Stomas

Question 1

What is the function of a temporary stoma?

Answer 1

To assume the function of elimination of waste, to permit healing or rest the gut or section of bowel

Question 2

What is the function of a permanent stoma?

Answer 2

To take over the function of elimination of the bowel that has been removed or permanently bypassed

Question 3

What are the three types of stoma?

Answer 3

Input

Output

Diverting

Question 4

What does an input stoma do?

Answer 4

Usually temporary, facilitates nutrients being put into the gut

e.g. gastrostomy, jejunostomy

Question 5

What does a diverting stoma do?

Answer 5

Diverts GIT contents away from the diseased or damaged gut

e.g. ileostomy, loop colostomy

Question 6

What does an output stoma do?

Answer 6

Provides an outlet for elimination of body waste, and usually follows excision of an excretory organ

e.g. bladder/bowel resection

Question 7

Indications for stoma in surgery?

Answer 7

Congenital - ano-rectal malformation, oesophageal atresia, ectopia vesicae

Acquired - radiation fistula secondary to radiation fibrosis, radiation enteritis, vesico vaginal, recto vaginal fistula

Traumatic - gunshot, stab, MVA

Infective/Inflammatory - IBD/Crohn’s/ulcerative colitis, diverticulitis, interstitial cystitis

Neoplastic - Ca bowel or bladder

Question 8

Common output stomas?

Answer 8

Faecal: colostomy, ileostomy

Urinary: ileal conduit, urostomy and nephrostomy

Question 9

Sites to avoid when siting a stoma?

Answer 9

• Lower costal margins
• Planned incision sites
• Old scars
• Obvious creases
• Umbilicus
• Iliac crests

Question 10

Types of colostomies? (4)

Answer 10

End colostomy: Permanent stoma with no other bowel distal to mobilised limb

Loop colostomy: Usually temporary, two limbs of the same piece of bowel are brought out and the lumen is opened, so both proximal (active) and distal (inactive) limbs drain into stoma

Divided: Stomas situated independently on the abdomen, usually unable to be brought together at the time of surgery

Double-barrel/Mikulicsz: Divided colostomy with both ends of both mobilised alongside each other through the same site in the abdomen

Question 11

Factors influencing stool frequency and consistency (through stoma?)?

Answer 11

• Site in the colon
• Precipitating condition/disease
• Previous surgery to GIT
• Radiotherapy and chemotherapy
• Medications
• Physical status
• Diet and eating/drinking habits

Question 12

Important factors when assessing a stoma? (4)

Answer 12

• Viability
• Size (measure diameter)
• Skin (condition of peri- and parastomal skin)
• Effluent faeces/urine

Question 13

Features of a healthy stoma?

Answer 13

• Pink/red in colour
• Moist
• May bleed easily

Ideal colostomy: healthy spout of ~1cm (mobilise to 2cm and evert to 1cm)

Ideal ileostomy: healthy spout of ~3cm (mobilise to 6cm and evert to 3cm)

Question 14

Important things to assess about a stoma and associated care?

Answer 14

• Output/effluent of stoma (urine or stool)
• Stool consistency (formed or fluid)
• Condition of skin (steroids, chemo)
• Diameter of stoma
• Financial considerations
• Ostomate’s ability to manage with a stoma
• Availability of the product

Question 15

Stoma complications?

Answer 15

Dermatological:

• Faecal contamination
• Adhesive pouch/tape allergy
• Mechanical damage
• Bacterial/fungal infection

Surgical:

• Parastomal hernia
• Stenosis: cutaneous or deep fascial
• Retraction
• Prolapse
• Peristomal granulation
• Bolus obstruction
• Stoma separation
• Ischaemia