Define a stoma
Aritificial openings of a hollow organ in which the opening is brought to the skin
For a colostomy, state:
- What it is
- What it drains
- Whether they need a spout
- Where commonly found
- Artificial opening in colon and opening is brought to the abdominal wall
- Drains more solid stools (mo**st of water been reabsorbed)
- Don’t need spout as solid contents less irritating to skin
- Left iliac fossa
For an ileostomy, state:
- What it is
- What it drains
- Whether it needs a spout
- Where typically located
- Artificial opening in small bowel and opening is brought to abdominal wall
- More liquid stools
- Need a spout (as more liquid contents may irritate skin)
- Right iliac fossa
For a gastrostomy, state:
- What it is
- What it is used for
- What is PEG?
For a urostomy, state:
- What it is
- What it drains
- Whether it needs a spout
- Where typically located
- An ileal conduit is made (15-20cm of ileum is removed)and anastomosed to the separted section of ileum. End of ileum section is brought out onto skin as a stoma to drain urine from the kidneys (anastomose conduit to ends of ureters)
- Urine
- Yes, spout is needed as urine can irritate skin
- RIF
All pts with stomas should have training on how to manage their stoma and have regular follow up with stoma nurse; true or false?
True
Explain the difference between an end colostomy or ileostomy and a loop colsotomy or ileostomy
- End colostomy: end part of proximal portion of colon is brought onto skin. The other end/distal part is sutured and left in the abdomen. May be reversed at a later date.
- Loop colostomy: bowel is partially opened and folded so that there are two openings on skin side-by-side attached in the middle. Allows distal part of bowel and anastomoses to heal after surgery. Reversed at a later date
End colostomies are permanent after what procedure?
Abdomino-perineal resection (removal of sigmoid colon, rectum & anus)
End ileostomoies are permanent after what procedure?
Panproctocolectomy (removal of large bowel, rectum and anus)
Discuss what a J pouch is
- Ileum is foled back on itself and made into a larger pouch that functions a bit like a rectum; J pouch then attached to the anus and collects stools prior to person passing a motion
- Can be an alternative to and end ileostomy
How can you distinguish between the proximal and distal end of a loop colostomy or ileostomy?
- Proximal end (productive side) is turned inside out to form a spout
- Distal end is flatter as no spout is created as this end is not productive
State some potential complications of stomas
- Psycho-social impact
- Local skin irritation
- Parastomal hernia
- Loss of bowel length leadin gto high output, dehydration & malnutrition
- Stenosis
- Obstruction
- Retraction (sinking into skin)
- Prolapse (telescoping of bowel through hernia site)
- Bleeding
- Granulomas around stoma
- Constipation (colostomies)
