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Medicine and Surgery Mushkies > Stoma mushkies > Flashcards

Stoma mushkies Flashcards

1
Q

What are the 5 features (quick) of an ileostomy?

A
  1. RIF
  2. Spouted
  3. Watery contents
  4. Permanent = Proctocolectomy
  5. Temporary = Anterior resection
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2
Q

What are the 5 features (quick) of a colostomy?

A
  1. LIF
  2. Flush with skin
  3. Formed faeces
  4. Permanent = AP resection
  5. Temporary = Hartmann’s
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3
Q

What are the 2 types of ileostomy?

A

End Ileostomy

Loop Ileostomy

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4
Q

What are the features and indications of an end ileostomy?

A
  1. Permanent = Panproctocolectomy, indication = UC

2. Temporary = Total colectomy with later IPAA, indication = FAP

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5
Q

What is an IPAA?

A

An ileal pouch-anal anastomosis

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6
Q

What are the features and indications of a loop ileostomy?

A
  1. A temporary stoma to defunction distal bowel, may be supported by a bridge or rod
  2. Indications = Anterior resection (Colon Ca), Bowel rest (Crohn’s disease)
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7
Q

When might a colostomy be located in the RUQ?

A

When pt has had a transverse loop colostomy

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8
Q

What are the 2 types of colostomy?

A

End Colostomy

Loop Colostomy

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9
Q

What are the features and indications of an end colostomy?

A
  1. Permanent = AP resection, indication = Colon Ca

2. Temporary = Hartmann’s, indication = Diverticulitis

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10
Q

What are the 2 types of loop colostomy?
What are the types of surgery performed?
What is the indication for a loop colostomy?

A
  1. RUQ and LIF
  2. Surgery performed = anterior resection/decompression
  3. Indication = Colon Ca
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11
Q

What are the features of a RUQ loop colostomy?

A

A defunctioning transverse colostomy to cover a distal anastomosis (rarely performed)

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12
Q

What are the features of a LIF loop colostomy?

A

Apex of sigmoid is exteriorised w/o a resection for inoperable Ca rectum which is likely to obstruct

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13
Q

How do you classify the complications of stoma?

A

Early and Delayed

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14
Q

What are the early complications of stomas?

A

Stomas should never be placed near the HIPSH (hips)

  1. Haemorrhage
  2. Ischaemia
  3. Parastomal Abscess
  4. Stoma retraction
  5. High output can cause hypokalaemia
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15
Q

How can you manage a high output stoma that is causing hypokalaemia?

A

Give loperamide ± codeine to thicken output

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16
Q

What are the delayed complications of stomas?

A

POP DSFP (sorry i couldnt make a decent mnemonic)

  1. Parastomal hernia
  2. Obstruction (adhesions/herniation)
  3. Prolapse
  4. Dermatitis
  5. Stricture
  6. Fistulae
  7. Psychosexual dysfunction
17
Q

What are 3 key features of stoma rehabilitation?

A
  1. Aim for a normal diet
  2. Good skin care and cleanliness
  3. Psychosexual support
18
Q

How do you classify stomas?

A

Depending on Anatomical Location (x8)

  1. Tracheostomy
  2. Gastrostomy
  3. Jejunostomy
  4. Ileostomy
  5. Caecostomy
  6. Appendicostomy
  7. Colostomy
  8. Urostomy
19
Q

What is a urostomy?

A

A surgically created opening in the abdominal wall through which urine passes

20
Q

What are the 2 types of urostomy?

A
  1. Ileal conduit (incontinent)

2. Indiana pouch (continent)

21
Q

What is an ileal conduit?

A
  1. Ureters are attached to a portion of resected ileum which is exteriorised as a spouted stoma
  2. Bowel continuity is maintained by a primary anastomasis
  3. Urine is collected in a bag
22
Q

What is an Indiana pouch?

A
  1. A pouch created from approx 2ft of resected ascending colon and portion of ileum which includes the ileocaecal valve
  2. The ureters are anastomosed to colonic end and the ileal end is exteriorised as a spouted stoma
  3. The ileocaecal valve prevents urinary leakage from the pouch
  4. Pt self-catheterises to drain the pouch
23
Q

What are the indications for a urostomy?

A
  1. Most commonly after a cystectomy for Bladder Ca
  2. Severe CKD
  3. Accidental damage to urinary tract
  4. Congenital defects that cause urine to backup
  5. Urinary incontinence
24
Q

What are the 5 indications for a stoma?

A
  1. Exteriorisation
  2. Diversion
  3. Decompression
  4. Feeding
  5. Lavage
25
Q

What are the possible indications for an exteriorised stoma?

A
  1. Perforated/contaminated bowel e.g. Hartmann’s

2. Permanent e.g. AP resection

26
Q

What are the possible indications for a diverted stoma?

A
  1. Protection of distal anastomosis (e.g. Contamination (faecal peritonitis), Anatomical (ileorectal anastomosis))
  2. Acute Crohn’s
  3. Urinary diversion following cystectomy
27
Q

What is the indication for a decompressive stoma?

A

Bypass of a distal obstructing lesion

28
Q

What are the indications for a feeding stoma?

A

Gastrostomy/Jejunostomy

29
Q

What are the indications for a lavage stoma?

A

Appendicostomy

30
Q

What is an appendicostomy?

A
  1. Formation of a conduit between the umbilicus and the colon via the appendix, used most commonly in paediatrics to allow frequent enemas in children to ease constipation
  2. Indications = Spina Bifida, Hirschprung’s, Spinal Injuries, Constipation
  3. A.k.a Malone procedure
31
Q

What is the definition for a stoma?

A

Artificial union between conduits or between a conduit and the outside

32
Q

When is a Hartmann’s procedure most commonly performed?

A

For a perforated diverticulitis

33
Q

What is a double-barrelled colostomy?

A

If after an a resection it is thought unsafe to join the bowel ends together, but the distal end is long enough, both ends might be brought out to the surface

34
Q

What is the spiel for examining a stoma?

A

I would like to thoroughly examine the stoma by removing the bag, checking its contents, inspecting the lumen and the surrounding skin

35
Q

What is the description for a normal colostomy?

A

There is a stoma in the LIF, with a single lumen which is flushed with the skin. It appears healthy with no associated surrounding skin changes. There is a concurrent midline laparotomy scar. This is most likely an end colostomy which may be a result of a Hartmanns.

36
Q

What is a stoma?

A

An artificial union between conduits or between a conduit and the outside

37
Q

5 things to ask in a stoma history?

A
  1. Surgery
  2. Output
  3. Pain
  4. Complications
  5. Psychosexual function

Medicine and Surgery Mushkies (52 decks)

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