FISTULA ☠️☠️☠️ - Live discussion (Dr. Martha & Meshy)

Added: 2026-05-10

[00:01:04]Okay. Um hello hello hello hello hello everyone. Um good morning to this today's session. So today we are having a very very special guest actually and we're going to tackle uh something very very So our guest speaker is already in the forum. So our guest speaker just wave if you can hear me.

[00:01:28]Hello our guest speaker. Can you look for a stable internet or stable connection? So guys today we are having a very very special guest in the forum with us and we're going to um tackle something small on what you call visa.

[00:01:42]So our guest just to confirm that you can hear me by just waving just w if you can hear me uh well okay uh that's all good. So uh my people the guest is already in the forum yet I'm not seeing anybody. I told you to come early. I'm sorry we couldn't make it by uh 10 or 10:30. We we had some uh some activities to attend to but uh it's good we've again uh made it possible. So today we're going to tackle something very very small on what you call a fist.

[00:02:17]So probably you've heard of fist from your schools, your lecturers, your doctors, your nurses, clinical officers.

[00:02:25]Yeah. So today Uhhuh. I can see most people are joining. That's all good. So Jennifer Juma, hi. Thank you so much for tuning in. This is me Mishi from Smart Health Africa 047 and we are very very happy to have you on board. We also have Nila Nil Y NP Y9P sorry. Hi pleasure to have you. Uh anybody else in the forum you can just chat with us in the comment section.

[00:02:55]Tell us anything. Drop your likes. If you are new to us, subscribe to our channel and we will I appreciate that just that. So guys, before I continue, let me give our guest speaker uh like 3 seconds. She maybe she introduces herself, she greets us and then we will proceed from there. So our guest speaker kindly uh proceed.

[00:03:15]>> Good morning. So I'm going to take you through together with I hope we're going to flow together.

[00:03:26]Yeah.

[00:03:30]Um, are you done with introduction?

[00:03:50]>> Okay. Maybe you can look for some for a stable internet because it seems there's some problems with the internet. But anyway guys, that was Dr. Ma uh with us today. So she's going to tackle uh the condition called fistula. So um I don't want to talk much today. I just want you to hear from the horse's mouth, right?

[00:04:08]Just want you to hear from her and see what she has for us today. So with no further ado, uh Dr. you can proceed and maybe give us something on the definition of fistula, the pathophysiology of fistula and maybe um I'll maybe I'll make a summary of what you've tackled. So just give us the definition then the pathophysiology of fistula then maybe you can alert me finish then we can proceed from there.

[00:04:33]Thank you.

[00:04:35]>> Okay. Um thank you ma for that. So I'm going to you is an abnormal epidmal line track that connects two internal organs.

[00:04:52]It results from chronical inflammation, infection, injuries, obstruction leading to tissue breakdown and abdominal complication. So in simple terms fist is when the two ano and internal internal outings connect I don't know if I'm allowed to use this for example this is the front part and what you >> pardon so this is when the front part like anal part and front part. Mostly this actually occurs in the ladies. Allow me to use the lemon language that everybody is going to understand.

[00:05:44]The ano and the vaginal part they connect. Now the supposed can can pass all the product that are supposed to come through the vagina can also through the ano. So that is a simple definition of a simple and an easy one to understand.

[00:06:07]So I'm also going to take a physiology.

[00:06:11]So fist follows for follows a biological process.

[00:06:20]So step by step I'm going to break it down.

[00:06:25]infection, trauma, insomnia or obstruction.

[00:06:30]And then you also have inflammation and tissue breakdown due to poor blood supply or pressure track formation drains and creates a channel. So this is basically what I've just explained comes to be like the and the vaginal products like for example suffering from So in this case, so that is basically simply about And um I'm done.

[00:07:45]>> Yes. Are you done with introduction and pathology?

[00:07:49]>> Yeah, I'm done.

[00:07:53]>> I'm done withology and >> Okay. our guest speaker just confirm with me just by nodding because I won't I can't hear you well just confirm that you've tackled the introduction part and maybe the pathophysiology that was a very very great presentation from our guest speaker today so I know most of you have already forgotten her name so she's called Dr. mother and she's taking us through uh condition called fistula. So in summary, let me just give a summary of what she has tackled a summary of what she has tackled. So uh fistula can best be defined as an abnor abnormal epithelial lined connection between two organs or between an organ and the skin. It is an abnormal abnormal connection abnormal epithelial lined connection which means that it's not something that is necessary. It's it maybe it can happen there by accident or maybe uh maybe through an abnormal condition. So fistula is a is an abnormal epithelial line connection between two organs or between an organ and the skin. So there can be connection between two organs or even between an organ and the skin. So that abnormal connection it must be abnormal. So that abnormal connection is what we call pistula. So in simple terms fistula is an abnormal passage or tunnel that forms between two body parts that are not supposed to be connected. These body parts are not are not supposed to be connected but they are interconnecting.

