Stomas Flashcards
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
2 - an artificial opening of a hollow organ
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
3 - location where the stoma is
- ileostomy
- colostomy
- jejunostomy
- duodenostomy
Are all stomas permanent?
- no
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
4 - 13,500 to 21,000
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
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
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
1 - when distal bowel needs to heal
- there also needs to be distal tissue that can be anastomosed
Is a competent or non-competent ileocaecal valve more likely to be emergency procedure that could have a temporary stoma?
- competent IC valve
- competent means there will be no dilation of small bowel so caecum could rupture
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
2 - protect an anastomosis
- distal anastomosis may be leaking or inflamed. The defunctioning stoma gives it time to heal and will then be removed
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
3 - fluid is alkalotic
- fluid can cause significant skin irritation
- normally at least 3cm
In an ileostomy would the fluid be stool consistency or fluid/semisolid?
- fluid/semisolid
- colon absorbs water so it will still have lots of water in
Typically is an ileostomy located on the left or right of the abdomen?
- right
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
3 - fluid is not as alkalotic
- less risk of irritating the skin
In an ileostomy would the fluid be stool consistency or fluid/semisolid?
- normally stool consistency
- colon has absorbed water
Typically is an colostomy located on the left or right of the abdomen?
- left
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
2 - bowel used as a conduit to redirect urine from ureters
- can include stents if newly formed
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
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
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
1 - loop ileostomy
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
1 - proximal bowel is made into an end colostomy and distal bowel is sutured closed
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?
- can be or it can be reversed
- depends on the patient and if distal bowel heals well
- distal bowel will continue secreting contents
What % of patients with a long term stoma will require further surgery?
1 - 0.2%
2 - 2%
3 - 20%
4 - 40%
3 - 20%
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
2 - perforation
What is the most common long term issue for patients with stomas?
1 - parastomal hernia
2 - prolapse
3 - retraction
4 - ischaemia
5 - mucocutaneous separation
1 - parastomal hernia
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
3 - 1000-2000ml/day
Are high output stomas more common in proximal or distal stomas?
- proximal
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%
3 - 25%
- most settle down spontaneously
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
1 - distal bowel
- it is the proximal bowel and short bowel syndrome that have a high risk of a high output stoma
Which of the following is NOT likely to be a cause of high output stoma?
1 - infection
2 - IBD
3 - obstruction
4 - ileus
4 - ileus
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
1 - Loperamide
- anti-diarrhoea
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
4 - Omeprazole
- proton pump inhibitor to reduce secretions of the stomach
- surgery may also be required
