Medical term:

fist

index

(pl. indexes, in´dices) (L.)

1. the numerical ratio of measurement of any part in comparison with a fixed standard.

2. forefinger.

Barthel index an objective, standardized tool for measuring functional status. The individual is scored in a number of areas depending upon independence of performance. Total scores range from 0 (complete dependence) to 100 (complete independence).

bleeding index any of various methods of assessing bleeding in the gingival sulcus before or after treatment.

body mass index (BMI) the weight in kilograms divided by the square of the height in meters, a measure of body fat that gives an indication of nutritional status.

cardiac index cardiac output corrected for body size.

cephalic index 100 times the maximum breadth of the skull divided by its maximum length.

citation index an index listing all publications appearing in a set of source publications (e.g., articles in a defined group of journals) that cite a given publication in their bibliographies.

Colour index a publication of the Society of Dyers and Colourists and the American Association of Textile Chemists and Colorists containing an extensive list of dyes and dye intermediates. Each chemically distinct compound is identified by a specific number, the C.I. number, avoiding the confusion of trivial names used for dyes in the dye industry.

erythrocyte indices the mean corpuscular volume, mean corpuscular hemoglobin, and mean corpuscular hemoglobin concentration. These are all useful for evaluating anemias because they provide information on the size of the erythrocytes and the concentration of hemoglobin. Called also red cell or red blood cell indices.

glycemic index a ranking of foods based on the response of postprandial blood sugar levels as compared with a reference food, usually either white bread or glucose. See table.

left ventricular stroke work index (LVSWI) an index of the amount of work performed by the heart.

leukopenic index a fall of 1000 or more in the total leukocyte count within 1.5 hours after ingestion of a given food; it indicates allergic hypersensitivity to that food.

index Medicus a monthly publication of the national library of medicine in which the world's leading biomedical literature is indexed by author and subject.

opsonic index a measure of opsonic activity determined by the ratio of the number of microorganisms phagocytized by normal leukocytes in the presence of serum from an individual infected by the microorganism, to the number phagocytized in serum from a normal individual.

phagocytic index any arbitrary measure of the ability of neutrophils to ingest native or opsonized particles determined by various assays; it reflects either the average number of particles ingested or the rate at which particles are cleared from the blood or culture medium.

red blood cell indices (red cell indices) erythrocyte indices.

refractive index the refractive power of a medium compared with that of air (assumed to be 1).

short increment sensitivity index (SISI) a hearing test in which randomly spaced, 0.5-second tone bursts are superimposed at 1- to 5-decibel increments in intensity on a carrier tone having the same frequency and an intensity of 20 decibels above the speech recognition threshold.

therapeutic index originally, the ratio of the maximum tolerated dose to the minimum curative dose; now defined as the ratio of the median lethal dose (LD₅₀) to the median effective dose (ED₅₀). It is used in assessing the safety of a drug.

in·dex

, gen.

in·di·cis

, pl.

in·di·ces

in·dex·es

(in'deks, -di-sis, -di-sēz, -dek-sĕz), Index of suspicion is jargon and says no more than simple suspicion.

1.
See also: quotient, ratio. Synonym(s): index finger

2. A guide, standard, indicator, symbol, or number denoting a relationship with respect to size, capacity, or function, of one part or thing to another.
See also: quotient, ratio.

3. A core or mold used to record or maintain the relative position of a tooth or teeth to one another and/or to a cast.

4. A guide, usually made of plaster, used to reposition teeth, casts, or parts.

5. In epidemiology, a rating scale.

[L. one that points out, an informer, the forefinger, an index, fr. in-dico, pp. -atus, to declare]

Farlex Partner Medical Dictionary © Farlex 2012

index

1. A table of contents.

2. A guiding principle.

3. A formula expressing the relationship of one value, property, form, or ratio to another. See Ankle-brachial index, Atherogenic index, Barthel index, Bessman index, Biotechnology index, Bispectral index, Body mass index, Cardiac index, Case-mix index, Cephalic index, Clamp-derived insulin-sensitivity index, DNA index, Duke Activity Status index, England index, Family suffering index, Foam stability index, Free thyroxine index, Framingham Physical Activity index, Geographic practice cost index, Glycemic index, Greenhouse index, Heat index, Hemacytology index, Hemogram index, Hepatic iron index, HERP index, Hollingshead index, Icterus index, IgG index, IgM index, International sensitivity index, Insulin sensitivity index, Krimsky index, Labeling index, Lesquesne index, Life Events index, Locomotion index, Maturation index, Medicare Economic index, Mentzler index, Merck index, Misery index, Mitotic activity index, Mother index, National Death index, Nuclear contour index, Obstructive apnea-hypopnea index, Organism-specific antibody index, Pearl index, Phagocytic index, Pollution Standards index, Poverty index, Prognostic nutritional index, Proliferation index, Singh index, Psoriasis Area and Severity index, Quetelet index, Rate-adjusted mortality index, Shine & Lal index, Side Effects & Symptoms Distress index, Sleep Impairment index, Splenic index, Standard deviation index, Stress index, Therapeutic index, Thymidine labeling index, Transitional-dyspnea index, Uncitedness index, UV index.

