Stoma

Question 1

What’s stoma?

Answer 1

• a surgically created opening into a hollow organ
• it is usually covered by a removable pouching system that collects the output for disposal

Question 2

Examples of stoma

Answer 2

Common examples include:

• colostomy (opening into large bowel)
• ileostomy (ileum)
• urostomy (urinary system)

Question 3

Apart from the usual (DOB, name, consent), what to ask a patient before starting the examination of their stoma?

(2)

Answer 3

Ask the patient if:

• they have any pain in their abdomen
• if they have had any problems with their stoma (such as pain around the stoma or a change in output)

Question 4

How the stoma should be exposed for the examination?

Answer 4

Ask the patient to fully expose their stoma site (ideally you should ask the patient if they would be able to remove their stoma bag)

Question 5

What should we comment on while inspection during stoma examination?

Answer 5

• Site
• Spout
• Consistency (output)
• Number of lumens

Question 6

Site of the stoma - what it will tell us

Answer 6

Site

• in the left iliac fossa → colostomy
• right iliac fossa → ileostomy

Question 7

Spout of the stoma, what it will tell us?

Answer 7

Spout

• spouted stoma → ileostomy (or urostomy) as small bowel contents are an irritant to the skin
• stoma flush with the skin → a colostomy

Question 8

Consistency of the stoma output, what does it tell us?

Answer 8

Consistency

• Colostomy output is generally thick and sludgy (like faeces)
• Ileostomy is waterier and often greener
• Urostomy will produce urine

Question 9

Number of lumens of a stoma on an inspection, what does it tell us?

Answer 9

Number of lumens

• Loop stomas → two lumens
• End stomas → one lumen

Question 10

Potential complications of the stoma to observe for on inspection

Answer 10

• parastomal hernia (common with colostomies)
• prolapse
• retraction
• infarction (whereby the stoma is turning jet black)

Question 11

What to observe for during skin inspection around the stoma?

Answer 11

• erythema
• ulceration
• fistulation

Question 12

What to do on palpation of the stoma (3)

Answer 12

• Gently feel around the stoma site for any tenderness
• Ask the patient to cough and feel for a cough impulse for any obvious parastomal hernia
• Gently digitate the stoma to assess for any stenosis and check patency