STOMAS

Question 1

What is a Stoma?

Answer 1

 Opening in front of abdomen

 Surgically created
 Bowel or bladder
 Enables elimination of contents

Question 2

Why may a patient need a stoma?

Answer 2

Some diseases predispose patients:
- Inflammatory bowel diseases (IBD)
- Diverticular disease
-Cancer of the Large Intestine

 Volvulus (twisted bowel)
 Perforation of colon
 Toxic Megacolon (inflammation>bowel wall thins>colon bloated with gas>fever/GI pain)
 Colonic Polyps

Question 3

Describe the different types of Stoma?

Answer 3

-Colostomy
-Ileostomy
- Urostomy

Question 4

What is a Colostomy?

Answer 4

 Most common

 Large intestine used

 End colostomy
-Descending = firmer stool
-Ascending or Transverse = more fluid stool
- Permanent or temporary

Question 5

What is a Ileostomy?

Answer 5

 End of small intestine becomes the stoma
 Large intestine removed
 Right-hand side
 Generally more fluid contents

Question 6

What is a Urostomy?

Answer 6

 Formed following bladder removal
 Output is urine
 Ileal Conduit Urinary Diversion
-Small piece of bowel connected to the ureters
-Acts as a channel for urine

 Not reversible
 Continuous flow
 **Urostomy Association

Question 7

What are the Colostomy Bags?

Answer 7

 Generally closed bag (Disposable)
-Change once – twice a day
 Opaque/beige more discrete
 Normally use one- or two-piece system

 Two Piece
-Base plate (change every 3-7 days)
-Pouch

Question 8

What are the Ileostomy Bags?

Answer 8

 Generally drainable bags (Reusable)
-Change every 3-5 days
 Also one- or two-piece systems

 Integrated clip, or no closure system
 Integrated tends to be preferred

Question 9

What are the Urostomy Bags?

Answer 9

 Many different types available
-Also one- or two-piece systems
 Tap outlet bag needs changing every 1-3 days
 Specialist stoma nurse involvement
 Night drainage bags can be used at home

Question 10

What other items are available with Stoma Bags?

Answer 10

 Adhesives
 Adhesive Removers
 Deodorants
 Skin Fillers and Protectives
 Stoma Caps

Question 11

What are the Psychosocial Dimensions of Stoma Bags?

Answer 11

 Diet: (Fluids, Fibre-rich food, Dispelling gas, Reducing odour)

 Clothes: (Discrete, Special designs)

 Travel: (Forward planning, Plenty of supplies, ORS and anti-diarrhoea medicines)

 Personal life: ( Most resume normal sex life, Smaller bag or stoma cap)

 Swimming/Sport: (Stoma caps can be helpful, perfect for stable patients who need to use a smaller capacity bag for a short time)

Question 12

What are some common problems with FOOD and Stoma bags?

Answer 12

1. Gas Producing: Alcohol, Banana, Beef, Cucumber
2. Odour Producing: B-Vits, Fish, Garlic, Onions, Turnips
3. Increase/Loosen stool: Apples, Figs, Spicy foods, WG-Cereal, Prunes
4. Cause Blockage: Beef, Broccoli, Celery, Grapes, Coleslaw, Nuts, Corn, Mushrooms
5. Red stool: Beetroot, Strawberries, Tomato sauce

Question 13

What are some common problems with DRUGS and Stoma bags?

Answer 13

1. DIARRHOEA: Antibiotics, Furosemide, NSAIDS, Laxatives, Mg ions, Misoprostol, Theophylline
2. CONSTIPATION: Anticholinergics, Diuretics, Fe2+, Opioids, Verapamil, Aluminium ions
3. INTESTINAL DYSMOTILITY: TCA, CCB, Opiates, Loperamide
4. GI SIDE EFFECTS: Aspirin, NSAIDS, CCB, Atenolol, Nitrates, Prednisolone, Ferrous Sulphate

Question 14

What Advice should be given to Patients with Stomas who have Constipation? What drug should they be on?

Answer 14

Constipation
 Diet and medicines review
 Increase fluid and fibre

 Consider use of Ispaghula Husk
-NOT ileostomy patients
-Increases water and salt loss
-Refer to Ileostomy nurse

Question 15

What Advice should be given to Patients with Stomas who have Diarrhoea? What drug should they be on?

Answer 15

Diarrhoea

 Diet and medicines review
 ORS use
 Loperamide (liquid or disp tab)
- Caps may pass too quickly to be absorbed (check stoma output to check)