Stoma Flashcards
What is an end …ostomy?
When the e.g. bowel ends in the outside world
And is a single lumen
Features of a colostomy
Location
Bag Contents
In relation to the skin
Left Iliac Fossa
Solid faeces because the faeces has had time to travel through the colon
Flush to the skin (no need for them to stick out because the enzymes are less alkali so less likely to damage skin)
What is a LOOP …ostomy?
Advantage
Bringing the bowel to the surface of the abdominal wall
Then making an incision in the proximal bowel allowing anything in that segment to go into the outside environment
However a communication remains between the proximal and distal segment
The bowel contents don’t actually go back into that segment though
Advantage: easily reversed
Features of an ileostomy
Location
Bag Contents
In relation to skin
Right Iliac Fossa
Spouted (because the enzymes in the faeces are toxic to the skin so there has to be a spout so the faeces drains without touching the skin)
(amongst other uses, it is essential in management of neonates)
Liquid contents
Complications of having a stoma (8)
Ischaemia (because of surgical manipulation disrupting blood supply)
Retraction (if the stoma is not “fastened” properly it can pull itself back into the abdominal cavity)
Necrosis (when the aperture or the sutures are too tight)
Prolapse (opposite of retraction)
High output (post-surgery output of the bowel/ stoma is more than normal which can result in derangement of electrolytes and dehydration) - more than 1.5L a day
Dermatitis (especially for ileostomy where the contents are irritative)
Psychological
Stenosis
early complications: ischaemia, retraction ( as the erythema settles), bleeding
late: skin complications, parastomal hernia, prolaps, stenosis
Hernia
OSCE Examination of a stoma
Introduce + wash hands
Inspect: where does it lie? Type of stoma? Stoma functioning (colour, type and amount of stoma discharge) Any scars? Any complications from stoma e.g. dermatitis / hernia?
Palpate: bag contents, and around the site in case of hernias
Digital examination of stoma: to find out if it is stenosed + bowel contents/ stool, differentiate between end or loop (single or double lumen)
When permanent stoma used
where are they found
When no distal bowel segment remaining after resection
usually below belt line
permanent ileostomy can can be found in RIF
When are temporary stoma used
To relieve complete distal large bowel obstruction causing proximal dilatation
E.g. as emergency for obstruction of large bowel
or defunctioining stomad
or for bowel rest
