Abdomen Flashcards
What is a stoma?
In anatomy, a stoma is any opening in the body. For example, a mouth, a nose, and an anus are natural stomata. Any hollow organ can be manipulated into an artificial stoma as necessary. This includes the oesophagus, stomach, duodenum, ileum, colon, pleural cavity, ureters, urinary bladder, and renal pelvis.
What are the features and indications for an end ileostomy?
- Permanent if the operation is a panproctocolectomy (no anus)
- Temporary if the operation is a total colectomy (removal of colon but not rectum). Removed after ileal pouch-anal anastomosis (IPAA).
Sprouted. Usually located in the right iliac fossa.
Panproctocolectomy is usually carried out for UC or FAP.
Total colectomy is carried out for UC, FAP or Crohn’s or colorectal cancer.
What are the features and indications for a loop ileostomy?
Temporary stoma to defunction distal bowel. It may be supported by a bridge or rod.
Sprouted. Usually located in the right iliac fossa.
Usually after anterior resection (removal of rectum through anterior approach rather than abdomino-perineal approach, in order to preserve sphincter). Or Crohn’s
What are the features and indications of an end colostomy?
- Permanent if the patient has had an AP resection (so not left with a rectum or sphincter).
- Temporary if a Hartmann’s procedure is performed (rectal stump is closed rather than anastomosed during a difficult or emergency).
Not-sprouted. Usually located in the left iliac fossa.
What are the features and indications of a loop colostomy?
If in the right upper quadrant this may indicate a transverse colostomy to defunction a distal anastomosis (rarely performed).
If in the left iliac fossa this may be due to sigmoid colostomy without resection of inoperable rectal cancer which is likely to cause obstruction.
Not-sprouted.
What types of stomas tend to be found in the left iliac fossa?
Colostomy
What types of stomas tend to be found in the right iliac fossa?
Iliostomy or urostomy
What types of stomas tend to be found in the right upper quadrant?
Transverse (loop) colostomy - to defunction a distal anatastamosis (rarely performed)
What are the complications of a stoma?
Early:
- Haemorrhage
- Ischaemia
- High-output (which can cause hypokalaemia)
- Parastomal abscess
- Stoma retraction
Late:
- Parastomal hernia
- Obstruction - adhesions or herniation through lateral space around stoma
- Dermatitis (especially with ileostomy)
- Stoma prolapse
- Psychosexual dysfunction
- Stenosis or stricture
- Fistula
What are the types of urostomy?
Tell me about this scar:
Midline Laparotomy
Good access
Bloodless line
Minimal nerve and muscle injury
Indications:
Emergency:
- Perforated duodenal ulcer
- Trauma
- Ruptured AAA
- Hartmann’s
Elective:
- Colectomy
- AAA
- Vascular bypass
What is the name of this scar?
Right paramedian
Tell me about this scar:
Kocher’s (Subcostal)
Indications:
Open cholecystectomy.
Left Kocher’s is used for splenectomy
Tell me about this scar:
Chevron/Rooftop modification (from Kocher’s).
And Mercedes Benz = rooftop + break of xiphisternum.
This may be used for oesophagectomy, gastrectomy, bilateral adrenalectomy, hepatic resections, or liver transplantation.
The Mercedes Benz is particularly associated with liver transplantation
Tell me about this scar:
Pfannenstiel
Indications:
- Gynae surgery
- Lower urinary tract / bladder surgery.
Tell me about these scars:
McBurney’s: Oblique
Lanz: Transverse
Lanz is preferred as is hidden in skin crease.
Risk of injury to ilioinguinal and iliohypogastric nerves may predispose to inguinal hernia.
Both for appendicectomies.
Tell me about this scar:
Transverse muscle splitting
For a right hemicolectomy. Limited access compared to midline incision, but less damage to rectus.
Segmental nerve supply means the muscle can be cut transversely w/o weakening
Tell me about this scar:
Right Inguinal
Incision over the inguinal ligament Follow’s Langer’s Lines
High rates of chronic neuropathic pain.
Indications:
- Open Inguinal Hernia Repair
- Orchidectomy
Tell me about this scar:
Loin
For nephrectomy
