomycosis, TB abdomen
3-Malignancy
 When growth of one organ penetrates into nearby organ.
 e.g., rectovesical fistula in rectum Ca
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9. ENTEROCUTANEOUS FISTULA
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10. ACTINOMYCOSIS..
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11. PATHOPHYSIOLOGY
CONGENITAL
Arise from remnants of embryonic ducts that persist instead of being
obliterated and disappearing comp;etely during embryonic
development.
E.g. branchial fistula, congenital AVF
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12. AQUIRED
Usually secondary to presence of foreign body, necrotic tissue in
affected area or microbial infection or following inadequate drainage
of abcess.
E.g. perianal abcess when burst spontaneously, they may form
perianal fistula
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13. CLINICAL FEATURES OF FISTULA
USUALLY ASYMPTOMATIC BUT WHEN INFECTED CAN
CAUSE..
Pain
Discharge
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14. SINUS
BLIND TRACK LINED BY GRANULATION TISSUE LEADING
FROM EPITHELIAL SURFACE DOWN INTO THE TISSUES.
LATIN WORD: HOLLOW (OR) A BAY
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15. CAUSES OF SINUS
CONGENITAL
Preauricular sinus
AQUIRED
Pilonidal sinus
Actinomycosis
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16. PILONIDAL SINUS..
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17. ULCER
DEFINITION..
 Discontinuity or break in a bodily membrane that impades normal
function of affected organ.
 OR
 Breach in a normal epithelium.
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18. Examples
Genital ulcers
Pressure ulcers (bed sores)
Diabetic foot ulcers
Perianal ulcers
Peptic ulcers
Mouth ulcers
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19. MOUTH / GENITAL ULCERS
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20. PERIANAL ULCERS..
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21. Partially heal leg ulcer..
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22. Clinical Examination
Ulcer,Sinus & Fistula..
Inspection
Location
Number
Color
Openings
Surface
Discharge
Edges
Overlying skin
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23. Palpation
Temprature
Tenderness
Consistency
Discharge
Induration
Fixity
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24. Investigations
CBC (Hb,TLC,ESR)
DISCHARGE for D/R , C/S , AFB , CYTOLOGY
Fistulogram
MRI
BIOPSY
CT SINUSOGRAM
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25. xRAY FISTULOGRAM
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26. TREATMENT
BASIC PRINCIPLES
Antibiotics
Adequate rest
Adequate excision and send Biopsy for HISTOPATHOLOGY
Adequate drainage
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27. SPECIFIC TREATMENT
It depends on specific cause.
So the principle is to treat the cause after confirming the diagnosis
through biopsy report.
Examples..
TB sinus, 1
st
line treatment will be ATT.
If there’s Fistula, then treatment option will be Fistulectomy/Fistulatomy.
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28. THANK YOU !! 
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