in·dex

, gen. indicis, pl. indices, pl. indexes (indeks, -di-sis, -di-sēz, -deks-ĕz) [TA]

1. [TA]
Synonym(s): index finger.

2. A guide, standard, indicator, symbol, or number denoting the relation in respect to size, capacity, or function, of one part or thing to another.
See also: quotient, ratio

3. A core or mold used to record or maintain the relative position of a tooth or teeth to one another or to a cast.

4. A guide, usually made of plaster, used to reposition teeth, casts, or parts.

5. epidemiology A rating scale.

Medical Dictionary for the Health Professions and Nursing © Farlex 2012

index

(in'deks?) (in'di-sez?) plural.indexes, indices [L. index, pointer]

1. The forefinger.

2. The ratio of the measurement of a given substance to that of a fixed standard.

addiction severity index

A structured assessment tool that evaluates the impact of addictive behavior on seven areas of living: alcohol use, drug use, employment, family relationships, illegal activities, physical health, and psychological health.

alveolar index

Gnathic index.

ankle-brachial index

Abbreviation: ABI

A measure of the adequacy of blood flow to the arteries of the legs. It is used to gauge the severity of peripheral vascular disease.

Patient care

The index is obtained by measuring the systolic blood pressure in the upper and lower extremities after the patient has been lying on his or her back for about 5 min and then repeating the measurements after the patient walks for 5 min. There are several ways to obtain an ABI. The most accurate test results are obtained by measuring the blood pressure in both arms using a blood pressure cuff and Doppler ultrasound and recording the higher of these two pressures. The measurement is repeated in each leg, with measurement of blood pressures at both the posterior tibial and dorsalis pedis arteries. The pressure that should be recorded is the pressure found during the first return of a pulse to the cuffed limb. The blood pressure in each leg is divided by the blood pressure in the higher pressure of the two arms to obtain an ABI for each lower extremity. An ABI above 0.9 is normal, except when it exceeds 1.3 (an indicator of severe peripheral arterial obstruction). Severe obstruction is also indicated by an ABI of less than 0.5. Moderate peripheral arterial disease is suggested by an ABI of 0.8. A drop in the ABI after exercise also strongly suggests peripheral arterial disease. Patients with mild or moderately abnormal ABIs are usually treated with antiplatelet medications, an exercise regimen, and cholesterol-lowering drugs or diet. Those who smoke are encouraged to quit. Patients with severe disease may need angiography and, in some instances, arterial bypass surgery or stenting.

apnea-hypopnea index

Abbreviation: AHI

The number of times in an hour when a sleeping person either stops breathing completely or has limited airflow. Each episode must last at least 10 sec. The AHI is one indicator of obstructive sleep apnea, although it is recognized as an imperfect diagnostic tool. An AHI of 30 or more events in an hour indicates severe sleep apnea; 15 to 29 events suggests moderate apnea; and 5 to 14 events indicates mild apnea.

Barthel index

See: Barthel index

bispectral index

Abbreviation: BIS

An electroencephalographic measure of the effect of sedative and hypnotic drugs on an anesthetized patient. It is used (along with clinical assessment of the patient) to determine the level of central nervous system depression. The index ranges from zero (completely unresponsive to stimulation) to 100 (awake and alert). At levels below 60, most patients are adequately sedated for surgery.

BODY MASS INDEX

body mass index

Abbreviation: BMI

An index for estimating obesity. The BMI can be obtained by dividing weight in kilograms by height in meters squared, or according to the following formula: BMI = (Weight/2.205) / (Height/39.37)². In adults, a BMI greater than 30 kg/m² indicates obesity; a BMI greater than 40 kg/m² indicates morbid obesity; and a BMI less than 18.5 kg/m² indicates a person is underweight. The lowest overall death rate is found in people with a BMI of 20 to 24.9 kg/m².

Synonym: Quetelet index See: illustration

burn scar index

A rating scale developed to assess hypertrophic burn scars and their rate of development or resolution. It is available at Burnsurgery.org.

