Gen Surg: Stomas Flashcards
What is a stoma?
Surgically created opening of a tube (bowel or urinary tract) to a body surface (usually abdomen - collection bag attaches over stoma
What are defunctioning stomas?
Temporary stomas eg loop colostomy/ielostomy
Are used to relieve distal obstruction or to protect distal anastomases
Aim to prevent digested produces reaching a distal section of bowel
Allow healing of an anastomoses or resolution of infection prior to reversal
What is an ileostomy?
Formed from any part of the mid or distal small bowel.
What’s the difference between end and loop ileostomy?
- Loop (often to rest the distal bowel )
- Section of bowel incised (ie its cut at one side and brought to the surface)
- Often temporary
- Defunctioning
- End (usually as a result of surgical removal of distal bowel
- Ends at abdominal wall,
- Single lumen of bowel
- Usuall after total colectomy
What is a colostomy?
Formed from any part of the large bowel. May be loop (to rest distally) or end (due to surgical resection)
What is a urostomy?
Ureters are ‘plumbed’ into the proximal vascularised isolated loop of ileum. The distal end is brought out as a stoma.
What is a gastrostomy?
Either surgically created or endoscopically formed connection between anterior stomach and anterior abdominal wall. Often for stomach drainage or direct feeding
What is a jejunostomy?
Either surgically or endoscopically created connection between the proximal jejunum and anterior abdominal wall. It is often used for direct feeding
What features of a stoma might suggest that it is a ileostomy?
- Spouted (so as to prevent iritant liquid from contacting skin),
- Liquid contents (so raised)
- Have prominent mucosal folds,
- Tend to be dark pink/red in colour,
- Most common on the right side fot he abdomen (between ASIS and umbillicus) - Ileostomy on the right
What features of a stoma would suggest that it is a colostomy?
- Usually flush,
- Formed stool (direct contact with skin)
- Have flat mucosal folds,
- Tend to be light pink in colour,
- Most common in the left side of the abdomen
What features of a stoma suggest that is a urostomy?
Usually spouted, have prominent mucosal folds, tend to be dark pink/red in colour, and are most common in the right side of the abdomen.
These are indistinguishable from ileostomies unless output can be seen - urine
What are features of a stoma which suggest that it is a gastrostomy or a jejunostomy?
Narrow calibre, flush with little visible mucosa, most common in upper left quardrant. They are usually fitted with indwelling tubes or access devices
Why is an ileostomy made into a spout?
The small bowel produces digestive enzymes which if spilled onto the skin will result in excoriation
What are complications of ileostomies/colostomies?
- Skin irritation (iloestomy) dermatitis
- Ileostomies can result in electrolye imbalance due to large fluid loss
- Prolapse (protrudes out)
- Ischaemia from strangulation or systemic infection/sepsis (necrotic/gangrenous)
- Retraction and stenosis (pulled back into cavity, tight)
- Parastomal hernia - Poor bag adherence, Leakage and excoriation, Loss of patient’s feeling of security (high pressure)
- High output
- Poor placement - Leakage and excoriation, Loss of patient’s feeling of security
- Stenosis
- Fistula formation
- Psychological impact
What are categories of poor function of a stoma?
- Non-passage of GI content
- Overactivity
What might excoriation around a stoma sight indicate?
This suggests small bowel enzymes digesting the skin and this can lead to poor adherence of the stoma bag
What are loop ileostomies and loop colostomies used for?
To divert enteric and faecal content away from:
- Distal anastomosis
- Obstructed distal bowel
- Distal tumour (e.g. sigmoid carcinoma)
When are end colostomies used in an elective setting?
- After APER (Abdomino-perineal resection of rectum)
-
As part of Hartmann’s procedure
- Locally advanced rectal cancer
- Anastomosis deemed to be dangerous
