Stoma Flashcards
What is a stoma?
A surgical created opening at the front of the abdomen either from the bowel or bladder allowing an alternative route of elimination of the waste contents.
What may be the reasons/conditions for a stoma?
IBD
Diverticular disease
Colon cancer
Volvulus
Perforation of the colon
Toxic megacolon
Colonic polyps
What do all the conditions that predispose the need for stoma use have in common?
In all the conditions previously mentioned, there is inflammation of the intestinal tissue to an extent where there is a need to bypass the inflammed tissue.
What are the three different types of stoma?
Colostomy (stoma inserted in the colon)
Ileostomy (stoma inserted at the ileum, final section of the small intestine)
Urostomy (stoma inserted at the ileum after redirection from the urethra)
How does stool type differ if the insertion is made in different portions of colon?
The large intestine is the site for water/fluid reabsorption. Therefore if a patient has a stoma inserted at the descending colon (end of the large intestine) the waste contents would have had the opportunity to pass through the majority large intestine so most of the fluid contents would have had the opportunity to be absorbed. If an insertion is made however in the ascending or transverse section of the colon which is nearer to the small intestine, the contents would not have had the opportunity to maximise absorption and therefore the stool contents are likely to be more fluid like.
Are colostomy temporary or permanent?
Can be both and is very dependent on the indication.
A temporary stoma could be made post surgery for example to allow part of the bowel to make a fully recovery, with the intention that it will be fully functioning again, and hence the stoma is temporary.
However, if a patient has a bowel cancer meaning that a large portion of their bowel has had to be removed, they will not regain that function and therefore the stoma is permanent.
When would an ileostomy be surgically made?
Ileostomy is when a stoma is formed at the end of the small intestine and in response to having had the large intestine removed (last management plan for ulcerative colitis).
The incision is made on the right hand side and you would expect fluid contents due to lack of exposure of waste to the large intestine where the majority of fluid reabsorption occurs.
When would a urostomy be surgically made?
A urostomy is formed following a bladder removal (after a diagnosis of cancer for example) with the output being urine.
What is another word for the process of forming a urostomy?
Ileal conduit urinary diversion, this is when the ureters are connected to a small piece of bowel (the ileal conduit). The ileal conduit then opens onto the surface of the skin as a urostomy so essentially a new channel for urine is created - diverting it away from the bladder.
What type of process is the urostomy?
A non-reversible procedure.
It is also important to note that there will be a continuous flow of urine.
How often do patients have to change their colostomy bags?
Usually once or twice a day depending on the contents
Describe the difference between the one or two piece systems.
In the one piece system the colostomy bag is already attached to the base plate which is the contact point for the bag to the skin.
In a two piece system the base plate is separated from the stoma pouch, so the base plate is attached to the skin and then the stoma pouch is attached to the base plate.
What is an advantage of the two piece stoma system in comparison to the one piece?
Patients have to change their stoma pouch once or twice a day depending on the contents, therefore in a one piece system this involves the entire removal of the stoma system including the base plate, which can be quite fiddly and can cause skin irritation. Whereas in the two piece system this can be avoided as the base plate can remain adhered to the skin and only the stoma pouch has to be changed.
How do ileostomy bags differ to that of colostomy bags?
Due to the differing contents in ileostomy bags (more fluid like contents) instead of the colostomy ‘pouches’ ileostomy bags are drainable and hence are reusable so only have to be changed every 3-5 days.
However similarly they also come in one or two piece system where the base plate is either already attached to the bag or has to be attached.
Aside from one or two piece system, what is the other differentiation of ileostomy bags?
Ileostomy bags either have an integrated clip or a no closure system.
An integrated clips allows the system to be closed off, and therefore it is drainable and then reclosed after use.
A no closure system means that they are not reusable and have be changed once full so much more frequently. These types of ileostomy bags look much more similar to colostomy bags.