Synonym: Vancouver scar index; Vancouver scar scale

cardiac index

The cardiac output (expressed in liters per minute) divided by the body surface area (expressed in square meters).

cephalic index

The biparietal diameter of the skull divided by its occipitofrontal diameter, all multiplied by 100.

cerebral index

The ratio of greatest transverse diameter to the greatest anteroposterior diameter of the cranium.

chemotherapeutic index

The ratio of the toxicity of a drug, expressed as the maximum tolerated dose per kilogram of body weight to the minimal curative dose per kilogram of body weight. This index is used in judging the safety and effectiveness of drugs.

clinical risk index for babies

Abbreviation: CRIB

An index of the severity of illness, used to estimate the likelihood of mortality in very low birth weight infants who are cared for in a neonatal intensive care unit.

color index

An outmoded method of expressing the amount of hemoglobin present in each red cell.

Cumulative Index to Nursing and Allied Health Literature

See: Cumulative Index to Nursing and Allied Health Literature

dental index

A system of numbers for indicating comparative size of the teeth.

DMF index

The index of dental health and caries experience based on the number of decayed, missing, and filled (DMF) teeth or tooth surfaces.

dynamic gait index

Abbreviation: DGI

A semiquantitative tool used to evaluate a patient's ability to modify gait by changing task demands, esp. in patients with dizziness and balance deficits. This test is used to identify patients, esp. older adults, who are predisposed to falling. Patients are graded on their ability to vary speed, turn their heads, turn their bodies, step over and around obstacles, climb stairs, turn while walking, pick objects up from the floor, and perform alternate step-ups on a stool.

exposure index

A relative value indicating the quantity of ionizing radiation received by a digital radiographic image receptor. Although vendors currently use many kinds of exposure indices, e.g., Sensitivity Numbers, standardization is being developed by physicists' organizations.

fatigue index

The difference between the muscle power generated during peak exertion and the power that can be generated after repeated loading and unloading of the muscle.

Frenchay Activities Index

A formal interview for patients who have suffered a stroke to compare their functional abilities preceding and following the stroke. The patient describes how employment, meal preparation and clean up, gardening, shopping, and other activities of daily living have been altered by the stroke.

gas exchange index

One of several measurements of the efficiency of respiration, esp. of the extent of intrapulmonary shunting in respiratory failure. Among the commonly used gas exchange indices is the alveolar-arterial oxygen tension difference (a measurement derived from an analysis of the oxygen tension of an arterial blood gas compared with the atmospheric oxygen content).

glycemic index

A ratio used to describe the ability of a food to increase blood glucose levels as compared with consumption of either glucose or white bread as the standard. Foods with a low glycemic index result in a slower rise and lower maximum elevation of blood glucose levels than foods with a higher glycemic index. Consumption of low glycemic index foods can contribute to blood glucose regulation in patients with diabetes mellitus. Another use for the index is to identify the choice of food that will raise blood sugar levels after, e.g., endurance exercise.

gnathic index

A measure of the degree of projection of the upper jaw by finding the ratio of the distance from the nasion to the basion to that of the basion to the alveolar point and then multiplying by 100. Synonym: alveolar index

human development index

A measure of national quality of life used by the United Nations Development Program. It consists of three elements: life expectancy at birth, mean years and expected years of schooling, and the gross national income at purchasing power parity per capita.

Insall-Salvati index

See: Insall-Salvati index

International Sensitivity Index

Abbreviation: ISI

A laboratory standard for thromboplastins, the reagents used to determine the prothrombin time (PT). Because thromboplastin contents vary, PT results performed on the same sample of blood in different laboratories can be markedly different, even though the patient's actual level of anticoagulation is a constant. The ISI is used to calculate the international normalized ratio, a standardized measure of anticoagulation, thus enabling health care professionals working with different laboratories to compare results and adjust anticoagulant doses according to a single set of guidelines.

Karnofsky Index

See: Karnofsky Index

labeling index

The rate at which cells take up identifiable chemicals that they use in cell division. The index is a measure of the rate of the reproduction of the cells, as in fetal tissue development or the growth of cancers.

leukopenic index

A test formerly used to determine hypersensitivity to foods, in which the white blood cell count is checked 90 min after the consumption of a suspected allergen. A precipitous decrease in the white blood cell count within 90 min after ingestion of the test food was thought to indicate that the food was incompatible with that person.

life satisfaction index

Abbreviation: LSI

A self-reporting instrument to measure personal fulfillment or contentment, esp. with one's social relationships, occupation, maturation, or aging. A total of five rating scales are used.

