Stoma

Question 1

What is a stoma

Answer 1

A stoma is an artificial opening on the abdomen to divert flow of faeces or urine into an external pouch located outside of the body.

Question 2

Name types of stoma [4]

Answer 2

Colostomy
Ileostomy
Urostomy
Defunctioning stomas

Question 3

Name 3 types of colostomy

Normal output

Answer 3

Loop colostomy
End colostomy
Paul-Mikulicz colostomy

1-2 motions/day

Question 4

Describe all 3 types of colostomy:

- Loop [4], end [3], Paul-Mikulicz [2]

Answer 4

Loop colostomy

• Colon loop is exteriorized, divided PARTIALLY to form 2 ends:
• proximal end passes stool
• distal end passes mucus
• rod under loop prevents retraction, removed after 7d

End colostomy

• Bowel divided, proximal end exteriorized
• Distal end resection, closed and left in abdomen (Hartmann’s procedure)
• exteriorized to form mucous fistula

Paul Mikulicz colostomy

• Double barreled colostomy
• Colon divided completely and each end exteriorized as 2 separate stomas

Question 5

Ileostomy

Answer 5

• Protrudes from skin, prominent mucosal folds, often right sided
• Emits fluid motions containing active enzymes

Question 6

Urostomy

Answer 6

• Post total cystectomy carry urine from ureter to abdo wall via ileal conduit with a catheterisable valvular mechanism to retain continence

Question 7

Defunctioning stomas
Define
Indications [2]

Answer 7

Loop colostomy or ileostomy

Used to relieve distal obstruction
or protect distal anastomosis

Question 8

Complications: early [5]

Answer 8

Hemorrhage at site
Stoma ischemia
High output > hypokalemia 
Obstruction secondary to adhesions
Stoma retraction
Infections

Question 9

Complications: late [7]

Answer 9

Obstruction
Dermatitis 
Stoma prolapse, intussusception, stenosis
Parastomal hernia
Fistulae
Hypergranulation

Question 10

Stoma care - main principle

Answer 10

Maintain peristomal skin integrity

Question 11

What are causes of skin breakdown [3]

Answer 11

Contact with faecal enzyme, moisture, leakage