mucus fistula and surgical fever q's

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Myempire1

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I'm on surg now but cannot spare any more time on searching on pubmed for the questions below... can anyone steer me in the correct direction on these?

1. Why does a mucus fistula reduced the likely of diversion colitis when compared to a Hartman's pouch? It's not like your are washing anything through it or anything like that... I just cannot figure it out.

2. What studies or rational set the cutoff for a surgical fever at 101.5 F? I know that it's less of OBGYN.... I am sure this is an old old study. I just cannot find it.

Thanks!

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I'm on surg now but cannot spare any more time on searching on pubmed for the questions below... can anyone steer me in the correct direction on these?

1. Why does a mucus fistula reduced the likely of diversion colitis when compared to a Hartman's pouch? It's not like your are washing anything through it or anything like that... I just cannot figure it out.

2. What studies or rational set the cutoff for a surgical fever at 101.5 F? I know that it's less of OBGYN.... I am sure this is an old old study. I just cannot find it.

Thanks!

Whoa, yikes! I had a tough time understanding your questions here...so I'm going to assume you're asking:

(1) Why does a mucous fistula have a reduced incidence of diversion colitis compared to a Hartmann's pouch?

(2) Why is a fever defined as 101.5 (sic) degrees Farenheit in General Surgery?

Is that what you're asking? Sorry to state the obvious, but maybe the spelling mistakes impaired the searches?

Additionally, a surgical fever is commonly understood to be 38.5 degrees Celsius (101.3 degrees Farenheit).
 
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What's the latest on diversion colitis? Is it ischemic or some sort of inflammatory/auto-immune process gone awry?

I've always gone with the theory that the colonic mucosa gets its nutrition from the stool and therefore, no stool going thru = no nutrition = mucosal breakdown. Mucosal breakdown leads to decreased barrier function, where the bacteria can cause inflammation of the colonic mucosa.

No proof of course, just another theory.
 
I've always gone with the theory that the colonic mucosa gets its nutrition from the stool and therefore, no stool going thru = no nutrition = mucosal breakdown. Mucosal breakdown leads to decreased barrier function, where the bacteria can cause inflammation of the colonic mucosa.

No proof of course, just another theory.

Hmmm... I suppose that would work, but colonocytes derive the majority of nutrition from blood rather than directly from poop. Besides, I don't think poop's got much in it by the time it gets to the colon.

Or else a possible therapy for Diversion Colitis would be to stuff the excrement from the ostomy into the mucous fistula. Sounds like a great job for an intern! :)
 
Hmmm... I suppose that would work, but colonocytes derive the majority of nutrition from blood rather than directly from poop. Besides, I don't think poop's got much in it by the time it gets to the colon.

Or else a possible therapy for Diversion Colitis would be to stuff the excrement from the ostomy into the mucous fistula. Sounds like a great job for an intern! :)

I think it's the Glutamine that feeds the enterocytes.

As for the "refeeding of the stoma" - i've actaully had to do that in a proximal fistula - had to feed the fistula output into the distal limb of a stoma. Actually i had to teach the nurses to do it.
 
Glutamine for SB cells; fatty acids (can't remember if short/med/long chain) for colonocytes. Board answers anyway.

Refeeding the stoma reminds me of the fecal enemas for relapsing C Diff.

Yummm....:oops:
 
Glutamine for SB cells; fatty acids (can't remember if short/med/long chain) for colonocytes. Board answers anyway.

Refeeding the stoma reminds me of the fecal enemas for relapsing C Diff.

Yummm....:oops:

Fecal enemas? Hmmm... Can't say I've come across that at all in the last four and a third years.

Neither have I seen refeeding a stoma, either, but I guess we're different like that.
 
Whoa, yikes! I had a tough time understanding your questions here...so I'm going to assume you're asking:

(1) Why does a mucous fistula have a reduced incidence of diversion colitis compared to a Hartmann's pouch?

(2) Why is a fever defined as 101.5 (sic) degrees Farenheit in General Surgery?

Is that what you're asking? Sorry to state the obvious, but maybe the spelling mistakes impaired the searches?

Additionally, a surgical fever is commonly understood to be 38.5 degrees Celsius (101.3 degrees Farenheit).

yes these are my actual questions... sorry. was kind of delerious at the time. I cannot find any good studies showing reduced incidence of diversion colitis in mucus fistulas.... anyone see any articles on this? Also I still cannot find out any references exploring the reduced incidence of div. colitis.

Thanks
 
Fecal enemas? Hmmm... Can't say I've come across that at all in the last four and a third years.

Neither have I seen refeeding a stoma, either, but I guess we're different like that.

Now mind you, I've never done either as well, but always liked to mention it to the attendings so as to get a rise out of them. There is definitely some literature on both; when you have a chance, Medline it. The ID guys always used to like to trot it out as well as a recommendation.
 
My mistake - it is short chain fatty acids in that feed the colonocytes, but they are still derived from the breakdown of fecal material by colonic bacteria.

As for the OP's questions about the mucous fistula - i've never heard anything about them preventing diversion colitis. I only use mucous fistulas if there is a question about distal obstruction or you are worried about the distal staple line busting open.

As for post-op fever - there are no hard and fast rules for a cut-off. Many people use 38.5 C, but i must say i still get concerned if it's less than that and the patient looks unwell or if they've been totally afebrile up to that point and then suddenly spike up to 38.4. I don't think the cutoff is based on any hard science.
 
As for the OP's questions about the mucous fistula - i've never heard anything about them preventing diversion colitis. I only use mucous fistulas if there is a question about distal obstruction or you are worried about the distal staple line busting open.

Thank God! I thought I was the only one who had never heard of a MF preventing Diversion Colitis!

I've been taught that the only reason for a MF is exactly that: distal obstruction that might blow out the staple line at the stump.

As for a surgical fever, we've used 100.8F here forever.
 
Tussy,
Just curious how you went about refeeding the stoma. Did you use a pump or just bolus feeds?
 
Thanks!...

I guess, I just happen to see that comment regarding mucus fistulas in some reports and it sounds entirely anecdotal.
 
Tussy,
Just curious how you went about refeeding the stoma. Did you use a pump or just bolus feeds?

No, just sucked it up with a 60cc syringe and then used a large foley to refeed it down the distal limb. This way we were able to avoid all the electrolyte and fluid issues of a proximal fistula. Patient eventually learned to do it themselves at home and were able to go home on home TPN until the time came to reoperate and close the fistula.
 
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