Stoma

Question 1

What are the common reasons of stoma formation?

Answer 1

Cancer 
Trauma
IBD 
Incontinence 
Diverticulitis 
Polyps 
Acute bowel obstruction 
Fistula 
Palliative management

Question 2

What are the types of stoma’s?

Answer 2

Colostomy
Ileostomy
Urostomy

Question 3

What are the two types of stoma on the surface?

Answer 3

End stoma

Loop stoma

Question 4

How long does it take roughly for consideration of a reversal of hartmanns procedure?

Answer 4

1 year

Question 5

What are the immediate post-op complications for stoma’s?

Answer 5

Bleeding

Oedema

Ischaemia/necrosis

Separation

Fistula

High output stoma

Question 6

What is the management of bleeding of stoma?

Answer 6

Earliest complication
Usually stops spontaneously

Use soft materials wringer in cold water to stop the bleeding.
In case of continuous bleeding, it might be necessary to ligate/tie off the bleeding.

Question 7

What is the management of oedema in stoma?

Answer 7

Usually clears after 1-2 weeks

Usually managed according to each patient by stoma nurses

Question 8

What is the management of ischaemia/necrosis of stoma?

Answer 8

Must be observed closely

Sometimes can resolve by itself but other times will need re operation

Question 9

What is the management of separation of stoma?

Answer 9

Can be partial or complete
Shallow or deep

Managed by stoma nurses

Question 10

What is the management of fistulae in stoma?

Answer 10

Conservative: pt stable 
Ensure fluid and electrolyte management 
Control sepsis with antibiotics 
TPN to decrease fistula output 
Drain fistula

Or surgery

Question 11

What is a fistula?

Answer 11

Is an epithelial lined channel that develops spontaneously between two normally unconnected structures.

Question 12

What is high output stoma?

Answer 12

Stoma output >1500mls/24hrs

Pt is experiencing increased frequency in emptying appliance

Stoma output is a watery consistency

Question 13

What is the management for high output stoma?

Answer 13

Fluid balance chart
Check U&Es daily
Faecal cultures
Stop laxatives
Start loperamide 4 mg QDS - given at least 30 mins before meals
Low fibre diet
Oral fluid restrict to 500-1000mls/24hrs : isotonic drinks as dioralyte/st marks solution

Assess daily until full hydration is established

Question 14

What are the late complications of stoma’s?

Answer 14

Stoma retraction

Parastomal hernia

Stoma prolapse

Stoma stenosis

Granulomas

Skin problems - parastomal skin

Question 15

What is a refracted stoma?

Answer 15

Lies below skin level, commonly caused by too short a section of intestine used

Question 16

What is the management of refracted stoma?

Answer 16

Convex adhesive, mouldable ring or paste

Weight loss

Irrigation if it is colostomy - activate left side of bowel

Further surgical procedure may be necessary

Question 17

What is a parastomal hernia?

Answer 17

Bulge around the stoma can be true, sliding or false hernia

Strict advise given to pt regarding heavy lifting to help avoid

Question 18

Explain the different types of parastomal hernias?

Answer 18

True hernia - loop of intestine moves through the hole in the abdominal wall

Sliding hernia - a segment of the intestine used to create the stoma becomes looped into the subcutaneous fatty tissue.

False hernia - increased abdominal pressure produces a bulge in the side of the body due to a weakened abdominal wall - most common cause

Question 19

What are stoma prolapses and what is the management?

Answer 19

Section of intestine used to create the colostomy is almost turned inside out and pushed forward. Most commonly after transverse colostomies.

Gently pushing prolapse section back into the abdomen.
If oedematous use ice to reduce blood flow and sugar to reduce oedema

Surgical repair might be needed

Question 20

What is stoma stenosis and what is the management?

Answer 20

Stoma is oedematous , mushroom shaped and glistening
Faeces is expelled in the form of a thin strip, the blockage is due to tightened tissue around the stoma .

Treated by dilation of the intestine. Pts taught by stoma nurses.

If at skin level, local surgery may be necessary.

Question 21

What are granulomas and how are the managed in stoma?

Answer 21

At the mucosa are seen in the transition between stoma and skin.
Causes include chemical or mechanical irritation

Can be treated by covering raised areas with silver nitrate
Diathermy
Laser treatment

Excision under LA

Question 22

What are some skin problems that can occur in stoma’s in the parastomal skin?

Answer 22

Trauma
Allergy
Chemical reaction - leak faecal contents on the skin
Infection

Question 23

What are the steps of stoma examination?

Answer 23

Inspection:

• site
• spout - ileostomy spouted as irritant to skin where as colostomy flush with skin
• consistency- thick sludgy in colostomy and waterier and greener in ileostomy
• number of lumens - loop or end?

Observe for complications

Palpation - tenderness around site, cough impulse (parastomal hernias), digitate the stoma (assess for stenosis and patency)

Finish and offer full GI examination