Ostomies/Stomas & Obesity

Question 0

What are the 3 curative surgical procedures indicated for Chronic Ulcerative Colitis?

Answer 0

1) Total colectomy with rectal mucosal stripping and ileoanal reservoir
2) Total protolectomy with continent Ileostomy (Kock pouch)
3) Total protolectomy with permanent Ileostomy

Question 1

What are the 7 Indications for a stoma as discussed in class?

Answer 1

1) Crohn’s Disease
2) Ulcerative Colitis
3) Cancer
4) Familial Polyposis
5) Diverticulitis
6) Congenital Conditions
7) Stab/Gunshot wounds

Question 2

What is removed during a protolectomy?

Answer 2

The rectum and the colon

Question 3

What are the 6 characteristics of a Total Colectomy with Rectal Mucousal Stripping and Ileoanal Reservoir?

Answer 3

1) Combination of two surgeries
2) 1st surgery Ileostomy is created
3) 2nd surgery Ileostomy is closed
4) Surgeries are 8-12 weeks apart
5) Adaptation of reservoir takes 3-6 months
6) Patient is able to control defication at anal sphincter

Question 4

What are the 4 characteristics of a Total Protolectomy with Continent Ileostomy (Kock Pouch)?

Answer 4

1) Rarely used today
2) Intra-abdominal pouch stores feces, made from terminal ileum, stoma flush with skin
3) One-way valve on abdomen, drained at regular intervals with catheter
4) Problems include: valve failure, leakage, and pouchitis

Question 5

What are the 5 characteristics of a Total Protolectomy with Permanent Ileostomy?

Answer 5

1) One-Stage operation
2) Removal of colon, rectum, and anus with closure
3) Stoma made from terminal ileum
4) Continence is not possible
5) Stoma created in RLQ

Question 6

What are the 4 characteristics of an Ileoanal Anastomosis (Ileorectostomy)?

Answer 6

1) Does not require Ileostomy
2) 12-15 cm stump left after colon removed
3) Small intestine inserted into rectal sleeve and anastomosed
4) Requires intact rectum

Question 7

What two class of meds are administered to patients preop to Ileostomy/colostomy patients to prepare them for surgery?

Answer 7

1) Antibiotics

2) Laxatives/Enemas

Question 8

What 3 thing s should you monitor your patient for when they are post-op for Ileostomy/Colostomy?

Answer 8

1) Stoma color (bright red and shiny), unusual bleeding and necrotic tissue.
2) Monitor output - Colostomy stool is liquid immediately post-op but becomes more solid overtime. Ileostomy stool is always liquid.
3) Monitor for skin irritation around stoma.

Question 9

When should a Ileostomy/Colostomy pouch be emptied?

Answer 9

When it is 1/3 full

Question 10

Between an Ileostomy and a Colostomy, which puts at a higher risk for dehydration and electrolyte imbalance and why?

Answer 10

Ileostomy - because water is absorbed in the colon and the GI contents are no longer reaching that far down the GI tract.

Question 11

What are the 4 common Ileostomy/Colostomy post-op complications?

Answer 11

1) Hemorrhage
2) Abdominal abscess
3) Small bowel obstruction
4) Dehydration

Question 12

What do the following stoma colors indicate:

1) Pink to bright-red and shiny-high vascularity
2) Pale pink
3) Purple-black

Answer 12

1) Pink to bright-red and shiny-high vascularity - Normal
2) Pale pink - Low H&H
3) Purple-black - Compromised circulation

Question 13

What are the 3 implications of having a terminal ileum surgery/inflammation?

Answer 13

1) ⬇ Absorption of Cobalamin (Vit-B12) resulting in Pernicious Anemia.
2) Tx with Vitamin B12 injections once per week initial and then once per month, or PO/nasal spray every day.
3) Iron supplements
4) Folic Acid supplements

Question 14

Where in GI tract is a Cecostomy coming from?

Answer 14

The cecum is the beginning of the large intestine, right above the appendix.

Question 15

What are the 3 causes of a disappearing stoma?

Answer 15

1) Thick abdominal wall (obesity)
2) Scar tissue
3) Adhesion

Question 16

What two methods are used to treat a disappearing stoma?

Answer 16

1) Use of an appliance with convexity

2) Surgical revision

Question 17

What can cause a stoma to pert rude and what 3 methods are used to treat it?

Answer 17

1) Caused by weak abdominal muscles

2) Treated by pushing stoma back, binding, or surgery

Question 18

What are the 3 characteristics of a Stoma?

