Manejo nutricional en una paciente con fístula enterocutánea de alto débito y desnutrición severa / Nutitional management in a patient with high output enterocutaneus fistula and severe malnutricion

Paciente de sexo femenino de 37 años de edad. Hace 2 arios fue sometida a una colecistectomía por presentar cálculos vesiculares. Hace aproximadamente 3 meses ingresa par emergencia al Hospital de Ventanilla con dolor abdominal y seguidamente es trasladada a Emergencia al Hospital Nacional Daniel Alcides Carrión. Inmediatamente después, la paciente fue evaluada por personal del servicio de Cirugía concluyen en un diagnostico pre-operatorio de sepsis, colangitis por ictericia obstructiva. Después de la intervención la paciente se descompensa par 10 que es llevada a UCI, donde se mantuvo durante 3 días, finalmente el servicio de Cirugía reevalúa a la paciente proponiendo que pase a su servicio; entonces deciden enviar interconsulta con el Departamento de Nutrición para evaluar a la paciente.

Female patient, 37 years of age. 2 years ago was operated vesciculares present stone problems, so who underwent cholecystectomy. About 3 months ago for emergency type Ventanilla Hospital with abdominal pain but is then transferred to the National Hospital Emergency Daniel Alcides Carrion. It is then evaluated by the surgical service with Ox. Preoperative sepsis, cholangitis by obstructive jaundice after surgery the patient is out of kilter and it is taken to UCI, where he remained for three days, finally revalued Surgery service to the patient to pass proposing that service, then decide send interconsultation with the Nutrition Department to evaluate the patient.

The use of Monogen in the conservative management of chylous fistula.

BACKGROUND: Chylous fistula is an uncommon complication of lower neck dissection. If untreated, it can lead to severe electrolyte disturbance, fluid, and protein loss and ultimately threaten skin flaps and vital structures. Conservative management aims to decrease chyle volume by replacing long-chain triglycerides (LCTs) with medium-chain triglycerides in the diet or by total parenteral nutrition. METHODS: In 2001, Greenlane Head and Neck unit conducted a prospective 2-year study of all patients with chylous fistula. RESULTS: Eleven patients developed chylous fistula in the period between 2001 and 2003, out of 210 neck dissections. All cases were managed conservatively. The mean time to diagnosis was 1.5 days (1-4), time to closure was 8.1 days (4-26), and mean duration of treatment was 11.5 days (4-35). CONCLUSION: We would recommend conservative management of chylous fistulae with a low LCT diet using Monogen alone to be continued only for the duration of the fistula.

The nursing care of a patient with enterocutaneous faecal fistulae.

This article discusses the nursing care given to a patient with a large abdominal, enterocutaneous faecal fistula. It highlights classification, signs, symptoms and some causal factors related to fistulas. Fistulas are rare and there is minimal evidence-based knowledge on the subject. However, incorporating knowledge from other specialties, such as tissue viability, can assist in caring for this client group. Diagrams illustrate the extent of the problems and assist with understanding the appliance techniques. There are many problems that may be encountered in the care of fistulas that are not encountered with planned stomas. Difficulties may include containment of the faecal matter within a wound, problems associated with skin care, leakage and dietary issues. The author's methods of confronting and coping with these problems in this case study are discussed, with the aim of assisting other nurses in similar situations.