Stomas Flashcards
Define stoma
An artificial opening made into a hollow organ (trachea, bowel, bladder)
Indications for a faecal stoma
Perforated: Hartmann’s in (e.g.) diverticulitis
Permanent: AP resection in malignancy
Diversion: Protect a distal anastomosis
Decompression: Bypass distal obstruction
What should be commented on on examination of a stoma bag
Site inspection: dermatitis, hernias, sloughing skin
Stoma: pink and healthy, sloughing, discolouration, ischaemia, inflammation
Lumens (1 = end ileostomy/colostomy; 2 = loop)
Spout (spouted = small bowel; flush = large bowel)
Effluent / stoma output / bag contents: how much, content
Surrounding skin
Digitation
Complications of stomas
Early
- haemorrhage
- ischaemia
- high output (¯K+, mx: loperamide)
- parastomal abscess
- stoma retraction
Delayed
- parastomal hernia
- obstruction (adhesion, herniation)
- dermatitis
- stoma prolapse
- stenosis, stricture
- fistula
- psychosexual dysfunction
How to tell between an ileostomy and colostomy
Ileostomy:
RIF
More watery contents
Spouted
Perm: proctocolectomy
Temp: Anterior resection
Colostomy:
LIF
More solid contents (formed faceces)
Flush with skin
Perm: AP resection
Temp: Hartmann’s
What are the types of urostomy
Ileal conduit
Ileal pouch
Features of ileal conduit and its types
Incontinent diversion, does NOT retain continence (creates stoma)
ureters are connected to a portion of resected ileum
Portion is exteriorised as a stoma (remaining ileum is anastomosed)
Bricker (2 ureters straight into ileal conduit)
Wallace (2 ureters joined together before entering ileal conduit)
Features of ileal pouch
Retains continence (continent diversion)
Kock pouch: pouch, valves and outlet made from terminal ileum
Indiana pouch: pouch from AC incl. IC valve (prevent backflow); ureters inserted in
Mitrofanoff procedure: pouch from bladder/SI/combination, outlet made from appendix
Ileal neobladder: pouch from ileum and outlet is urethra; ureters inserted in