Answer 18

1) Mild to moderate edema is normal for up to 2-3 weeks
2) Mild bleeding is normal because Stomas are highly vascular
3) Moisture is normal

Question 19

What are the 4 causes of bulging around a stoma?

Answer 19

1) Protrusion of bowel around the stoma
2) Weak abdominal muscles
3) Obesity
4) Heavy lifting

Question 20

What are the 4 methods used to treat bulging around a stoma?

Answer 20

1) Abdominal binder
2) Weight control
3) Progressive exercise
4) Surgical revision

Question 21

How should a stoma be cleansed and how often should the appliance be changed?

Answer 21

1) Clean with warm Warner and pat dry

2) Re-pouch with appropriate appliance q5-7 days

Question 22

What are the 7 characteristics of Colostomy irrigation?

Answer 22

1) It stimulates bowel emptying
2) It’s more successful with formed stools
3) Use 500-1000 mL of Luke-warm water
4) Prime tubing with water
5) Hang container above stoma
6) Allow fluid to flow 5-10 mins (if cramping occurs, clamp irrigation, you may continue irrigating if cramping subsides)
7) Allow 30-40 mins for output after removing irrigation tubing

Question 23

What are the 5 criteria required for Bariatric Surgery?

Answer 23

1) BMI > or equal to 40 with one or more obesity related complications
2) 18 years or older
3) Understands the risks and benefits
4) Has been obese for more than 5 years
5) Has tried and failed to lose weight

Question 24

What are the 3 broad categories of Bariatric Surgery?

Answer 24

1) Restrictive - Vertical and circumgastric banding
2) Malabsorptive - Biliopancreatic diversion (BPD)
3) Combination of restrictive and malabsorptive - Roux-en-Y

Question 25

What are the 4 characteristics of Restrictive Bariatric Surgery?

Answer 25

1) ⬇ the size of the stomach to 30 mL or less
2) Causes the patient to feel full more quickly
3) Normal stomach digestion and intestinal absorption of food, which ⬇ risk of anemia but weight loss is slower.
4) two types: vertical banding and circumgastric banding

Question 26

What is the difference between the vertical banding and circumgastric banding methods of Bariatric Surgery?

Answer 26

1) Vertical banding - Staples create small stomach leading to small intestines
3) Circumgastric banding - An inflatable band is placed around the stomach, leading to the small intestine (AKA lap band)

Question 27

What are the 4 characteristics of the Malabsorptive type of Bariatric surgery called Biliopancreatic Diversion (BPD)?

Answer 27

1) Removes 3/4 of the stomach to ⬇ food intake and ⬇ acid output
2) Remaining 1/4 of stomach is connected to lower portion of small intestine
3) Pancreatic bile and enzymes enter final segment of the intestine
4) Nutrients pass without being digested

Question 28

What are the 2 characteristics of the Biliopancreatic Diversion with duodenal switch variation of BPD?

Answer 28

1) By including the duodenal switch, surgeons leave a larger portin of the stomach intact
2) Helps to prevent dumping syndrome

Question 29

What are the 3 characteristics of the Route-en-Y form of the Malabsorptive type of Bariatric Surgery?

Answer 29

1) Has low complication rates
2) Excellent patient tolerance
3) Stomach size is decreased with a gastric pouch anastomosis that empties directly into Jejunum

Question 30

Lipectomy Vs. Liposuction

Answer 30

1) Lipectomy - Surgical removal of skin folds and fat tissue

2) Liposuction - Surgical removal of fat tissue

Question 31

What 4 interventions are used post-op for Lipectomy and Liposuction?

Answer 31

1) Early ambulation
2) I.S.
3) NG
4) Wound care

Question 32

How long is a patient’s diet restricted to full liquids and puréed foods after a Lipectomy/Liposuction?

Answer 32

6 weeks

Question 33

What should the diet of a patient post-op for Lipectomy/Liposuction consist of?

Answer 33

1) High protein
2) Low carbs
3) Low fats
4) Low roughage
5) Six small feedings with no fluids at the same time

Question 34

What are the 7 possible complications of Bariatric Surgery?

Answer 34

1) Anemia
2) Vitamin deficiencies
3) Peptic ulcer formation
4) Dumping syndrome
5) Small bowel obstruction
6) Diarrhea
7) Psychiatric problems

Question 35

What is Murphy’s sign?

Answer 35

Right sub costal tenderness associated with Cholecystitis (Gallbladder Infection).