Urinary And Faecal Stomas Flashcards
What does ostomy mean?
Opening
What does stoma mean?
Mouth - refers to any surgically constructed opening onto the body surface to facilitate a bodily function
What are indications for stomas
Malignancy, obstruction, disease process e.g crones, trauma, congenital abnormalities, neurological impairment.
Used to rest or by pass bowel
What is a peristomal wound?
Lesion that is circumferential
What is a parastatal wound?
Unilaterally sited lesion
What are the types of GI stomas?
Oesphagostomy, gastrostomy, jejunostomy, illeostomy, colostomy
Describe an illeostomy
- ileum is exteriorised onto abdominal wall to form stoma
- ileum is 3.6m- longest part of small instestine
- provides extensive area of digestion and absorption
- chyme is alkaline
- vit ADEK and B12 absorption
- 7.5L of secretions/day
- fluid loss from stoma 500-1500ml /day requires drainable bag
Describe a colostomy
- Surgical opening into large intestine with colon exteriorised to abdo wall
- permanent= end stoma
- temporary = loop stoma with bar or end stoma
- one piece closed or drainable appliances (clear or opaque, flat or convex)
- two piece closed or drainable
- irrigation sets - suitable for descending or sigmoid
What is a Urostomy?
Used to drain urinary system.
Appliance requires a non return valve> prevents leaks around stoma
Discuss a permanent colostomy (end stoma)
Abdo - perineal resection
Sigmoid colon, rectum, ischio-rectal tissue and anus is removed
Indications: anal and lower rectal cancers
Hartmanns procedure: rectal stump preserved for later anastomosis
Excision of sigmoid colon and upper 1/3 rectum, stump oversewn.
Hartmanns for disease, trauma and cancer
Eversion of stoma inhibits contraction and stenosis
End colostomy stoma usually flush or level with skin
What is a temporary (loop) colostomy?
May have rod insitu
Proximal opening drains faeces
Distal opening drains mucus
What is a procto-colectomy?
Permanent illeostomy Colon,rectum, and anus removed Stoma sited at terminal ileum (RLQ) Spouted stoma to assist drainage Indications: crohns, ulcerative colitis,adenomatous polyposis with anal invasion
Why perform a temporary illeostomy?
Rest an anastomosis
Allow internal reservoir or pouch to heal
What are the indications for illeal anal anastomosis and pouch?
Frequent loose bowels due to removal of colon
No appliances needed
What is urostomy or illeal conduit?
Opening to urinary system, urinary stoma created and exteriorised onto abdo wall.
Stoma on left side
Spouted
Always drainable bags > transparent or opaque
Performed for;
Cancer of lower UT, trauma, intractable incontinence, congenital abnormalities, problems with supra pubic catheter.
How long is the large instestine from caecum to anus?
1.5 m
How long is the rectum?
17cm
How long is the anal canal?
3cm
What type of muscle is the internal anal sphincter?
Smooth (involuntary)
What type of muscle is the external sphincter?
Striated (voluntary)
Discuss pre-op stoma care
Procedure info
Stoma education
Appliance options
Sitting of stoma - not in creases, bony parts, scars, lines, use an appliance to assist positioning
Reviews and appliance trials
Routine pre-op care (bowels flush, fasting)
Describe features of the colon
Slower mass colonic movements in the left/descending colon,reduces the frequency and force of faecal expulsion.
Gas and odour are more marked in the right/ascending colon due to bacterial and enzymatic activity.
Prolonged skin contact with effluent is likely to compromise skin ( not same PH)
Discuss post op care for stomas
- self care and rehab
- observe stoma (colour of mucous, oedema, sutures, passing flatus or stool,passing urine stoma activity, peri- stomal skin condition, size and shrinkage)
- skin care ( gentle removal of appliance, cleanse with gentle soap and water, dry skin, remove hair, skin protective barrier products,correctly cut appliances)
- appliance selection and use (ostomy pastes: fill creases, seal and rings: fill creases, skin protective barrier wipes (prevent contact dermatitis from effluent or skin stripping from adhesives), remover wipes , belts and supports
- purchasing appliances
- odour
- disposal
- diet and hydration (health balance, avoid onions, cabbages , peas)
- returning to work and ADL’s
List potential stoma complications
Leakage, stenosis, bleeding, prolapse, retraction or flush stoma
What is a peristomal defect?
Stomas sited in or adjacent to skin folds, tissue creases or scars which causes poor security for adhesion of appliance.
Peri, or para stomal hernias also compromises this
Uneven surfaces can be levelled with skin barrier agents
Comfortable or convex appliances and belts can add security
Adhesive skin barriers attached to appliances can be trimmed
Discuss ulceration and erosion as a complication for stomas
Unprotected skin around appliance (e.g Urostomy or illeostomy) is at risk due to contact dermatitis from effluent.
Ulceration - loss of epidermis and some or all of dermis
Erosion - loss of epidermis,leaving a depressed moist surface
U and E can be caused by pressure belts
Treated with skin barrier powders or pastes
May need surgical refashioning
What are the terms used to describe hyperkeratonic and acanthonic changes around urostomies exposed to urine?
Pseudoverucous lesion, pseudo-epiyheliamotous hyperplasia and chronic papillomatous dermatitis
Discuss allergic reaction as a complication for stomas
Protective films, remover wipes, adhesive agents
Itching or stinging
Complete patch tests
What is a granuloma?
Mass of granulation tissue
Raised round lesion that compromises mainly of histocytes
Aetiology: idiopathic or result from inflammatory responses or presence of foreign body
Problematic if on mucosal surface
Silver nitrate is effective to reduce
Biopsy if persists with treatment
Discuss mucosal implants as a complications for stomas
Seeds of mucosal tissue that are implanted on the cutaneous at the peristomal suture sites that result from surgical Eversion and suturing of stomal mucosa
Prone to bleeding
Looks like small islands of mucosal tissue situated in peri-stomal skin at previous suture sites
Silver nitrate for treatment
Discuss infection as a complication for stoma
Peri-stoma bacterial- not common Fungal problematic esp in hot climate Systemic AB's used to treat Lotions can be applied Emollients interfere with security
Discuss mucocutaneous separation as a complication for stomas
Post- dehiscence at stomal mucosal and peri-skin border - occurs as a result of poor surgical technique or complications (infection, abdo stress, haematoma)
Partial - results in local defect -can heal by secondary intention
Circumferential - results in retraction of gut opening below skin surface
Retracted stoma complicates effluent drainage and skin integrity
Superficial ones respond to treatment with skin barrier powders sealed with pastes, hydro colloid rings or seals.
Deep defect or sinus tracking use calcium alignate or hydro fibre dressing to lightly fill cavity- these can be covered and sealed with barrier agents.
Avoid moisture donating cavity filling agents (hydro gels) as these compromise security.
Discuss pyoderma gangrenosum as a complication for stoma
Painful and necrotising ulcer with violsceous undermined borders associated with fistula tracking.
Associated with systemic disease (auto immune, chron’s , trauma)
Treatment =pain management, control of inflammation and promotion of healing.
Calcium alignate or hydrofibre to conform to wound and absorb
Silver calcium alginate and/or hydrofibre help reduce inflammation and provide anti microbial barrier.
Pastes, rings, hydro colloid sheets applied over dressings
Two piece appliances minimise changes
