Stoma mushkies Flashcards
What are the 5 features (quick) of an ileostomy?
- RIF
- Spouted
- Watery contents
- Permanent = Proctocolectomy
- Temporary = Anterior resection
What are the 5 features (quick) of a colostomy?
- LIF
- Flush with skin
- Formed faeces
- Permanent = AP resection
- Temporary = Hartmann’s
What are the 2 types of ileostomy?
End Ileostomy
Loop Ileostomy
What are the features and indications of an end ileostomy?
- Permanent = Panproctocolectomy, indication = UC
2. Temporary = Total colectomy with later IPAA, indication = FAP
What is an IPAA?
An ileal pouch-anal anastomosis
What are the features and indications of a loop ileostomy?
- A temporary stoma to defunction distal bowel, may be supported by a bridge or rod
- Indications = Anterior resection (Colon Ca), Bowel rest (Crohn’s disease)
When might a colostomy be located in the RUQ?
When pt has had a transverse loop colostomy
What are the 2 types of colostomy?
End Colostomy
Loop Colostomy
What are the features and indications of an end colostomy?
- Permanent = AP resection, indication = Colon Ca
2. Temporary = Hartmann’s, indication = Diverticulitis
What are the 2 types of loop colostomy?
What are the types of surgery performed?
What is the indication for a loop colostomy?
- RUQ and LIF
- Surgery performed = anterior resection/decompression
- Indication = Colon Ca
What are the features of a RUQ loop colostomy?
A defunctioning transverse colostomy to cover a distal anastomosis (rarely performed)
What are the features of a LIF loop colostomy?
Apex of sigmoid is exteriorised w/o a resection for inoperable Ca rectum which is likely to obstruct
How do you classify the complications of stoma?
Early and Delayed
What are the early complications of stomas?
Stomas should never be placed near the HIPSH (hips)
- Haemorrhage
- Ischaemia
- Parastomal Abscess
- Stoma retraction
- High output can cause hypokalaemia
How can you manage a high output stoma that is causing hypokalaemia?
Give loperamide ± codeine to thicken output
What are the delayed complications of stomas?
POP DSFP (sorry i couldnt make a decent mnemonic)
- Parastomal hernia
- Obstruction (adhesions/herniation)
- Prolapse
- Dermatitis
- Stricture
- Fistulae
- Psychosexual dysfunction
What are 3 key features of stoma rehabilitation?
- Aim for a normal diet
- Good skin care and cleanliness
- Psychosexual support
How do you classify stomas?
Depending on Anatomical Location (x8)
- Tracheostomy
- Gastrostomy
- Jejunostomy
- Ileostomy
- Caecostomy
- Appendicostomy
- Colostomy
- Urostomy
What is a urostomy?
A surgically created opening in the abdominal wall through which urine passes
What are the 2 types of urostomy?
- Ileal conduit (incontinent)
2. Indiana pouch (continent)
What is an ileal conduit?
- Ureters are attached to a portion of resected ileum which is exteriorised as a spouted stoma
- Bowel continuity is maintained by a primary anastomasis
- Urine is collected in a bag
What is an Indiana pouch?
- A pouch created from approx 2ft of resected ascending colon and portion of ileum which includes the ileocaecal valve
- The ureters are anastomosed to colonic end and the ileal end is exteriorised as a spouted stoma
- The ileocaecal valve prevents urinary leakage from the pouch
- Pt self-catheterises to drain the pouch
What are the indications for a urostomy?
- Most commonly after a cystectomy for Bladder Ca
- Severe CKD
- Accidental damage to urinary tract
- Congenital defects that cause urine to backup
- Urinary incontinence
What are the 5 indications for a stoma?
- Exteriorisation
- Diversion
- Decompression
- Feeding
- Lavage
What are the possible indications for an exteriorised stoma?
- Perforated/contaminated bowel e.g. Hartmann’s
2. Permanent e.g. AP resection
What are the possible indications for a diverted stoma?
- Protection of distal anastomosis (e.g. Contamination (faecal peritonitis), Anatomical (ileorectal anastomosis))
- Acute Crohn’s
- Urinary diversion following cystectomy
What is the indication for a decompressive stoma?
Bypass of a distal obstructing lesion
What are the indications for a feeding stoma?
Gastrostomy/Jejunostomy
What are the indications for a lavage stoma?
Appendicostomy
What is an appendicostomy?
- 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
- Indications = Spina Bifida, Hirschprung’s, Spinal Injuries, Constipation
- A.k.a Malone procedure
What is the definition for a stoma?
Artificial union between conduits or between a conduit and the outside
When is a Hartmann’s procedure most commonly performed?
For a perforated diverticulitis
What is a double-barrelled colostomy?
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
What is the spiel for examining a stoma?
I would like to thoroughly examine the stoma by removing the bag, checking its contents, inspecting the lumen and the surrounding skin
What is the description for a normal colostomy?
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.
What is a stoma?
An artificial union between conduits or between a conduit and the outside
5 things to ask in a stoma history?
- Surgery
- Output
- Pain
- Complications
- Psychosexual function
