January 23, 2011

Surgical Short Case; Stoma examination

download the pdf version [here]

Examination and how to comment



1) Site (Which quadrant the stoma located)
2) Type of stoma
- End stoma
- Loop
- Double barrel stoma
3) Surrounding skin
- Excoriation
- Fungal infection
- Redness
4) Covering of surrounding skin (paint, lotion, cream)
5) Loop
- Retracted
- Parastomal hernia (conceal vs. reveal)
- Stenosis
6) Stoma functioning or not, then comment on the discharge
7) Stoma discharge
- Color (bilious, red, clear)
- Type (mucous, blood, pus, feces)
- Amount (copious, moderate, no amount)
8) Open up the stoma bag and examine



Comment

I think this is end/ double barrel / loop stoma located at right iliac fossa/ left iliac fossa/ epigastric region. It is most likely Ileostomy/ colostomy/ gastrostomy. It is well/ not functioning. There is feces/ bilious/ clear fluid discharge with copious/ moderate/ no amount. The surrounding skin is excoriated/ inflamed/ suggestive of fungal infection / not inflamed. The loop is retracted/ with presence of Parastomal hernia/ stenosed.




Questions

1) What is stoma
2) What are the functions of the stoma?
3) How to know whether stoma is functioning or not?
4) When to remove the stoma
5) Complication of stoma
6) Ileostomy vs. colostomy. How to differentiate?

Answer


1) Stoma definition
- Literally means mouth or opening.
- Being described as artificial external opening in lumenated organ


2) Function of stoma includes
- feeding purposes (gastrostomy or jejunostomy)
- bypass the surgical site like distal end of bowel (ileostomy to bypass large bowel, colostomy to bypass anus,urostomy bypass the bladder)


3) By looking at whether there is a discharge or not and the amount of discharge.


4) Stoma may be removed after the distal end (site of surgery) healed. It could be as early as 2 months.



5) Complication of stoma includes skin irritation, prolapsed, retraction, necrosis, Stenosis, Parastomal hernia, bleeding, fistulation, electrolyte imbalance, superficial infection, colostomy diarrhea and constipation. Apart from that, patient may be affected psychologically with the appearance of the stoma and phantom rectum (urge to defecate)


6) Ileostomy vs colostomy


Ileostomy

Colostomy

Site

Right sided (RIF)

Anywhere but more common in left side

Spout

Present

Flush

Discharge

Watery

Solid (feces)

Surrounding

Excoriation, inflamed

Nil

Color

Dark pink/ red

Light pink



7) Stoma care
- Referral to stoma nurse and support group
- Avoid fizzy drink before and during air travel and use stoma with gas filter as change in pressure in the aircraft can cause lot of wind to be passed.
- Take extra fluid and salt intake for patient with ileostomy
- Explain regarding various types of stoma bag and seals.
- Care for the surrounding skin. Wipe with warm water to prevent inflammation, excoriation.




Ileostomy

Image from: http://www.securicaremedical.co.uk/images/ileostomy-image.jpg




Loop Ileostomy

Image from: http://www.securicaremedical.co.uk/images/Loop-ileostomy-image.jpg




Ileostomy with stoma bag at right lower quadrant region. Notice the fluid discharge.

Image from: http://ucstory.files.wordpress.com/2008/05/ib-14.jpg


Mix stoma (Vesicostomy and colostomy)

Image from: http://img.medscape.com/pi/emed/ckb/pediatrics_surgery/933425-939455-1818tn.jpg

10 comments:

  1. I think you mean in greek it means mouth.

    ReplyDelete
  2. Asalamu alaykom warahmatullahi wbt
    first of all, my allah make easy for you to acheave your goal. Ameen
    jazakalah khayran it is very helpfull. i was studying nursing board test and i wanted to understand the different kind surgery and stomies and your web help me alot my allah give you Ajar insha allah

    ReplyDelete
  3. I don't think the first one is a colostomy

    there is a sprout so it is more compatible with an ileostomy

    ReplyDelete
    Replies
    1. That isnt a spout its just protruding a bit. Its a colostomy

      Delete
  4. what is your first picture, can you give me more info and how it heels? what kind is it? and was this after surgery? what does it involved?

    ReplyDelete
  5. first one is flush with the skin, so it is colostomy

    ReplyDelete
  6. i have exam tomorrow, thanx alot dr.
    may Allah bless u

    ReplyDelete
  7. The dung that leave the stoma can be exceptionally bothering to the skin. So it is critical to take extraordinary consideration of the stoma to maintain a strategic distance from harm to the skin. Wear good quality of Ostomy Belts.

    ReplyDelete
  8. Really informative. Thanks a ton.
    Visit: www.helpmedico.com for medical notes and Indian PG preparation.

    ReplyDelete

Ya Allah! Permudahkanlah aku untuk menuntut ilmuMu, memahaminya, mengingati dan menyebarkannya. Berkatilah ilmu itu dan tambahkanlah ia. Amin.