McMurtryindex

See: McMurtry index

Index Medicus

A publication of the National Library of Medicine that lists biomedical and health sciences journal articles by title, subject, field, and country of publication. The major national and international medical and biological journals are indexed.

Mentzer Index

See: Mentzer index

mitotic index

The number of mitoses seen in a biopsy specimen per square millimeter of tissue examined. Mitoses in tissue are indicative of malignancy. The higher the mitotic index, the more rapidly a tumor is dividing and the worse the prognosis.

nasal index

The greatest width of the nasal aperture in relation to a line from the lower edge of the nasal aperture to the nasion.

notch width index

The width of the femoral intercondylar notch divided by the width of the femoral condyles.

opsonic index

A ratio of the number of bacteria that are ingested by leukocytes contained in the serum of a normal individual compared with the number ingested by leukocytes in the study patient's blood serum.

oral hygiene index

Abbreviation: OHI

A popular indicator developed in 1960 to determine oral hygiene status in epidemiological studies. The index consists of an oral debris score and a calculus score. Six indicator teeth are examined for soft deposits and calculus. Numerical values are assigned to the six indicator teeth according to the extraneous deposits present. The scores are added and divided by the number of surfaces examined to calculate the average oral hygiene score.

Oswestry Disability Index

Abbreviation: ODI

A questionnaire that requires a patient to rate the effect of back pain on 10 different activities, each having six levels of disability. The test was designed to assess patients with failed back surgery, but it is widely used for nonsurgical patients with other spinal conditions.

Synonym: Oswestry disability score

oxygenation index

Abbreviation: OI

A measure of the efficiency of oxygen exchange by the lungs. The index is used in critical care medicine to assess the severity of acute lung injury and to gauge the effectiveness of ventilator management strategies. Mathematically it is represented as the product of the fractional concentration of inspired oxygen and the mean airway pressure, divided by the arterial oxygen concentration.

Pearl index

See: Pearl index

pelvic index

The ratio of pelvic conjugate and transverse diameters multiplied by 100.

periodontal (Ramfjord) index

An extensive consideration of the periodontal status of six teeth by evaluating gingival condition, depth of gingival sulcus or pocket, appearance of plaque or calculus, attrition, tooth motility, and extent of tooth contact.

phagocytic index

The average number of bacteria ingested by each leukocyte after incubation of the leukocytes in a mixture of serum and bacterial culture.

physiological cost index

Abbreviation: PCI

The metabolic expenditure per unit of distance traveled. It is expressed as the number of heartbeats per meter traveled and is calculated by subtracting the resting heart rate from the exercise heart rate divided by the distance traversed.

Pneumonia Severity Index

, pneumonia severity index

A diagnostic scoring system for predicting the level of care a patient with pneumonia will require. It includes demographic factors (such as the patient's age, whether he or she resides in a nursing home); findings on physical examination (such as altered mental status, fever, tachycardia, and low blood pressure); laboratory data (including serum pH, glucose and sodium levels); and the presence of other illnesses (such as heart, lung, brain, liver, or kidney disease). Synonym: pneumonia PORT score.

ponderal index

The ratio of an individual's height to the cube root of his or her weight; used to determine body mass.

See: body mass index

proliferative index

Abbreviation: PI

The proportion of cells within a tumor specimen that are actively reproducing. In general, as the number of replicating cells in a tumor increases, the cancer behaves more aggressively and the prognosis for the patient worsens.

index of refraction

1. The ratio of the angle made by the incident ray with the perpendicular (angle of incidence) to that made by the emergent ray (angle of refraction).

2. The ratio of the speed of light in a vacuum to its speed in another medium. The refractive index of water is 1.33; that of the crystalline lens of the eye is 1.413.

Synonym: refractive index

refractive index

Index of refraction.

rapid shallow breathing index

Abbreviation: f/TV; RSBI.

The ratio of the respiratory rate (f) and the tidal volume (TV) of a patient treated with mechanical ventilation while breathing on a T-piece (or at minimal levels of positive airway pressure or pressure support). Levels less than 105/min/L indicate that a patient may be able to be weaned successfully from the ventilator and breathe unassisted.

Reid index

See: Reid index

respiratory index

Abbreviation: RI
Alveolar/arterial gradient.

respiratory disturbance index

A measurement of the number of disordered breathing cycles during sleep. Sleep disordered breathing, which includes both apneas and hypopneas, results in daytime fatigue. It is also associated with an increased prevalence of cardiovascular disease.

sacral index

The sacral breadth multiplied by 100 and divided by the sacral length.

satiety index

The relative degree to which different foods of the same caloric value satisfy hunger.

saturation index

In hematology, the amount of hemoglobin present in a known volume of blood compared with the normal amount.

