Ostomies/Stomas & Obesity Flashcards
What are the 3 curative surgical procedures indicated for Chronic Ulcerative Colitis?
1) Total colectomy with rectal mucosal stripping and ileoanal reservoir
2) Total protolectomy with continent Ileostomy (Kock pouch)
3) Total protolectomy with permanent Ileostomy
What are the 7 Indications for a stoma as discussed in class?
1) Crohn’s Disease
2) Ulcerative Colitis
3) Cancer
4) Familial Polyposis
5) Diverticulitis
6) Congenital Conditions
7) Stab/Gunshot wounds
What is removed during a protolectomy?
The rectum and the colon
What are the 6 characteristics of a Total Colectomy with Rectal Mucousal Stripping and Ileoanal Reservoir?
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
What are the 4 characteristics of a Total Protolectomy with Continent Ileostomy (Kock Pouch)?
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
What are the 5 characteristics of a Total Protolectomy with Permanent Ileostomy?
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
What are the 4 characteristics of an Ileoanal Anastomosis (Ileorectostomy)?
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
What two class of meds are administered to patients preop to Ileostomy/colostomy patients to prepare them for surgery?
1) Antibiotics
2) Laxatives/Enemas
What 3 thing s should you monitor your patient for when they are post-op for Ileostomy/Colostomy?
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.
When should a Ileostomy/Colostomy pouch be emptied?
When it is 1/3 full
Between an Ileostomy and a Colostomy, which puts at a higher risk for dehydration and electrolyte imbalance and why?
Ileostomy - because water is absorbed in the colon and the GI contents are no longer reaching that far down the GI tract.
What are the 4 common Ileostomy/Colostomy post-op complications?
1) Hemorrhage
2) Abdominal abscess
3) Small bowel obstruction
4) Dehydration
What do the following stoma colors indicate:
1) Pink to bright-red and shiny-high vascularity
2) Pale pink
3) Purple-black
1) Pink to bright-red and shiny-high vascularity - Normal
2) Pale pink - Low H&H
3) Purple-black - Compromised circulation
What are the 3 implications of having a terminal ileum surgery/inflammation?
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
Where in GI tract is a Cecostomy coming from?
The cecum is the beginning of the large intestine, right above the appendix.
What are the 3 causes of a disappearing stoma?
1) Thick abdominal wall (obesity)
2) Scar tissue
3) Adhesion
What two methods are used to treat a disappearing stoma?
1) Use of an appliance with convexity
2) Surgical revision
What can cause a stoma to pert rude and what 3 methods are used to treat it?
1) Caused by weak abdominal muscles
2) Treated by pushing stoma back, binding, or surgery
What are the 3 characteristics of a Stoma?
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
What are the 4 causes of bulging around a stoma?
1) Protrusion of bowel around the stoma
2) Weak abdominal muscles
3) Obesity
4) Heavy lifting
What are the 4 methods used to treat bulging around a stoma?
1) Abdominal binder
2) Weight control
3) Progressive exercise
4) Surgical revision
How should a stoma be cleansed and how often should the appliance be changed?
1) Clean with warm Warner and pat dry
2) Re-pouch with appropriate appliance q5-7 days
What are the 7 characteristics of Colostomy irrigation?
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
What are the 5 criteria required for Bariatric Surgery?
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
What are the 3 broad categories of Bariatric Surgery?
1) Restrictive - Vertical and circumgastric banding
2) Malabsorptive - Biliopancreatic diversion (BPD)
3) Combination of restrictive and malabsorptive - Roux-en-Y
What are the 4 characteristics of Restrictive Bariatric Surgery?
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
What is the difference between the vertical banding and circumgastric banding methods of Bariatric Surgery?
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)
What are the 4 characteristics of the Malabsorptive type of Bariatric surgery called Biliopancreatic Diversion (BPD)?
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
What are the 2 characteristics of the Biliopancreatic Diversion with duodenal switch variation of BPD?
1) By including the duodenal switch, surgeons leave a larger portin of the stomach intact
2) Helps to prevent dumping syndrome
What are the 3 characteristics of the Route-en-Y form of the Malabsorptive type of Bariatric Surgery?
1) Has low complication rates
2) Excellent patient tolerance
3) Stomach size is decreased with a gastric pouch anastomosis that empties directly into Jejunum
Lipectomy Vs. Liposuction
1) Lipectomy - Surgical removal of skin folds and fat tissue
2) Liposuction - Surgical removal of fat tissue
What 4 interventions are used post-op for Lipectomy and Liposuction?
1) Early ambulation
2) I.S.
3) NG
4) Wound care
How long is a patient’s diet restricted to full liquids and puréed foods after a Lipectomy/Liposuction?
6 weeks
What should the diet of a patient post-op for Lipectomy/Liposuction consist of?
1) High protein
2) Low carbs
3) Low fats
4) Low roughage
5) Six small feedings with no fluids at the same time
What are the 7 possible complications of Bariatric Surgery?
1) Anemia
2) Vitamin deficiencies
3) Peptic ulcer formation
4) Dumping syndrome
5) Small bowel obstruction
6) Diarrhea
7) Psychiatric problems
What is Murphy’s sign?
Right sub costal tenderness associated with Cholecystitis (Gallbladder Infection).
