DrE: Stoma

Question 1

Stoma examination: inspection

Answer 1

Start: pt exposed to underwear, pt initially flat, stoma bag removed for thorough examination of op site and bag constituents

ask re pain

Inspection:

• Site: ideally away from bony prominence, scars and skin folds
  
  • ​epigastric - PEG & transverse loop colostomy
  • RIF - ileostomy
  • LIF - colostomy
• Bag & contents:
  
  • fluid - small bowel contents (ileostomy)/urine (urostomy
  • solid - large bowel contents (colostomy)
• Spout:
  
  • present = ileostomy
  • flush to skin = colostomy
• Lumen:
  
  • 1 = end
  • 2= loop
• Mucosa; health/inflammaed/ulcerated
• Scar: assoc scars indicate underlying procedure
• old sites
• Complications:
  
  • anatomical - prolapse, retraction, stenosis, parastomal herniae
  • dermatological - skin discomfort, escoriation
  • metabolic - electrolyte imbalance
  • vascular - haemorrhage, ischaemia, gangrene
  • psych - psychosexual disturbance
  • other - assoc gallstone disease
• Perineum - anus absent in AP resection

Question 2

stoma examination: palpation

Answer 2

• Temp discrepency - back of hand
• lumen - finger into lumen to ensure adequate patency
• parastomal hernia - and check for cough impulse
• stoma bag: 1 piece/2 piece with base plate

Question 3

Stoma examination: auscultation

Answer 3

presence/absence of bowel sounds

character of bowel sounds - obstriction = tinckling

Question 4

Stoma examination: completion

Answer 4

full abdo exam

Question 5

what is an enteric surgical stoma?

Answer 5

An iatrogenic opening that connects part of the bowel to the outside world

Question 6

How would you classify enteric surgical stomas?

Answer 6

• end:
  
  • ileostomy: panproctocolectomy
  • colostomy: hartmann’s (rectosignmoid emercencies), AP resection
• loop:
  
  • ileostomy: diversion, protect distal anastomosis
  • colostomy: palliative, diversion (pre-cheom/radio)

Question 7

What are the clinical indications for an enteric surgical stoma?

Answer 7

• Feeding: enteral feeding preferred to TPN e.g. PEG/PEJ
• Diversion: temporarily protects distal bowel with view to later reversal e.g. defunctioning loop ileostomy (primary bowel anastomosis CI.distal abscess/fistula)
• Lavage: temporary stoma for on table lavage prior to bowel resection
• operation: hartmann’s procedure requires temp colostomy that can be later reversed or AP resection requiring permanent colosctomy or panproctocolectomy requiring permanent ileostomy