Science Citations Index

Abbreviation: SCI.

An electronic database of scientific journal articles published and referred to by other authors.

The Index is a proprietary product of the Thomson Corporation.

shock index

1. The systolic blood pressure divided by the heart rate.

2. The heart rate divided by the systolic blood pressure.

sulcus bleeding index

Abbreviation: SBI.

A sensitive measure of gingival condition that involves probing of all sulci. The score is based on six defined criteria. It is calculated by counting the number of sulci with bleeding, dividing by the total number of sulci, and multiplying by 100.

sunscreen protective factor index

In preparations for protecting the skin from the sun (using sunscreens), the ratio of the amount of exposure needed to produce a minimal erythematous response with the sunscreen in place divided by the amount of exposure required to produce the same reaction without the sunscreen. This index assesses the ability of sunscreens to block (short-wavelength) ultraviolet B rays but does not measure the protective effect of sunscreens against (long-wavelength) ultraviolet A radiation.

See: erythema dose

therapeutic index

The maximum tolerated dose of a drug divided by the minimum curative dose.

thoracic index

The ratio of the thoracic anteroposterior diameter to the transverse diameter.

Vancouver scar index

Burn scar index.

ventilation index

Abbreviation: VI.

1. A calculation used to determine the severity of respiratory illness (acute lung injury and/or respiratory distress syndrome) in critically ill patients. The VI is the partial pressure of arterial CO₂ multiplied by the peak airway pressure multiplied by the rate of ventilation, all divided by 1000.

Symbolically, the ventilation index is calculated as follows: VI = [RR x (PIP - PEEP) × PaCo₂]/1000.

2. In environmental science, a measure of air pollution based on the speed of the wind and the height of the column of air in which smoke or other pollutants mix.

vital index

The ratio of the number of births to the number of deaths in a population over a stated period of time.

Western Ontario McMaster Osteoarthritis Index

See: Western Ontario McMaster Osteoarthritis Index

in·dex

, pl. indices, pl. indexes (indeks, -di-sēz, -deks-ĕz) [TA]

1. A core or mold used to record or maintain the relative position of a tooth or teeth to one another and/or to a cast.

2. A guide, usually made of plaster, used to reposition teeth, casts, or parts.

Medical Dictionary for the Dental Professions © Farlex 2012

Patient discussion about index

Q. how can i know my body mass index? how do they calculate it.thank you. this is bse i have a problem with my weight and the right diet to take.i wana have some tips on that bse its too much for me.new year.

A. BMI is a simple method to have an estimation of your body weight. because just measuring weight is not enough because it differentiate between people due to their hight. a 5 footer does not have normal weight as a 6 footer...
here is a link to the WHO site that explains how to calculate it and what the results mean:
http://www.who.int/bmi/index.jsp?introPage=intro_3.html

More discussions about index

This content is provided by iMedix and is subject to iMedix Terms. The Questions and Answers are not endorsed or recommended and are made available by patients, not doctors.

Fistula

Definition

A Fistula is a permanent abnormal passageway between two organs in the body or between an organ and the exterior of the body.

Description

Fistulas can arise in any part of the body, but they are most common in the digestive tract. They can also develop between blood vessels and in the urinary, reproductive, and lymphatic systems. Fistulas can occur at any age or can be present at birth (congenital). Some are life-threatening, others cause discomfort, while still others are benign and go undetected or cause few symptoms. Diabetics, individuals with compromised immune systems (AIDS, cancer) and individuals with certain gastrointestinal diseases (Crohn's disease, inflammatory bowel disease) are at increased risk of developing fistulas.

Fistulas are categorized by the number of openings they have and whether they connect two internal organs or open through the skin. There are four common types:

Blind fistulas are open on one end only.
Complete fistulas have one internal opening and one opening on the skin.
Horseshoe fistulas are complex fistulas with more than one opening on the exterior of the body.
Incomplete fistulas are tubes of skin that are open on the outside but closed on the inside and do not connect to any internal structure.

Fistulas of the digestive tract

Anal and rectal fistulas develop in the wall of the anus or rectum. They connect the interior of the body to one or several openings in the skin. Anal and rectal fistulas almost always begin as an inflammation in an anal gland. The inflammation then moves into muscle tissue and develops into an abscess. In about half of all cases, the abscess develops into a fistula, degrading the muscle until an opening in the skin is created. About 9 people of every 100,000 develop anal fistulas, with men almost twice more likely to develop the condition than women. Although they may develop at any age, the average age for the development of anal fistulas is 38.

