Stomas and Comparing UC and Crohns Flashcards
What is a stoma?
When is it usually done? - 3
The connection between bowel and skin
IBD
Cancer
Diverticular disease
End stomas:
What is the main purpose?
How many lumens are there?
What is an end colostomy in Hartmann’s?
Usually permanent solution
If there is not enough distal bowel to anastomose with
Single
Removal of the rectosigmoid colon and inputting an ileostomy - TEMPORARY
Loop stomas (aka defunctioning stomas): Look at pics
What is the main purpose?
2 indications for its use
Temporary - defunctioning a distal bowel segment - prevent the flow of GI content to it - to allow anastomosis healing or if there is an anastomotic leak
Dysfunction a fistula
Emergency treatment of obstruction
Ileostomies:
Where are they usually found?
What is done to prevent irritation to the skin?
What is the small bowel effluent (contents) like?
When are end ileostomies used?
When are loop ileostomies used?
RLQ
Sprout is formed several cm clear of skin
Continuous and liquid
Panproctocolectomy (total removal) or subtotal colectomy (IBD especially UC)
Allow healing of distal anastomosis after anterior resection or left hemicolectomy (CRC)
Colostomies:
Why is it flush with the skin?
What 2 situations is it commonly used in?
What does the effluent look like?
Contents are not as irritating to the skin
Colon cancer and Diverticular disease
Intermittent solid effluent
Colostomies - RUQ stomas:
What type is it?
When is it used?
Loop transverse colostomy
Alleviate or prevent obstruction from inoperable distal cancer
Colostomies - LLQ stomas:
End colostomy - when is it put in temporarily and permanently?
Loop colostomy - when is it used?
Hartmann’s
OR
Abdominoperineal resection of anus and rectum
Alleviate or prevent obstruction from inoperable distal cancer
Urostomies - what is it?
When is it done?
What do they look like and how can you tell it is different from a normal stoma?
A urostomy is a surgical procedure that creates a stoma (artificial opening) for the urinary system.
A urostomy is made to avail for urinary diversion in cases where drainage of urine through the bladder and urethra is not possible, e.g. after extensive surgery or in case of obstruction.
The contents of the bag - would be filled with urine
Complications of stomas - Short term:
- General surgical problems - 2
- One embarrassing issue
- Skin
- What can happen to the colon itself?
Bleeding, infection
Leaking and skin irritation
Necrosis due to vascular comprimise
Complications of stomas - short term:
What dangerous thing can happen especially with ileostomies?
How should this be managed?
What would you suspect if there is no output>
High output
Maintain hydration
Check electrolytes
Monitor losses
Give IV fluid
Obstruction - NBM, bloods, CXR and AXR, IV fluids, NG tube
Complications of stomas - long term:
What can happen to the bowel over time? - 2
What can also happen that also happens to heart valves?
What may happen in a person’s life that they might care about more?
Prolapse of bowel through stomal opening
Parastomal hernia - look at pics
Stenosis
Psychosexual problems
Crohns vs UC:
Where does it tend to affect?
Main symptom
Thickness of inflammation
Complications - 2
Rectum - UC
Terminal ileum - C
Bloody diarrhoea - UC
Crampy abdo pain - C
Submucosa or mucosa - UC
Transmural - C
Haemorrhage and toxic megacolon - UC
Fistulas, abscesses, obstruction - C
