Which fistula type is associated with the greatest degree of nutritional loss?

• A. Proximal high output
• B. Distal high output
• C. Proximal low output
• D. Distal low output

Answer: (A)

High-output fistulas drain large volumes of intestinal contents, and when this is proximal, you also lose stomach, pancreatic, and biliary secretions into the fistula output. That combination means substantial losses of calories, protein, electrolytes, and fluids, driving the greatest degree of nutritional depletion. Distal or low-output fistulas, even if present, lose much less volume and fewer digestive secretions, so the overall nutritional impact is smaller.