MET3 Revision: Colorectal Surgery II Flashcards
(43 cards)
What type of stoma is this? [1]
Colostomy: flushed appearance
What type of stoma is this? [1]
Ileostomy: spouted appearance
What type of stoma is this? [1]
Loop stoma
What type of stoma is this? [1]
Label which of A & B is the proximal and distal part [2]
Double barrel stoma
A: Proximal
B: Distal
State the following for an ileostomy [6]
Where it is formed
Appearance
Location
Contents
Quantity
Odour
Ileostomy
Small intestine
Spout appearance
RIF site
Liquid / semi liquid formed
Large volume
Mild odour
State the following for an colostomy [6]
Where it is formed
Appearance
Location
Contents
Quantity
Odour
Colostomy
Large intestine
Flush appearance
LIF
Formed / more solid contents
Small volume
Offensive odour
Which muscle do you use when stoma site marking? [1]
Rectus muscle; at least 2/3” away from scars / bony prominance
State what the three different types of colostomy are [3]
Loop colostomy
End colostomy
Double barrel colostomy
Describe what a loop colostomy is [3]
Temporary stoma used to allow a distal portion of the bowel and anastomosis to heal after surgery
Allow faeces to bypass the distal, healing portion of bowel until healed and ready to restart normal function, by draining into a stoma bag
They are usually reversed around 6-8 weeks later
Describe how you differentiate between the proximal and distal end of a loop colostomy [1]
The proximal end (the productive side) is turned inside out to form a spout to protect the surrounding skin.
This distal end is flatter
Describe what a double barrel stoma is [1]
Divides the colon into 2 ends that form separate stomas:
Stool exits from one of the stomas & mucus made by the colon exits from the other
Describe what is meant by pancaking of a stoma [1]
Internal layers of the stoma bag stick together causing a vacuum which prevents the contents from dropping to the bottom. The stool remains at the top of the stoma bag which can potentially block the filter. The bag can also be forced off the body.
Physiological complications of high output ileostomy? [2]
○ > 1.5 - 2 litres
○ Fluid & Electrolyte imbalance
■ Dehydration, AKI
■ ↓Na, ↑K, ↓Mg (Addison’s picture)
■ Vitamin B12, Folate Def.}}
Problems associated with low volume ileostomy? [2]
● Low Volume (↓frequency & or quantity)
○ Stenosis
○ Impending obstruction}
Treatment for high output stomas? [5]
● Hydrate (fluid and high salt replacement)
○ Glucose-electrolyte solution aids sodium absorption
○ Restrict low sodium (Hypotonic) fluid (500-1000ml/day)
● Anti-diarrhoeal medication, eg loperamide
● Anti-secretory drugs
○ PPI (omeprazole) ○ Octreotride (rarely)
● Correct Hypomagnesaemia
● Opiates (codeine phosphate)
Where exactly are loop colostomies located? 1[]
usually in the right transverse colon, proximal to the middle colic artery
Ileostomies can be low or highoutput:
Low output tends to output [] ml/day for a low output ileostomy, and [] ml/day for a high output ileostomy
tends to output 500 ml/day for a low output ileostomy, and 1000 ml/day for a high output ileostomy
How do you know if stoma retraction has occurred? [2]
Stoma retraction presents with persistent leakage and peristomal irritant dermatitis.
When is stoma ischaemia most likely to occur? [1]
24hrs post op
Define what is meant by a parasternal hernia [1]
Parastomal hernia is a type of incisional hernia occurring in abdominal integuments in the vicinity of a stoma, i.e. a condition wherein abdominal contents, typically the bowel or greater omentum, protrude through abdominal integuments surrounded by the hernia sac at the location of formed stoma
How do you determine if a stoma has a parasternal hernia?
Positive cough impulse and and lump at the hernia site
What are the NICE guidelines on what makes patients with colorectals adenomas low, intermediate and high risk? [3]
How often should low, intermediate and high risk colorectal adenoma patients be offered colonoscopies? [3]
Classification of risk and advised management in patients with colorectal adenomas are as follows:
Low risk
- one or two adenomas smaller than 10 mm
- should be considered for colonoscopy at five years
Intermediate risk
- three/four adenomas smaller than 10 mm
or
- one/two adenomas if one is 10 mm or larger
- should be offered a colonoscopy at three years
High risk
- five or more adenomas smaller than 10 mm
or
- three or more adenomas if one is 10 mm or larger
- offered a colonoscopy at one year.
National Institute for Health and Care Excellence (NICE) guidelines recommend a surveillance colonoscopy for patients with UC how often for low, medium and high risk patients? [3]
aLow: every 5 years
Medium: every 3 years
High: annually