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Ostomy 2.2 > Lessons 8-11: Colostomy In Adults > Flashcards

Lessons 8-11: Colostomy In Adults Flashcards

1
Q

Colostomy Options

A
  • end stoma
  • end stoma with distal bowel and sphincter intact (Hartmann’s Pouch)
  • end stoma with mucous fistula
  • loop colostomy
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2
Q

Indications for temporary colostomy - colonic perfusion

A
  • trauma, ischemic damage, or severe damage
  • sudden spillage of stool and bacteria into abdo
  • diverticulitis
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3
Q

Indications for temporary colostomy - colonic obstruction

A
  • tumour, structures, volvulus
  • goal is to restore fecal elimination and prevent perforation
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4
Q

Indications for temporary colostomy - protection of distal anastomosis

A
  • Anastomosis under tension
  • Anticipated delays in healing d/t comorbidities
  • Overwhelming infection/sepsis/inflammation
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5
Q

Indications for temporary colostomy - bowel rest for refractory inflammation

A
  • crohns colitis
  • crohns proctitis
  • anorectal disease
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6
Q

Indications for temporary colostomy - healing

A
  • rectovaginal fistula
  • complex pressure injuries
  • extensive perineal wounds
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7
Q

Indications for permanent colostomy

A
  • intractable crohns with rectum and anal canal
  • cancer involving distal rectum
  • intractable fecal incontinence
  • colorectal cancer
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8
Q

Colorectal cancer - Etiology

A
  • Adenocarcinoma most common
  • Starts as single cell that transforms and begins abnormal growth
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9
Q

Colorectal cancer - Risk Factors

A

Non-modifiable
- Age >50
- Family history of polyps or colorectal cancer
- Genetic predisposition
- IBS

Modifiable
- High fat, low fiber diet
- Sedentary lifestyle
- Obesity

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10
Q

Colorectal cancer - clinical presentation

A
  • Blood in stool
  • Ribbon-like stools
  • Generalized abdo pain
  • Weight loss
  • Fatigue and anemia (d/t chronic bleeding)
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11
Q

Colorectal cancer - diagnostics

A

Colonoscopy and biopsy
- Metastatic workout
- MRI or endoscopic ultrasound
- CT chest/abdo/pelvis
- Carcinoembyronic antigen (CEA)

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12
Q

Colorectal cancer - staging

A

Stage 0: tumor limited to mucosal layer of bowel
Stage 1: tumor confined to bowel wall with negative nodes
Stage 2: tumor extended to through outer layers of bowel with negative nodes
Stage 3: tumor extends to/through outer layers of bowel with positive nodes
Stage 4: any degree of tumor invasion with positive nodes and distant metastasis

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13
Q

Colorectal cancer - treatment

A

Stages 1-3
- Surgical resection with end-to-end anastomosis
- All colon between main vessels proximal and distal to tumor
- Wide margins
- If large obstructing tumor, possible temp diversion

Stage 4
- If resectable = surgical resection with chemo
- If unresectable and obstructing = fecal diversion with chemo
- If unresectable and nonobstructing = chemo only

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14
Q

Colorectal cancer - surgical resection

A

Goal: remove segment of rectum, tumor, adjacent tissues, and regional lymph nodes

Stage 1 = Transanal resection
- Mid to upper rectum = lower anterior resection
- Distal rectum = abdominal perineal resection

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15
Q

Surgical Construction - End Stoma

A
  • singe opening
  • For abdo perineal resection
  • Distal bowel, anal canal, and sphincters removed
  • Colostomy is permanent
  • Proctectomy - perineal wound d/t rectal resection
    — Anal opening closed with sutures +/- drain
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16
Q

Surgical Construction - Loop Stoma

A
  • 2 openings
  • Proximal - mouth to stoma
  • Distal - stoma to anus
  • Disease/damaged section of bowel is removed
  • Usually temporary
  • As risk for diversion colitis if reversal is delayed
    — Gut flora becomes imbalanced from isolation from functional colon
17
Q

Surgical Construction - End Stoma with Mucus Fistula

A
  • 2 openings
  • Diseased/damaged section of bowel removed
  • Both ends of bowl on surface as stomas
  • Proximal = stool (needs pouch)
  • Distal = mucous
  • If close together, can pouch as one
18
Q