Intestinal fistulas can develop in both the large and small intestine. They are commonly associated with diseases such as inflammatory bowel disease(IBD) and Crohn's disease.

Tracheoesophageal fistulas (TEF) are usually birth defects. The windpipe, or trachea, is abnormally connected to the esophagus. This allows air to enter the digestive system and makes it possible to breathe food into the lungs (aspiration). In many cases, the esophagus is also incomplete, causing immediate feeding problems. There are several types of TEFs categorized by where the fistula is located and how the esophagus and trachea are connected, but all are life-threatening and require prompt surgery to repair. TEFs occur in about one of every 1,500-3,000 births.

Fistulas of the urinary and reproductive tract

The most common type of fistula involving these systems is a vesicovaginal fistula, in which the woman's vagina is connected to the urinary bladder. This causes leakage of urine from the vagina and results in frequent vaginal and bladder infections. Fistulas may also develop between the vagina and the large intestine (a enterovaginal fistula) so that feces leaks from the vagina. Although both these types of fistulas are uncommon in the developed world, they are common in poor developing countries and result from long, difficult labor and childbirth, especially in very young girls. As a result, they are sometimes referred to as obstetric fistulas.

Some experts suggest that in parts of Africa, as many as 3-4 women develop these fistulas out of every 1,000 births. Others estimate that as many as 2 million women worldwide are living with unrepaired obstetric fistulas. If left unrepaired, obstetric fistulas cause women to constantly leak urine and feces. As a result, they become social outcasts, causing them extreme hardship and psychological trauma.

Fistulas of the circulatory system

Arteriovenous fistulas (AVF) can develop between an artery and a vein in any part of the body. These fistulas vary in size, length, and frequency. Arteries contain blood carrying oxygen to all parts of the body, while veins carry blood that has given up its oxygen back to the lungs. Connections between arteries and veins cause changes in blood pressure that result in abnormal development of the walls of the arteries and abnormal blood flow. Arteriovenous fistulas that are present at birth are sometimes referred to as arteriovenous malformations (AVMs). Many arteriovenous fistulas are present, but not evident at birth, and become obvious only after trauma. AVFs can also be acquired from penetrating trauma.

Causes and symptoms

The causes and symptoms of fistulas vary depending on their location. Anal and rectal fistulas are usually caused by an abscess. Symptoms include constant throbbing pain and swelling in the rectal area. Pus is sometimes visible draining from the fistula opening on the skin. Many individuals have a fever resulting from the infection causing the abscess.

Vaginal fistulas are caused by infection and trauma to the tissue during childbirth. They are easily detected, because the woman smells unpleasant and leaks urine or feces through her vagina. Rarely these fistulas may develop as a complication of hysterectomy.

Tracheoesophageal fistulas are the result of errors in the development of the fetus. They are evident at birth, because the infant is unable to swallow or eat normally and are considered a medical emergency that requires surgery if the infant is to survive.

Arteriovenous fistulas are most often congenital defects. Symptoms vary depending on the size and location of the fistula. Often the skin is bright pink or dark red in the area of the fistula. Individuals may complain of pain. The pain is a result of some tissues not receiving enough oxygen because of abnormal blood flow.

Diagnosis

Tests use to determine the presence of a fistula vary with the location of the fistula. When there is an opening to the outside, the physician may be able to see the fistula and probe it. Various imaging studies such as x rays, CT scans, barium enemas, endoscopy, and ultrasonography are used to locate less visible fistulas.

Treatment

Anal and rectal fistulas are treated by draining the pus the infected area. The individual also is usually given antibiotics to help prevent recurrence of the abscess. If this fails to heal the fistula, surgery may be necessary.

Intestinal fistulas are treated first by reducing the inflammation in the intestine and then, if necessary with surgery. Treatment varies considerably depending on the degree of severity of symptoms the fistula causes. TEFs are always treated with surgery. Obstetric fistulas must also be repaired with surgery. The treatment of arteriovenous fistulas depends on the size and location of the fistula and usually includes surgery.

Alternative treatment

No effective alternative treatments for fistulas are known.

Prognosis

The outcome of fistulas depends on the type and cause of the condition. Surgical repair of obstetric fistulas is almost always successful. Unfortunately, many women in developing countries do not have access to this type of surgery. Treatment of anal and rectal fistulas is almost always successful, although fistulas may recur in up to 18% of individuals. The outcome of surgery on TEFs is highly variable, especially since infants born with this condition often have other developmental abnormalities that may affect the outcome of fistula repair. The degree of successful repair of arteriovenous fistulas depends on their size and location. Uncontrolled bleeding is the most common complication of surgery to repair AVFs.

