Stomas Flashcards
What is an ileostomy?
Formed from any part of the mid or distal small bowel. May be loop (often to rest the distal bowel) or end (usually as a result of surgical removal of distal bowel
What is a colostomy?
Formed from any part of the large bowel. May be loop (to rest distally) or end (due to surgical resection)
What is a urostomy?
Ureters are ‘plumbed’ into the proximal vascularised isolated loop of ileum. The distal end is brought out as a stoma.
What is a gastrostomy?
Either surgically created or endoscopically formed connection between anterior stomach and anterior abdominal wall. Often for stomach drainage or direct feeding
What is a jejunostomy?
Either surgically or endoscopically created connection between the proximal jejunum and anterior abdominal wall. It is often used for direct feeding
What features of a stoma might suggest that it is a ileostomy?
These are ususally spouted, have prominent mucosal folds, tend to be dark pink/red in colour, and are most common on the right side fot he abdomen
What features of a stoma would suggest that it is a colostomy?
Usually flush, have flat mucosal folds, tend to be light pink in colour, and are most common in the left side of the abdomen
What features of a stoma suggest that is a urostomy?
Usually spouted, have prominent mucosal folds, tend to be dark pink/red in colour, and are most common in the right side of the abdomen.
These are indistinguishable from ileostomies unless output can be seen - urine
What are features of a stoma which suggest that it is a gastrostomy or a jejunostomy?
Narrow calibre, flush with little visible mucosa, most common in upper left quardrant. They are usually fitted with indwelling tubes or access devices
Why is an ileostomy made into a spout?
The small bowel produces digestive enzymes which if spilled onto the skin will result in excoriation
What are complications of ileostomies/colostomies?
- Poor function
- Poor placement - Leakage and excoriation, Loss of patient’s feeling of security
- Prolapse
- Parastomal hernia - Poor bag adherence, Leakage and excoriation, Loss of patient’s feeling of security
- Stenosis
- Fistula formation
What are categories of poor function of a stoma?
- Non-passage of GI content
- Overactivity
Why might stomas not pass GI contents?
Technical problems
- Tight trephine e.g. opening through abdominal wall too narrow
- Twisting of intestine as it enters thro abdominal wall
Non-technical problems
- Paralytic ileus
- Post-operative adhesions
What is meant by the term overactive stoma?
This refers to the passage of excess fluid through the stoma (usually an ileostomy). This fluid appears ‘watery’ with little normal gastrointestinal content i.e. very pale green in colour indicating the presence of very little bile.
What can cause stoma overactivity?
Sub-acute obstruction
- Tight trephine resulting in stomal narrowing
- Post-operative adhesions
- Intermittent twisting of stoma
Intra-abdominal sepsis
What might excoriation around a stoma sight indicate?
This suggests small bowel enzymes digesting the skin and this can lead to poor adherence of the stoma bag
What are loop ileostomies and loop colostomies used for?
To divert enteric and faecal content away from:
- Distal anastomosis
- Obstructed distal bowel
- Distal tumour (e.g. sigmoid carcinoma)
When are end colostomies used in an elective setting?
- After APER (Abdomino-perineal resection of rectum)
-
As part of Hartmann’s procedure
- Locally advanced rectal cancer
- Anastomosis deemed to be dangerous