Surgical Construction - Loop Colostomy

A
  • Bowel is not divided
  • Entire loop of bowel brought to surface and stabilized
  • Proximal = stool
  • Distal = mucous
  • Loop support in place for 5-14 days
  • Pouch over or around
19
Q

Implications for Anatomical Location - Cecostomy

A
  • For obstructing mass in colon
  • Not a true stoma - a tube diversion
  • Output is semi-liquid and malodorous
  • Begins functioning at 2-3 days postop
20
Q

Implications of Anatomical Location - Ascending Colostomy

A
  • Output like cecostomy
  • Output is semi-liquid and malodorous
  • Requires drainage pouch
  • Begins functioning at 2-3 days postop
21
Q

Implications of Anatomical Location - Transverse Colostomy

A
  • Output is mushy and malodorous
  • A large stoma - requires pouch
  • Begins functioning 3-5 days postop
22
Q

Implications of Anatomic Location - Descending or Sigmoid Colostomy

A
  • Output is pasty-formed, mild odor
  • Can be irrigated
  • Requires pouch - drainable or closed-end
23
Q

Colostomy Self Care - Pouch Selection

A
  • All patients should be taught with drainable pouch
  • Can transition to closed end if option
  • Usually for descending or sigmoid colostomy
24
Q

Colostomy Self Care - Pouch Emptying

A
  • When ⅓ - ½ full
  • Usually 1-3 times day
  • Either open and drain (drainable) or removed and replace (closed-end)
25
Q

Colostomy Self Care - Pouch Change

A
  • Standard approach
  • Remove, skin cleanse, measure, cut, apply
  • Can use paste/barrier ring for liquid/mushy stool
26
Q

Colostomy Self Care - Odor Control

A
  • Clean bottom of pouch thoroughly
  • Pouches are usually odor-proof
  • Use of pouch and room deodorants
  • Rx
    — Chlorophyllin 100 mg PO OD - BID
    — Bismuth Subgallate 1-2 tabs PO TID - QID
    —— Thickens and deodorizes stool
    —— Constipation risk!
    —— Color becomes dark green/black
27
Q

Colostomy Self Care - Gas Control

A
  • Colostomy > ileostomy
  • Identify gas-forming foods
  • Lag time from intake to gas (usually 4-8 hours)
  • Rx
    — Beano (gas-controlling)
    — Simethicone (reduces size of gas bubbles)
28
Q

Colostomy Self Care - Dietary Guidelines

A
  • no absolute
  • fiber and fluid intake critical
29
Q

Constipation

A
  • Descending and sigmoid colostomy at greatest risk
  • Fluids + fiber!
  • Signs/symptoms
    — Hard stools
    — Bloating
    — Cramping
    — No ostomy output >24 hours
  • Management
    — OTC laxatives
    — Irrigation PRN
30
Q

Diarrhea

A
  • Common in ascending or transverse colostomy
  • Management
    — Fluid + electrolyte intake
    — BRAT diet
    — Can take liquid antidiarrheal meds
31
Q

Colostomy Irrigation

A
  • Regulates stool elimination via “training” the bowel on a strict schedule
  • Goal is modified continence when the bowel empties on a schedule with minimal leakage between irrigations
  • Can be time consuming and required strict schedule
32
Q

Colostomy Irrigation - Contraindications

A
  • Children
  • Poor prognosis
  • Active bowel disease
  • Hx of frequent diarrhea
  • Ongoing chemotherapy
  • Stoma complications
33
Q

Colostomy Irrigation - Procedure

A
  • Fill irrigation bag with 1 L tepid water
  • Flush air from tubing
  • Attach irrigation sleeve to stoma
  • Lubricate cone tip and insert into stoma
  • Open clamp and allow water to flow
  • Goal = 1 L fill in 5-10 mins
  • When patient feels full, clamp and remove
  • Close top of irrigation sleeve and wait
  • Once returns are complete, remove sleeve and pouch up
34
Q

Colostomy Irrigation - Complications

A
  • difficult instillations
  • failure of returns
  • vasovagal response
  • rebound constipation

Ostomy 2.2 (15 decks)

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