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C. Year 3: Gastroenterology Random NOT on MLA Map > Stomas > Flashcards

Stomas Flashcards

1
Q

What is a stoma?

1 - a narrowing of a hollow organ
2 - an artificial opening of a hollow organ
3 - a connection between two hollow organs

A

2 - an artificial opening of a hollow organ

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2
Q

How are different stomas given their names?

1 - disease that caused the need for it
2 - contents of the bag
3 - location where the stoma is

A

3 - location where the stoma is

  • ileostomy
  • colostomy
  • jejunostomy
  • duodenostomy
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3
Q

Are all stomas permanent?

A
  • no
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4
Q

How many people have a stoma operation in the UK each year?

1 - 13.5 - 21
2 - 135 - 210
3 - 1350 - 2100
4 - 13,500 to 21,000

A

4 - 13,500 to 21,000

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5
Q

Stomas can be temporary or permanent. When is a permanent stoma performed?

1 - when patient is old
2 - when patients bowels are very inflamed
3 - when patient is unfit for surgery
4 - when there is no distal bowel remaining following surgery

A

4 - when there is no distal bowel remaining following surgery

  • abdominoperianal excision (rectum is removed, normally due to rectal cancer)
  • ileostomy if the whole bowel is removed due to IBD of familial adenomatous polyposis
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6
Q

When is a temporary stoma used?

1 - when distal bowel needs to heal
2 - when patient bowels are not inflamed
3 - when patient requests not to have an end stoma

A

1 - when distal bowel needs to heal

  • there also needs to be distal tissue that can be anastomosed
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7
Q

Is a competent or non-competent ileocaecal valve more likely to be emergency procedure that could have a temporary stoma?

A
  • competent IC valve
  • competent means there will be no dilation of small bowel so caecum could rupture
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8
Q

A defunctioning stoma is generally a temporary stoma used to divert faecal flow. When are these stomas used?

1 - patient is too sick for extensive surgery
2 - protect an anastomosis
3 - when inexperienced surgeon is operating

A

2 - protect an anastomosis

  • distal anastomosis may be leaking or inflamed. The defunctioning stoma gives it time to heal and will then be removed
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9
Q

In an ileostomy the intestines will be spouted. Why is this?

1 - easier to create
2 - fluid is acidic
3 - fluid is alkalotic
4 - distal bowel is infected

A

3 - fluid is alkalotic

  • fluid can cause significant skin irritation
  • normally at least 3cm
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10
Q

In an ileostomy would the fluid be stool consistency or fluid/semisolid?

A
  • fluid/semisolid
  • colon absorbs water so it will still have lots of water in
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11
Q

Typically is an ileostomy located on the left or right of the abdomen?

A
  • right
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12
Q

Why is a colostomy flush against the skin and not spouted like the ileostomy?

1 - easier to create
2 - fluid is acidic
3 - fluid is not as alkalotic
4 - distal bowel is infected

A

3 - fluid is not as alkalotic

  • less risk of irritating the skin
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13
Q

In an ileostomy would the fluid be stool consistency or fluid/semisolid?

A
  • normally stool consistency
  • colon has absorbed water
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14
Q

Typically is an colostomy located on the left or right of the abdomen?

A
  • left
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15
Q

What is an ileal/urostomy?

1 - bladder has been redirected out of the abdomen
2 - bowel used as a conduit to redirect urine from ureters
3 - ureters drain out of the abdomen

A

2 - bowel used as a conduit to redirect urine from ureters

  • can include stents if newly formed
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16
Q

What is a loop stoma?

1 - bowel removed from a loop and stoma formed
2 - bowel is twisted on itself needed a stoma
3 - bowel is removed from abdomen and dissected creating a loop

A

3 - bowel is removed from abdomen and dissected creating a loop

  • collect proximal effluent
  • acts as a blow off from distal end
  • allows distal bowel to rest and heal
17
Q

Which of the following is the most common type of loop stoma?

1 - loop ileostomy
2 - loop ascendingostomy
3 - loop duodenostomy
4 - loop transverse colostomy

A

1 - loop ileostomy

18
Q

A hartmanns procedure is often used during bowel surgery. What is this procedure?

1 - proximal bowel is made into an end colostomy and distal bowel is sutured closed
2 - bowel is divided allowing distal and proximal contents to drain
3 - whole rectum is removed
4 - whole colon is removed

A

1 - proximal bowel is made into an end colostomy and distal bowel is sutured closed

19
Q

A hartmanns procedure is often used during bowel surgery. Here the proximal bowel is made into an end colostomy and distal bowel is sutured closed. Is this procedure permanent?

A
  • can be or it can be reversed
  • depends on the patient and if distal bowel heals well
  • distal bowel will continue secreting contents
20
Q

What % of patients with a long term stoma will require further surgery?

1 - 0.2%
2 - 2%
3 - 20%
4 - 40%

A

3 - 20%

21
Q

Which of the following is NOT an early complication of a stoma?

1 - hernia
2 - perforation
3 - prolapse
4 - retraction
5 - ischaemia
6 - mucocutaneous separation

A

2 - perforation

22
Q

What is the most common long term issue for patients with stomas?

1 - parastomal hernia
2 - prolapse
3 - retraction
4 - ischaemia
5 - mucocutaneous separation

A

1 - parastomal hernia

23
Q

A high output stoma is one that has a large content. What is the definition of a high output stoma?

1 - 100-200ml/day
2 - 500-600ml/day
3 - 1000-2000ml/day
4 - >3000ml

A

3 - 1000-2000ml/day

24
Q

Are high output stomas more common in proximal or distal stomas?

A
  • proximal
25
Q

Are high output stomas are more common in proximal stomas. What % of ileostomy patients are likely to have a high output stoma?

1 - 0.25%
2 - 2.5%
3 - 25%
4 - 50%

A

3 - 25%

  • most settle down spontaneously
26
Q

Which of the following is NOT a risk factor for a high output stoma?

1 - distal bowel
2 - ileostomy following total protocolectomy
3 - diabetes
4 - inability to drink
5 - GI infection

A

1 - distal bowel

  • it is the proximal bowel and short bowel syndrome that have a high risk of a high output stoma
27
Q

Which of the following is NOT likely to be a cause of high output stoma?

1 - infection
2 - IBD
3 - obstruction
4 - ileus

A

4 - ileus

28
Q

If a patient has a high output stoma, we need to replace their fluids and electrolytes. What medication can they be given to help reduce the high output?

1 - Loperamide
2 - Senna
3 - Docusate sodium
4 - Macrogol

A

1 - Loperamide

  • anti-diarrhoea
29
Q

If a patient has a high output stoma, we need to replace their fluids and electrolytes. They can also be given Loperamide, which is anti-diarrhoea. Which of the following medications could they also be given to help reduce secretions?

1 - Macrogol
2 - Senna
3 - Docusate sodium
4 - Omeprazole

A

4 - Omeprazole

  • proton pump inhibitor to reduce secretions of the stomach
  • surgery may also be required

C. Year 3: Gastroenterology Random NOT on MLA Map (12 decks)

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