Colorectal surgery: Stomas

Question 1

What type of stoma is this? [1]

Answer 1

Colostomy: flushed appearance

Question 2

What type of stoma is this? [1]

Answer 2

Ileostomy: spouted appearance

Question 3

What type of stoma is this? [1]

Answer 3

Loop stoma

Question 4

What type of stoma is this? [1]
Label which of A & B is the proximal and distal part [2]

Answer 4

Double barrel stoma
A: Proximal
B: Distal

Question 5

State the following for an ileostomy [6]

Where it is formed
Appearance
Location
Contents
Quantity
Odour

Answer 5

Ileostomy
Small intestine
Spout appearance
RIF site
Liquid / semi liquid formed
Large volume
Mild odour

Question 6

State the following for an colostomy [6]

Where it is formed
Appearance
Location
Contents
Quantity
Odour

Answer 6

Colostomy
Large intestine
Flush appearance
LIF
Formed / more solid contents
Small volume
Offensive odour

Question 7

Why are ileostomies often irritated? [1]

Answer 7

Ileal contents have digestive enzymes and acids that may cause skin irritation

Question 8

Describe the formation of ileo- & colostomies [2]

Answer 8

Ileostomy: spouted at least 2cm from skin level

Colostomy: mucosa level with skin

Question 9

Which muscle do you use when stoma site marking? [1]

Answer 9

Rectus muscle; at least 2/3” away from scars / bony prominance

Question 10

State what the three different types of colostomy are [3]

Answer 10

Loop colostomy
End colostomy
Double barrel colostomy

Question 11

Describe what a loop colostomy is [3]

Answer 11

Temporary stoma used to allow a distal portion of the bowel and anastomosis to heal after surgery

Allow faeces to bypass the distal, healing portion of bowel until healed and ready to restart normal function, by draining into a stoma bag

They are usually reversed around 6-8 weeks later

Question 12

Describe how you differentiate between the proximal and distal end of a loop colostomy [1]

Answer 12

The proximal end (the productive side) is turned inside out to form a spout to protect the surrounding skin.

This distal end is flatter

Question 13

Describe what a double barrel stoma is [1]

Answer 13

Divides the colon into 2 ends that form separate stomas:

Stool exits from one of the stomas & mucus made by the colon exits from the other

Question 14

Describe what is meant by pancaking of a stoma [1]

Answer 14

Internal layers of the stoma bag stick together causing a vacuum which prevents the contents from dropping to the bottom. The stool remains at the top of the stoma bag which can potentially block the filter. The bag can also be forced off the body.

Question 15

Physiological complications of high output ileostomy? [2]

Answer 15

○ > 1.5 - 2 litres

○ Fluid & Electrolyte imbalance
■ Dehydration, AKI
■ ↓Na, ↑K, ↓Mg (Addison’s picture)
■ Vitamin B12, Folate Def.}}

Question 16

Problems associated with low volume ileostomy? [2]

Answer 16

● Low Volume (↓frequency & or quantity)
○ Stenosis
○ Impending obstruction}

Question 17

Treatment for high output stomas? [5]

Answer 17

● Hydrate (fluid and high salt replacement)
○ Glucose-electrolyte solution aids sodium absorption
○ Restrict low sodium (Hypotonic) fluid (500-1000ml/day)

● Anti-diarrhoeal medication, eg loperamide

● Anti-secretory drugs
○ PPI (omeprazole) ○ Octreotride (rarely)

● Correct Hypomagnesaemia

● Opiates (codeine phosphate)

Question 18

Where exactly are loop colostomies located? 1[]

Answer 18

usually in the right transverse colon, proximal to the middle colic artery

Question 19

Ileostomies can be low or highoutput:

Low output tends to output [] ml/day for a low output ileostomy, and [] ml/day for a high output ileostomy

Answer 19

tends to output 500 ml/day for a low output ileostomy, and 1000 ml/day for a high output ileostomy

Question 20

How do you know if stoma retraction has occurred? [2]

Answer 20

Stoma retraction presents with persistent leakage and peristomal irritant dermatitis.

Question 21

When is stoma ischaemia most likely to occur? [1]

Answer 21

24hrs post op

Question 22

Define what is meant by a parasternal hernia [1]

Answer 22

Parastomal hernia is a type of incisional hernia occurring in abdominal integuments in the vicinity of a stoma, i.e. a condition wherein abdominal contents, typically the bowel or greater omentum, protrude through abdominal integuments surrounded by the hernia sac at the location of formed stoma

Question 23

How do you determine if a stoma has a parasternal hernia?

Answer 23

Positive cough impulse and and lump at the hernia site