[00:09:28]We are calling crystal in simple terms.

[00:09:31]Abnormal passage it has it has to be an abnormal passage or a tunnel that forms between two body parts that are not supposed to be connected. Let me give you a very very good example. A good example is between uh a connection between the bladder and the vagina.

[00:09:46]Right? So you know very well that uh the bladder should not meet the vagina. But in fist you find the bladder and the vagina. So this one can lead to maybe a leaking of urine. So urine will be passing through the part which it should not be supposed to be passing through. Okay. In ladies, I hope you know the reproductive part and the urinary system or urinary part. So you will find that there's going to be interconnection between the vagina and the bladder. So there's going to be urine leaking out. Another example, another example is a connection between the rectum and the vagina. This one these conditions are very very severe.

[00:10:27]Okay? And actually it's not it's not a disease but it's just a condition an abnormal condition. So if there is a connection between the rectum and the vagina, there's going to be stool leakage. I hope we all know where the stool should be passing through. But now when there is a connection between now the the rectum, rectum is part of the excretory system, right? Yeah. But now if there is a connection between now the excretary system and the reproductive, you're going to have a mess, right? So let's just imagine a condition where we having a passage a connection between the rectum and the vagina. What's going to happen? There's going to be stool leakage meaning stool is going to pass out through the vagina which is not supposed to be meant to be like like that. Right? So that's a second example.

[00:11:14]The third example is a connection between intestine and skin. The intestine and skin.

[00:11:21]So if the intestine and skin are are interconnected, fluid is going to come out in the skin. Fluid, which fluid?

[00:11:29]Fluid from the intestines. This one is a very like this condition is not like it's not something you can maybe smile about, right? Because now tell me fluid is coming out of the skin. The flu that was supposed to be uh to be located in the intestine is coming out through the skin. So I've given three practical examples. A connection between the bladder and the vagina, a connection between the rectum and the vagina. And a connection between the skin and the intestine. Those were three practical examples of a fistula. Another thing I want to mention before I I continue that again I'm giving the definition this can best be simply defined as an abnormal connection leakage you can just say that in simple terms an abnormal connection leading to an unwanted uh an unwanted leakage because the leakages we have mentioned they are unwanted leakages we've talked about urine leakage we've talked about two leakage and we've talked about again fluid leakage. So in simple terms I am saying that fistula is an abnormal connection leading to an unwanted leakage that being done let's now talk about the pathophysiology of uh fistula how does this fistula come to exist what brings it about right so we have got u the first process the very very first process before fistula forms we have got what we call initial tissue damage remember this tissue the tissue maybe can still be intact or can just be normal but for fistula to be formed this tissue should be can must be damaged at first. So we have got initial tissue damage. Under this you say uh this one is caused by infection, pressure, trauma or surgery. I've mentioned the four things that can cause uh tissue damage.

[00:13:19]Infection, trauma, uh surgery or what you call um pressure. Okay. So I hope you know where how trauma trauma occurs and I also mentioned of surgery. So if s surgery has been done and the right mechanisms have not been followed or the right procedures have not been followed fella can occur at high chances. We also have infection. Okay. Some infections lead to tissue damages. Then then ofula. The second process out of the second stage under the formation of fistula is inflammation and necrosis.

[00:13:57]So under inflammation and necrosis we have the tissue breaking down forming an abscess.

[00:14:03]So when the tissue breaks down it forms what we call an absess. Okay. The third process is what we call a drainage pathway formation. Drainage pathway formation. So under this the body tries to drain pass then creates a tract. Do you know what pass is? So under drainage pathway formation the body is going to try to drain or to get rid of uh get rid of what you call the pass. And this one is going to lead to what you call the tract. That was the third process. Then the fourth process and the final process under fistula formation is what you call epolization.

[00:14:38]Under this the tract becomes lined with epithelium then forms what you call a permanent fistula. So if the tract that has been formed lines with the epithelium, get this right. If the track that has been formed lined with the epithelium, it's going to form what we call a permanent fistula.

[00:14:55]So we have got some examples of uh fistula here or the types of fistula.

[00:15:00]But before I go to that let me give the guest speaker the guest speaker now to take us through um the classification.

