Urinary And Faecal Stomas

Question 0

What does ostomy mean?

Answer 0

Opening

Question 1

What does stoma mean?

Answer 1

Mouth - refers to any surgically constructed opening onto the body surface to facilitate a bodily function

Question 2

What are indications for stomas

Answer 2

Malignancy, obstruction, disease process e.g crones, trauma, congenital abnormalities, neurological impairment.
Used to rest or by pass bowel

Question 3

What is a peristomal wound?

Answer 3

Lesion that is circumferential

Question 4

What is a parastatal wound?

Answer 4

Unilaterally sited lesion

Question 5

What are the types of GI stomas?

Answer 5

Oesphagostomy, gastrostomy, jejunostomy, illeostomy, colostomy

Question 6

Describe an illeostomy

Answer 6

• 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

Question 7

Describe a colostomy

Answer 7

• 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

Question 8

What is a Urostomy?

Answer 8

Used to drain urinary system.

Appliance requires a non return valve> prevents leaks around stoma

Question 9

Discuss a permanent colostomy (end stoma)

Answer 9

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

Question 10

What is a temporary (loop) colostomy?

Answer 10

May have rod insitu
Proximal opening drains faeces
Distal opening drains mucus

Question 11

What is a procto-colectomy?

Answer 11

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

Question 12

Why perform a temporary illeostomy?

Answer 12

Rest an anastomosis

Allow internal reservoir or pouch to heal

Question 13

What are the indications for illeal anal anastomosis and pouch?

Answer 13

Frequent loose bowels due to removal of colon

No appliances needed

Question 14

What is urostomy or illeal conduit?

Answer 14

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.

Question 15

How long is the large instestine from caecum to anus?

Answer 15

1.5 m

Question 16

How long is the rectum?

Answer 16

17cm

Question 17

How long is the anal canal?

Answer 17

3cm

Question 18

What type of muscle is the internal anal sphincter?

Answer 18

Smooth (involuntary)

Question 19

What type of muscle is the external sphincter?

Answer 19

Striated (voluntary)

Question 20

Discuss pre-op stoma care

Answer 20

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)

Question 21

Describe features of the colon

Answer 21

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)

Question 22

Discuss post op care for stomas

Answer 22

• 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

Question 23

List potential stoma complications

Answer 23

Leakage, stenosis, bleeding, prolapse, retraction or flush stoma

Question 24

What is a peristomal defect?

Answer 24

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

Question 25

Discuss ulceration and erosion as a complication for stomas

Answer 25

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

Question 26

What are the terms used to describe hyperkeratonic and acanthonic changes around urostomies exposed to urine?

Answer 26

Pseudoverucous lesion, pseudo-epiyheliamotous hyperplasia and chronic papillomatous dermatitis

Question 27

Discuss allergic reaction as a complication for stomas

Answer 27

Protective films, remover wipes, adhesive agents Itching or stinging Complete patch tests

Question 28

What is a granuloma?

Answer 28

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

Question 29

Discuss mucosal implants as a complications for stomas

Answer 29

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

Question 30

Discuss infection as a complication for stoma

Answer 30

``` 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 ```

Question 31

Discuss mucocutaneous separation as a complication for stomas

Answer 31

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.

Question 32

Discuss pyoderma gangrenosum as a complication for stoma

Answer 32

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