Surgical Short Case; Stoma examination

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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.

Colostomy

Images from: http://www.securicaremedical.co.uk/images/colostomy-image.jpg

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