[00:15:08]Guest speaker are you hearing me?

[00:15:11]Hello.

[00:15:13]>> Yes I can hear you.

[00:15:14]>> Madame guest speaker are you hearing me?

[00:15:17]H >> yes.

[00:15:20]>> Okay. Hope you're hearing me. So madame guest speaker get take us through the classification of fistula the and the ethology of fistula and ethology of fistula. So kindly uh maybe you can take the stage from that point.

[00:15:36]>> Okay thank you me. So um I'm going to take classification of uh based on an anatomical location. Um so the first one is anorctis in the ano. So yeah between anocan and skin most common type usual usually followed by electro absess and then we have fistula example and the vagina and then we have vaginal fistula rectum and the vagina And then I hope you have understood that like the first one is from the ano and then the second one is from eurogenito.

[00:16:41]This is basio vaginal fistula that is the bladder and the vagina. And then second one vaginal fistula the rectum and vagina. This is actually common in prolonged or prolonged labor. So this one mostly comes about from the and then you have gastra intestinal fistula between the segments or boil to skin. example fistula. So this is between the B and the skin.

[00:17:25]The B segment of the B to skin. And then we have obstructed fistula strongly associated prolonged obstructed labor major public health issue in lower resource settings based on output. So yeah um obstructed fistula comes up obstructed labor like when the labor is obstructed and then um we have complex anist and then complete deep involves and then theology ology infectious causes. So abdominal.

[00:18:21]So we have absess most common causes of tuberculosis especially in developing regions.

[00:18:30]And then we have inflammatory diseases and then uh and then we have obstructs prolonged labor. That one said prolonged labor. Then um surgical causes.

[00:18:48]So yes have infectious causes. It can be caused through infection infections and then diseases. We alsoed causes like through the labor when the labor is obstructed and then um injuries, trauma cases. So that those are the cancer causes destruction. So the first cause of infections or um obstructed labor surgical trauma is cancers. So um measure I guess the classifications measure um I'm actually done with the classification and the process measure.

[00:19:58]If you can summar Okay. Uh are you done with uh the classifications andology of pistula?

[00:20:21]>> Yes, I'm >> Hello. Hello. Are you done with the classification andology of fistula?

[00:20:33]Just just or you can do this. You can do this. I'm not hearing you well. Are you done?

[00:20:46]>> Okay guys, let's proceed. It seems like our guest speaker has got some internet problems, but anyway. So our guest speaker has just taken us through the classifications of fistula and the ethiology of fistula. So ethology is just like the cause what causes uh this condition called fistula. Then classification she has talked of certain types of what you call the fistula. So just in a nutshell or just in summary let me just go through maybe the types of the types of fistula she has talked about.

[00:21:19]So the first one, the first one she has talked about what you call obstetratic fistula. Obstratic fistula and this one I need you to pay much attention to it cuz maybe you can if you're a medical student, you are maybe a health professional, you are a community health officer, you're a public health officer, you will encounter these terms, okay?

[00:21:36]And if you don't listen to what I'm going to say next, then maybe you may be in a very very real shock when someone mentions ful and you are like what the hell is that? So let me just take you through what she has talked about under the types of fistulas. So she has talked about the first one as obstructic fistula. So for obstructive fistula it is common in a low resource setting and it's also due to prolonged obstructed labor. So this one is all about having an obstructed labor. So when you have a prolonged it has to be prolonged. So when there is prolonged obstructed labor there's going to be formation of what you call obstatric fistula. Okay.

[00:22:14]Obstratic just from the word uh from the word uh let me see from the word obstructed we get obstetric uh fistula and we have said that is it is common in low resource setting. Low resource setting simply means it can even mean the villages those up country. Okay.

[00:22:30]Yeah. Where the resources are maybe inadequate. So you find that maybe women are finding it hard while maybe doing maybe what you call delivery or something sort of that right. Then Shel talked about the second type of fistula called intercutaneous fistula.

[00:22:48]Intercutaneous fistula it is found between the intestine and the skin.

[00:22:53]Remember I mentioned that there can be an interconnection between the between the intestine and the skin and this one can lead to a fluid leakage. So that interconnection between the intestine and the skin is what we are calling intercutaneous fistula. So for this intercutaneous fistula it's of postsurgical or due to Crohn's disease postsurgical someone under go surgery and maybe the process was not done uh was not done according to the guidelines or the process was not done maybe in a in a in a better way there can be what you call uh intercutaneous fistula that is post postsurgical postsurgical we also have so postsurgical can also be caused by what you called Crohn's disease. So apart from postsurgical issues, it can also be caused by what you call Crohn's disease. Another type of fistula she mentioned is what you call the anal fistula. So anal fistula also called the fistula in ano.