Prevention

Obstetric fistulas are the only preventable fistulas. These can be prevented with good prenatal and childbirth care and by avoiding pregnancy in very young girls. Although anal and rectal fistulas are not preventable, their damage can be minimized by prompt drainage and treatment.

Key terms

Abscess — A collection of pus surrounded by inflamed, infected tissue.

Lymphatic system — The part of the circulatory system that carries lymph, a clear fluid that is involved in immune system response.

Resources

Organizations

American Society of Colon and Rectal Surgeons. 85 W. Algonquin Road, Suite 550, Arlington Heights, IL 60005. 847-290-9184. http://www.facrs.org.

Other

Legall, Ingrid. Anal Fistulas and Fissures, 11 June 2004 [cited 16 February 2005]. http://www.emedicine.com/emerg/topic495.htm.

"Fistula." Medline Plus Medical Encyclopedia 29 October 2003 [cited 16 February 2005]. http://www.nlm.nih.gov/medlineplus/ency/article/002365.htm.

Morasch, Mark D. and Dipen Maun. Arteriovenous Fistulas, 24 October 2003 [cited 16 February 2005]. http://www.emedicine.com/med/topic169.htm.

Zagrodnik, Dennis II. Fistula-in-Ano, ii June 2004 [cited 3 March 2005]. http://www.emedicine.com/med/topic2710.htm.

fistula

[fis´tu-lah] (pl. fistulas, fis´tulae) (L.)

any abnormal tubelike passage within body tissue, usually between two internal organs or leading from an internal organ to the body surface. Some fistulas are created surgically for diagnostic or therapeutic purposes; others occur as result of injury or as congenital abnormalities. Among the many kinds of fistulas, the anal type (fistula in ano) is one of the most common. It generally develops as a result of a break or fissure in the wall of the anal canal or rectum, or an abscess there. Treatment is by surgery.

In women, difficult labor in childbirth may result in formation of a vesicovaginal fistula between the bladder and the vagina with resulting leakage of urine into the vagina. In a vesicointestinal fistula, there is leakage of urine from the bladder into the intestine. In a rectovaginal fistula, feces escape through the wall of the anal canal or rectum into the vagina. This condition, formerly a serious hazard of childbirth, is now rare; like other kinds of fistula, it can be corrected by surgery.

With the types of fistulas described here, typical symptoms are pain in the affected region and an abnormal discharge through the skin near the anus or through the vagina. Fistulas at different places of the body may be caused by tuberculosis, actinomycosis (a fungus infection), the presence of diverticula, or certain other serious diseases, and the fistula itself may be a site of infection and discomfort.

abdominal fistula one between a hollow abdominal organ and the surface of the abdomen.

anal fistula (fistula in a´no) one opening on the cutaneous surface near the anus, which may or may not communicate with the rectum.

arteriovenous fistula one between an artery and a vein, either pathologic (such as a varicose aneurysm) or surgically created to ensure an access site for hemodialysis. The site must be allowed 6 to 8 weeks to mature before it can be cannulated. Such a fistula may be the anastomosis of a natural artery and vein, a bovine graft, or a synthetic polytetrafluoroethylene (PTFE) graft. The bovine graft is taken from the bovine carotid artery and anastomosed to the vein and artery of the patient. In a PTFE graft, fibers are woven into a mesh called Gore-Tex and made into a sleeve and flange; this is available in a variety of sizes.

Precautions necessary to insure patient safety when caring for an individual with an arteriovenous fistula include frequent assessments for adequate circulation in the fistula and the distal extremity. A bruit or thrill can be heard over the access site. Blood pressure measurements, withdrawal of blood, injections, and administration of intravenous fluids should not be done on the extremity with such a fistula.

Internal arteriovenous fistulas.

blind fistula one open at one end only, opening on the skin (external blind fistula) or on an internal surface (internal blind fistula).

branchial fistula a persistent pharyngeal groove (branchial cleft).

Brescia-Cimino fistula an arteriovenous fistula for hemodialysis access, connecting the cephalic vein and radial artery.

bronchopleural fistula one between a bronchus and the pleural cavity, causing an air leak into the pleural cavity; sometimes seen as a complication of empyema, fibrosis, or pneumonia.

cerebrospinal fluid fistula one between the subarachnoid space and a body cavity, such as from head trauma or bone erosion, with leakage of cerebrospinal fluid, usually in the form of rhinorrhea or otorrhea.

complete fistula one extending from the skin to an internal body cavity.

craniosinus fistula one between the cerebral space and a paranasal sinus, permitting escape of cerebrospinal fluid into the nose.

