Define stoma.
Refers to any surgically constructed opening onto the body surface to facilitate a bodily function.
List reasons for stoma formation/
Malignancy Obstruction Disease process Neurological impairment TraumaTypes
Types of stomas.
Colostomy
Ileostomy
Urostomy (Ileal conduit)
Define colostomy.
A surgical opening into the large intestine with a stoma created on the abdomen
A colostomy can be:
1. Permanent
2. Temporary
Permanent Colostomy - Abdominal-Perineal Resection
- Sigmoid colon, rectum, ischio-rectal tissues and anus removed
- Performed for anal and low rectal cancers
Permanent or Temporary Colostomy - Hartmann’s Procedure
- Abdominal excision of Sigmoid Colon and upper 1/3 of Rectum - Rectal stump oversewn - End colostomy (temporary or permanent) - Performed for disease / trauma / malignancy
Temporary Colostomy - Anterior Resection
- Excision sigmoid colon and rectum with surrounding tissues
- Colostomy (temporary) to protect the anastomosis
- Performed for rectal cancers not invading anal sphincters
Describe Colostomy Appliances
- One-piece Closed or drainable appliances - Two-piece Closed or drainable appliances - Colostomy irrigation No pouch or mini pouch required
Define Ileostomy.
- A surgical opening into the ileum with a stoma created on the abdomen
- Stoma is commonly sited in the terminal ileum
Describe your colon!
- The large intestine (colon) is 1.5 metres long, from caecum to anus
- The rectum is 17cm long
- The anal canal is 3 cm
- The internal anal sphincter is smooth (involuntary) muscle
- The external anal sphincter is striated (voluntary) skeletal muscle
- 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 the skin
Describe your ileum!
- The longest part of the small intestine 3.6 metres long
- Provides the most extensive area of digestion and absorption
- Ileal contents (Chyme) are slightly alkaline –pH 7.6
- Prolonged skin contact with effluent is likely to compromise the skin.
Indications for permanent ileostomy.
Crohn’s disease
Ulcerative colitis
Familial Adenomatous
Polyposis
Describe Temporary Loop Ileostomy
- Performed to rest an anastomosis
- To allow a internal reservoir or pouch to heal
- Ileostomy patients need a drainable appliance as the effluent is fluid
Describe a Urostomy or Ileal Conduit. List indications.
An opening into the urinary track with a stoma created on the abdomen.
Indications:
- Malignancy of lower urinary tract
- Intractable interstitial cystitis
- Neurogenic disorders of the bladder
- Trauma to bladder or urethra
- Intractable urinary incontinence
- Problematic suprapubic catheter
- Congenital anomalies
A urostomy or ileal conduit requires a drainable appliance with a non-return value
Pre-operative stoma care.
Stomal Therapy Counselling
- Surgical procedure information
- Introduction to living with a stoma
- Skin care, odour, diet and activities
- Appliance options
- Appliance collection
- Trial an appliance
Site the stoma
Routine pre-op care (bowel cleansing, fasting, shave or clip hair, pre-medication)
Post-operative stoma care.
Goal is to promote self-care and rehabilitation - Observation of the stoma - Skin care - Appliance selection & use - How to obtain their appliances - Odour control & Flatus - Disposal of used appliances - Diet & hydration
Stoma observations.
Colour Sutures Size Flatus Action
Stoma skin care.
Remove appliance gently
Cleanse the skin with gentle soap and water
Dry the skin
Shave or clip excess hair if necessary
Use skin protective film barriers if needed
Correctly size aperture
Potential stoma problems.
Appliance leakage Skin ulceration Muco-cutaneous separation Peri or para-stomal hernia Prolapse Retraction or flush stoma Stenosis
When should stoma bags be emptied?
- Bags should be changed or emptied when 1/3 full
- Over distension of bags will pull on base plate and may cause detachment and leakage