[00:24:03]Anal fistula is also called fistula in ano. So what about this anal fistula?

[00:24:08]For anal fistula a connection between the anal canal and the skin. So when there is an interconnection when there is a connection between the anal canal called anol fistula or what you call in fistula in ano this one usually follows peranol absess. Okay. So another thing let me mention there are also other types. So those were the three main types of fistula. The three main types of fistula I've talked of obstetic fistula intercutaneous fistula and anal.

[00:24:42]So what what are the other types of fistula that we have? Other types you have got what you call tracheio sophagial fistula.

[00:24:53]This one maybe it's a maybe connection between the uh okay this one is a fist of the trachea or the esophagus. Hope you know where the trachea is. You know what the esophagus these are just part of parts of the breathing system. Okay.

[00:25:08]So if there there can be connection between the trachea or even the parts of the breathing system it can be called trachio tracheio fist it's a bit difficult to pronounce it so it's just a connection between the trachea and the esophagus that's why it's called trachio then sophagel so we have got trachea and the esophagus there you also have another type called arteriovenenous fistula this one is uh it's found in artery then and this one may be surgical maybe an effect of maybe surgical uh issues or surgical processes. So uh there are some things here there are some things here uh okay there are other types also we have got vesico vaginal pistula so let me mention now okay we have someone by the name Mr. Shippy Mr. Shippy Mr. Shippy, you have a very great name. Thank you so much for joining. It's so uh wonderful to have you on board. We also have Jan Armed saying hi. Okay. Hi to Mr. Mr. R and Jan. It's a great pleasure to have you on board. And uh if you are new to this funny face, if you're new to this funny channel, this small channel, kindly do us a favor of subscribing so that we grow together. Okay. So, thank you so much for tuning in. You can invite friends, you can share the link and we will appreciate that. So I'm mentioning the other types of fistula.

[00:26:32]We have got what you call vesico vaginal fistula. So for vesico vaginal fistula it's a connection between the bladder and the vagina. So just imagine there's a connection between the bladder and the vagina. What's going to happen? There's going to be leakage of urine. Okay.

[00:26:47]There's going to be leakage of urine and you know very well where urine should be passing through. You know that. I hope you know that. Another type another type of fistl is what we call rectrovaginal fistula.

[00:26:59]So just from the word rectum you have got rectto vaginal fistula. So for recttovaginal fistula it's a connection between the rectum and the vagina. So what's going to happen if we have got a connection between the rectum and the vagina there's going to be leakage of stool. So instead of instead of stool being excreted through the excretory system it's going to get excreted through the reproductive system. And this one is very very messy. This one is very very pathetic cuz you'll be have there will always be false smells and this one can also be accompanied by some infections because now just imagine now that we having an excretionary product a waste product passing through the reproductive system and we all know that there are some bacteria in the reproductive system that maybe aid in moisturization and all that. So it's going to affect the it can affect the pH maybe the concentration of the enzymes there. that will be mentioned. Uh so I've just tackled what our guest speaker told us on the classifications of uh fistula and the ideology of fistula. So what you're going to tackle next because uh I only wanted 30 minutes and you've already spent 27 minutes. So I'm only having 3 minutes but before those 3 minutes elapse let me just give the guest speaker time. She takes us through the risk factors of fist. Okay we have someone by the name Spider Sammy.

[00:28:21]You people are having very very it's a great pleasure having you on board. We having a guest by the name uh Dr. Ma. So we really privileged to have doctors on board. So Spider do us a favor subscribing so that you we may have another other important guests coming this week. Okay. So if you want to see these beautiful faces, these handsome faces, maybe you just have to subscribe to us. So our guest speaker take us through the risk factors of fistula, the clinical features of fistula and the complications of fistula. I've said three items risk factors of fistula, clinical features of fistula and the complications of fistla.

[00:29:02]Then I will pick from that uh point.

[00:29:06]>> Okay. Um thank you ma for that factors of fistla. One we have poor access to maternal care.

[00:29:15]And then we also have my nutrition and then um previous surgeries actually can be through if somebody underwent a surgery and then the surgery surgery was done was not done properly.

[00:29:33]So that can also be a risk factor. And then we have chronic inflammatory.