Eck's fistula an artificial communication made between the portal vein and the vena cava.

enterocutaneous fistula see enterocutaneous fistula.

enterovesical fistula one connecting some part of the intestine with the urinary bladder; called also vesicoenteric f.

fecal fistula one between the colon and the external surface of the body, discharging feces.

gastric fistula

1. one communicating between the stomach and some other body part.

2. a passage created artificially through the abdominal wall into the stomach.

horseshoe fistula one near the anus, having a semicircular tract with both openings on the skin.

incomplete fistula blind fistula.

perilymph fistula rupture of the round window with leakage of perilymph into the inner ear, so that changes in middle ear pressure directly affect the inner ear, causing sensorineural deafness as well as dizziness, vertigo, nausea, and vomiting. Head trauma and dramatic changes in atmospheric pressure are the most common causes. The usual treatment is restriction in activity (sometimes with complete bed rest), so that the fistula can heal. Surgical repair may be necessary, consisting of placement of a graft over the defect.

pilonidal fistula pilonidal sinus.

pulmonary arteriovenous fistula a congenital fistula between the pulmonary arterial and venous systems, allowing unoxygenated blood to enter the systemic circulation.

rectovaginal fistula one between the rectum and vagina.

rectovesical fistula one between the rectum and urinary bladder.

salivary fistula one between a salivary duct or gland and the cutaneous surface, or into the mouth through an abnormal pathway.

thoracic fistula one communicating with the thoracic cavity.

umbilical fistula one communicating with the intestine or urachus at the umbilicus.

urinary fistula any fistula communicating between the urinary tract and another organ or the surface of the body.

vesicoenteric fistula (vesicointestinal fistula) enterovesical fistula.

vesicovaginal fistula one from the bladder to the vagina.

fis·tu·la

, pl.

fis·tu·lae

fis·tu·las

(fis'tyū-lă, -tyū-lē, -tyū-lăz),

An abnormal passage from one epithelial surface to another epithelial surface.

[L. a pipe, a tube]

fistula

(fĭs′chə-lə)

n. pl. fistu·las or fistu·lae (-lē′)

1. A duct or passage resulting from injury, disease, or a congenital disorder that connects an abscess, cavity, or hollow organ to the body surface or to another hollow organ.

2. Such a passage that has been created intentionally, especially a surgically constructed connection between an artery and a vein that is used for vascular access in hemodialysis.

fistula

Surgery An abnormal communication or conduit between one internal organ and another or with the skin surface. See Gastrointestinal fistula, Inner ear fistula, Urinary fistula.

fis·tu·la

, pl. fistulae, pl. fistulas (fis'tyū-lă, -lē, -lăz)

An abnormal passage from one epithelialized surface to another, either congenital, caused by disease or injury, or created surgically.

[L. a pipe, a tube]

fistula

An abnormal communication between any part of the interior of the body and the surface of the skin, or between two internal organs. Fistulas may be present at birth (congenital) or may arise as a result of disease processes such as abscesses or cancer.

fistula

An unnatural passage from an organ to the body surface or from one organ to another.
carotid-cavernous fistula An abnormal interconnection between the internal carotid artery and the cavernous sinus. It may be caused by trauma to the skull or orbit, vascular disease or systemic hypertension. Common signs are pulsating proptosis, eye redness, diplopia, dilated epibulbar vessels and bruit. The pressure in the orbital veins is elevated as a result of the flow of arterial blood into the cavernous sinus.
lacrimal fistula An abnormal opening from the skin onto any part of the lacrimal passage, although most often the lacrimal sac. It may follow a severe acute dacryocystitis.

fis·tu·la

, pl. fistulae, pl. fistulas (fis'tyū-lă, -lē, -lăz)

An abnormal passage from one epithelial surface to another.

[L. a pipe, a tube]

Patient discussion about fistula

Q. I developed an AV Fistula after a heart catherization procedure. I am bleeding through the tissues in left arm I am on coumadin, but currently have a lower than usual INR. Corrective surgery was scheduled for yesterday, but had to be delayed. I am concerned that I have a large amount of blood (dark red) bleeding though the tissues right under the skin in my left arm. Should I seek immediate medical attention? The bleeding is over approximately a 3 and 1/2" area on my left arm. Came about in a period of a few minutes.

A. well, you are on blood thinners. i wouldn't take the chance. i mean- i'm not sure i follow what is happening over there. it could be a severe problem or nothing. i would let a doctor check it out. the worse thing that could happen is you wasting a day at the hospital, on the other end of that scenario- you can end up dead. i would go with the first one.

More discussions about fistula

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