9. Living with Stoma & Stoma Management Flashcards
Stoma
- Stoma is a Greek word meaning ‘mouth’ or ‘opening’
- In this context it is an opening of the bowel onto the abdominal wall for the passage of faeces or urine
- Colostomy
- An opening of the large bowel or colon
- The faeces is usually firm or formed
- Colostomy pouches are usually closed pouches which get changed 1 or 2 times a day
Indications for Colostomy Formation
- Cancer
- Inflammatory bowel disease (IBD)
- Diverticulitis
- Trauma
- Ischaemic bowel
- Congenital abnormalities
- Chronic faecal incontinence
- Illeostomy
- Opening of the small bowel, or ileum
- Faeces is liquid like or paste like
- Ileostomy pouches have an opening for emptying faeces – usually ~4 – 5 times a day
- Pouches stay on for 3 or 4 days
Indications for ileostomy formation
- Anterior resection with covering loop ileostomy for anastomosis of resected lower bowel/rectum for cancer
- Ulcerative colitis
- Crohn’s disease
- Ischaemic bowel
- Trauma
- Urostomy
- For drainage of urine following a cystectomy (removal of the bladder)
- Ileal conduit – part of the small bowel is used to form a tube with ureters at one end & a stoma at the other end to drain urine through
- Urostomy pouches have a tap at the bottom for draining urine into the toilet & for attaching a urine bag at night time
- The pouches usually stay on for 3 or 4 days
Indications for ileal conduit
- Bladder cancer
- Pelvic cancers
- Interstitial cystitis
- Congenital conditions
Stoma formation
- Intestine is fed through an opening in the abdomen
- It is then inverted and stitched to attach it to the abdomen
Appliances/pouches
- One piece pouch
- 2 piece appliance (flange & pouch)
- Closed pouch
- Drainable pouch
- Urostomy pouch
Medicines & Ostomates
Ileostomies:
High output > ~1000 mL per day (depends on patient’s size)
- Electrolyte replacement solutions (Enerlyte, Pedialyte, Electral)
- Loperamide – Nodia now brand of choice as can be dissolved in small amount of water
+ Needs to be easily absorbable
+ Capsules should be broken up & contents put into water or with something like yoghurt
- Codeine phosphate – usually short term use as can lead to physical dependence
Electrolyte replacement
- Patients advised to have one or 2 sachets per day in water for high output stoma (>1000 mL/day)
- May need more if output is very watery
- Patients sometimes advised to have electrolyte solution instead of plain water
Antidiarrhoeals
Loperamide slows intestinal peristalsis:
- Patients advised can have up to 16 mg per day for high outputs to aim for paste-like consistency from stoma & titrate accordingly
- 4 mg half hour before meals & 4 mg before bed for high output
- Doctors can prescribe higher doses for very high output
Psyllium:
- Metamucil & Konsyl D – absorbs fluid from the stool & bulks up
Medication effects
Diarrhoea (high output)
- Antibiotics
- Metoclopramide
- Lactulose
- Digitalis
- Some antihypertensives
Discolouration of Stoma Output:
- Iron supplements – black
- Antibiotics – green/grey
Topical applications
- Dimethicone (Cavilon) barrier cream for reddened skin around colostomies
- Miconazole for fungal infections – with hydrocortisone if there is also pruritis (Micreme H)
- Corticosteroid creams with or without anti-infective agents
- Use creams NOT ointments
Application of stoma pouches
- Stoma pouches do not stick to greasy skin
- Dimethicone can be applied sparingly around stoma before applying pouch
- For other topical creams patient is advised to:
+ Choose time when stoma is quiet
+ Remove old pouch, clean & dry peristomal skin
+ Apply cream, leave on for half hour, then wash off with water
+ Apply new pouch