[00:29:40]Um so um under these factors we have one poor access to mater and then malnutrition you know malnutrition I hope you know what it means um somebody's man like does not somebody does not have a notition and then we have previous and chronical so Among the risk factors um clinical features we have one one of the signs and symptoms that is um persistent discharge um non-healing wounds like and then pain and and inflammation and then we have specific types of specific symptoms by types we have anam And then we have um eating and irritation locage of um and then we have social stigma and distress like And then we have um stigma stress like stress and uh sorry mish for that. And again we have um gastine we have lo of intestinal content and um electrol electrolytic imbalance. So um under signs and symptoms we have persistent abnorminal disaling wounds pain and inflammation and then Sorry about that. My kind of disturbing.

[00:32:09]Um, sorry about that. My network is not that stable. And then I'm going to through complications. So we have chronic in infection palutration especially in the GPI distalation.

[00:32:27]This is the we have you will have problems with the skill and then we have infertility actually also infertility in women and then we have psychological trauma and social isolation.

[00:32:43]So our measure deal with the risk factors sign and symptoms and also complications.

[00:33:00]I am done with the presentations the risk factors sign and symptoms and complications.

[00:33:16]Okay. Okay. Okay. Okay. Uh thank you so much for that uh uh presentation on uh so guys she has just taken us through the risk factors of fistula the complications related to fistula and maybe uh clinical uh features.

[00:33:43]So that one being done now let me take you now through because I'm not going to repeat what she has already tackled because they are just simple things because I know you've mastered the clinic the signs and symptoms the risk factors and maybe the complications related to fistular condition. So let me just quickly go through the interruption. I think there's some technical uh I hope uh we are back. So let me just quickly take us through the diagnostic measures for pista. How do we know that someone is having pistula?

[00:34:34]Will you just look at someone and say that the person is having fistula? No, we have to we have to consider one we have to consider the clinical features the signs and symptoms and before we even conclude we have to do what you call diagnose. Okay. So the first diagnostic measure is what you call clinical assessment. So this one cannot be done by anyone else. It's only done maybe the by the clinical officers, the nurses like uh the medical health professionals. Okay. So not anybody not just any random guy can do what you call clinical assessment. It has to be someone who has got the knowledge. Okay.

[00:35:09]Yeah. Who has got knowledge on fistula and who has got maybe knowledge on uh these diseases. It can even be a pathologist. In that case is what you call history plus physical examination. History you going to consider maybe the maybe you can the family history of this person then the physical examination. Now for physical examination we can now here consider the clinical features or the signs and symptoms because there are some things you can just see and note that this one is such a condition because you are now having the knowledge you're having the experience you're having the expertise.

[00:35:45]So for physical examination we're going to consider the signs and symptoms and maybe um we also have inspection of discharge site. Inspection of discharge site.

[00:35:56]Which site is discharging uh what fluid or what item? Okay. If there is a stool leakage to leakage you said occur.

[00:36:36]Whoa, whoa, whoa. Guys, you're going to stick measure called inspection of discharge site. So we going to inspect the dist site. Where is this item coming from? If you're having a leakage of urine, where is this urine coming from?

[00:37:00]Okay. If there is leakage of stool, you're going to consider where is this uh stool being discharged from. If just take us through the investig investigations for fistula. Okay. So you've got something called fistilography. Filography just the contrasting of contrasting imaging of the tract. Okay. We also have MRI.

[00:37:44]Someone might be wondering what's MRI.

[00:37:45]MRI in full is just magnetic resonance imaging. So for M it is best for complex fist got those fistulas that are complex. Okay. So for complex fistulas we can do an in Okay guys, I'm going to be forced to end the session at that point. I'm going to force be end the session at that point because uh we can't continue when maybe we are having such technical issues but at least we've tackled the major part.

[00:38:37]So maybe we are only remaining with the prevention measures maybe the general prevention these ones are that you know.

[00:38:43]So in quick summary for prevention you have got skilled birth attendance, emergency obstructive care, early referral of obstructed labor. Then for general prevention we can have good surgical techniques. We can have management of chronic diseases and early treatment of infections or abscesses.

[00:38:59]That was all about fistula. I hope you enjoyed the session. I hope itive it was impactful. Next time from next week we're going to tackle uh we going to tackle skin cancer probably on Tuesday.

[00:39:10]So we'll just have a guest again who will take us through cancer. But with no further ado, let me just say that it was a nice session though. We had some technical issues but uh God made us maybe.

[00:39:25]Thank you so much guys for tuning meet maybe on Tuesday from 7:00 p.m.

[00:39:30]usual time usual face usual channel but for a different purpose on skin cancer.

[00:39:35]Have a great day. Have a great weekend and have a great Sabbath ahead. Bye.

[00:39:40]Bye.