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Surgery (Britney) > Stomas > Flashcards

Stomas Flashcards

1
Q

What is a Stoma?

A

An artificial opening of a hollow organ (i.e., bowel, urinary system) brought onto the surface of the skin.

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2
Q

What are the different types of stomas?

A
  1. Colostomy
  2. Ileostomy
  3. Gastrostomy
  4. Urostomy
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3
Q

What is a Colostomy?

A

an artificial opening of the large intestine brought onto the surface of the abdomen. It is typically located in the Left Iliac Fossa (LIF) and drains solid stools because water is reabsorbed in the large intestine.

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4
Q

What are the indications of Temporary Colostomy?

A
  • Congenital megacolon
  • Anorectal malformations
  • Sigmoid volvulus
  • Perforated left sided colon
  • Left sided colonic growth
  • Trauma to left sided growth
  • High anal fistula
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5
Q

What are the indications of a Permanent Colostomy?

A
  • Abdomino-perineal resection (APR)
  • Anal Canal Carcinoma
  • After Hartmann’s operation
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6
Q

What are the types of Colostomy?

A
  1. End / Single-Barrel Colostomy
  2. Loop Colostomy
  3. Double barrel Colostomy
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7
Q

What is an End / Single-Barrel Colostomy?

A

An End / Single-Barrel Colostomy is where the proximal end of the bowel is brought onto the abdominal surface, while the distal end is left inside the abdomen.

It may be temporary, where the 2 bowel ends are sutured together, creating an anastomosis. Or permanent after an abdomino-perineal resection (APR) because the entire rectum and anus are removed.

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8
Q

What is a Loop Colostomy?

A

A Loop Colostomy is a temporary stoma where a loop of bowel is brought onto the surface of the abdomen. The middle section is cut to expose 2 openings, while the under surface is still attached. The proximal end is turned inside out forming a spout, which protects the surrounding skin, while the distal end is left flat. One opening puts out stool, while the other puts out mucus (i.e., mucus fistula).

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9
Q

What is a Double Barrel Colostomy?

A

A Double Barrel Colostomy is where the large bowel is divided completely and both openings are brought onto the abdominal surface as a seperate stoma. One opening puts out stool, while the other puts out mucus (i.e., mucus fistula).

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10
Q

What is a Diversion Colostomy?

A

A diversion Colostomy can be a end colostomy with a mucus fistula or a Hartmann’s procrdure. It can be done at the Sigmoid, Descending and Transverse colon.

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11
Q

What are the indications for a Diversion Colostomy?

A
  1. Bowel wall perforation
  2. Trauma
  3. Sphincter injuries
  4. Crohn’s disease
  5. Rectosigmoid carcinoma
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12
Q

What are the indications for a Decompression Colostomy?

A
  1. Obstructive lessions in the rectosigmoid
  2. Toxic megacolon
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13
Q

What are the types of Decompression Colostomy?

A
  1. Blow hole Colostomy
  2. Tube caecostomy
  3. Loop Colostomy
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14
Q

What is a Blow Hole Colostomy?

A

is where single or multiple small stomas are created to decompress an ischemic colon in patients with dilated or impending colon perforation.

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15
Q

What are the Cons of a Blow Hole Colostomy?

A

Increased risk of:
* perforaton, because other other ischemic parts of the colon may be missed

  • mucosal prolapse
  • local skin irritation
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16
Q

What are the Pros & Cons of Tube Caecostomy?

A

Pros: Easier to do with little complications
Cons: Tube is easily blocked

17
Q

What are the Pros & Cons of a Irrigation Colostomy?

A

Pros:
* less leakage of stools
* reduce passage of uncontrolled gas
* no stoma bag

Cons:
* risk of water intoxication due to excess water absorption during irrigation
* time consuming

18
Q

What is an Ileostomy?

A

an Ileostomy is an artificial opening of the small intestine brought onto the surface of the abdomen. It is typically located in the Right Iliac Foss (RIF) and drains liquid stools, because water is reabsorbed later in the small intestine.

19
Q

What are the types of Ileostomy?

A
  1. End Ileostomy
  2. Loop Ileostomy
20
Q

What is an End Ileostomy?

A

An End Ileostomy is where the proximal end of the bowel is brought onto the abdominal surface, while the distal end is left inside the abdomen.

An End Ileostomy becomes permanent after a Panproctolectomy (i.e., a total colectomy with removal of the large bowel, rectum and anus), for e.g., in the treatment of Inflammatory Bowel Disease (IBD) or Familial Adenomatous Polyposis (FAP)

21
Q

What is an alternative to an End Ileostomy?

A

An Ileo-anal anastomosis (AKA: J-pouch)

22
Q

What is an Ileo-anal anastomosis (AKA: J-pouch)?

A

a J-pouch is where a portion of the ileum is folded back onto itself to create a larger pouch, which would function like a rectum. This “J-pouch” is then attached to the anus.

23
Q

What is a Urostomy?

A

A urostomy is used to drain urine from the kidneys, bypassing the bladder and urethra. It created from an ileal conduit, where a 15-20cm portion of ileum, is cut out. One end is anatamosed with the ureter, while the other end is brought onto the surface of the abdomen as a stoma.

24
Q

What is the indication for a Urostomy?

A

Cystectomy (removal of the bladder)

25
Q

What are the complications of a stoma?

A
  • Local skin irritation
  • Parastromal hernias
  • Prolapse (telescoping of bowel through hernia site)
  • Loss of bowel length leading to high output, dehydration and malnutrition
  • Constpation (due to colostomies)
  • Stenosis
  • Obstruction
  • Retraction (sinking into the skin)
  • Bleeding
  • Granulomas causing raised red lumps around the stoma.

Surgery (Britney) (5 decks)

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