G.I Stomas-1 updated.pptx presentation on surgery

This is the presentation on different types of stoma and indications suggesting it

1. GASTROINTESTINAL STOMA By U19MD2043 U17DS1019 U17DS1020 Department of Surgery, Faculty of Basic Clinical Sciences College Of Health Sciences ABU Zaria 5 /05/25 Tutorial Presentation Moderator: Dr Abubakar Yahaya 1

2. OUTLINE INTRODUCTION CLASSIFICATION INDICATIONS STOMA CARE COMPLICATIONS AND MANAGEMENT PSYCHOLOGICAL AND EMOTIONAL SUPPORT NUTRITION EXERCISE AND PHYSICAL ACTIVITY LIVING WELL WITH A STOMA CONCLUSION REFERENCES 2

3. Brief Anatomy and Physiology Schematic Representation of the Human GIT 3

4. Definition of Stoma A stoma refers to a surgically created opening of a hollow organ on the surface of the body to enable excretion of waste products or for enteral feeding. Classification of Stoma Temporary Stomas Input Stomas Output stomas Permanent Stomas 4

5. Classification of Stoma .Temporary stomas Input output .Permanent 5

6. Input Stomas Include : Gastrostomy Jejunostomy Output Stomas include : Colostomy Ileostomy caecostomy Urostomy 6

7. Gastrostomy 7

8. Jejunostomy 8

9. Colostomy Temporary Colostomy Loop Colostomy Double Barrel Colostomy Hartmann’s procedure Permanent Colostomy End Colostomy 9

10. Loop Colostomy 10

11. Double Barrel Colostomy 11

12. Hartmann's Procedure 12

13. Permanent Colostomy 13

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15. ILEOSTOMY Can be temporary or permanent 1.end-ileostomy 2.loop ileostomy 3.continent ileostomy 15

16. End ileostomy 16

17. Continent ileostomy 17

18. Ileostomy 18

19. Indications Congenital Congenital Megacolon Anorectal Malformation Anal Stenosis Anal Atresia Anorectal agenesis Acquired Intestinal Obstruction Gangrene due to strangulation of the bowel Cancers e.g Anal , Colon ,rectal G.I diseases e.g IBD , Diverticulitis 19

20. AIM OF STOMA CARE Skin Integrity : Prevent skin breakdown and ulceration. Infection Prevention : Maintain hygiene to reduce the risk of infection. Promptly address any signs of infection around the stoma. Complication Management : Identify and address issues like leakage or skin irritation promptly. Collaborate with healthcare professionals for complex cases. Quality of Life Promotion : Address physical, emotional, and practical concerns related to living with a stoma. Empower individuals to lead fulfilling lives despite their condition. 20

21. PRINCIPLES OF STOMA CARE Immediate Bag Change for Leakage : Change the stoma bag promptly to prevent skin irritation and breakdown. Regular Emptying : Empty the bag when it’s 1/3 OR ½ full to prevent overfilling and leakage. Observation and Documentation : Regularly observe and document the stoma's appearance, output, and skin condition to detect complications early. Assessment of Reducing Substances : Check stool output for reducing substances to identify potential digestive issues. Avoid Bag Irrigation : Avoid irrigating the bag to maintain the adhesive bond and prevent skin excoriation. Proper Stoma Cleaning : Clean the stoma initially with warm saline post-operation, then with warm water for regular hygiene. 21

22. OSTOMY BAGS 22

23. OSTOMY BAGS 23

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25. EMPTYING STOMA BAGS Items required for emptying a stoma bag: A pair of non-sterile gloves One 10 ml or 20 ml syringe for measuring output 1 gallipot or kidney dish if output is large Soft absorbent cloth or non-sterile pad Procedure for emptying stoma bag Put on non-sterile gloves. For One-piece stoma bag: hold the bag with the opening upward. Open the clip and position the bag into a gallipot or kidney dish for easy emptying Wipe end of bag with absorbent cloth or non-sterile pad, empty air out of bag and reapply clip. 25

26. EMPTYING STOMA BAGS CONTD… For Two-piece stoma bag: Apply light pressure to the baseplate with one hand and remove the bag with the other hand. Measure output and observe consistency. Inform medical staff if output is more than 20mls/kg/day. Dispose gloves and output in a waste bin. Wash hands. 26

27. COMPLICATIONS OF GIT STOMAS 1. Peristomal Skin Complications Complications : Irritation, erythema, maceration, and dermatitis around the stoma. Management : Use proper fitting appliances. Keep the skin clean and dry. Utilize skin barrier creams or pastes. Used of antibiotics and proper wound care in case of infection 2. Stoma Prolapse Complications : Protrusion of the stoma beyond the abdominal wall, leading to potential strangulation or necrosis. Management : Apply gentle pressure to reduce the prolapse. Adjust appliance size. Surgical correction may be required for severe cases. 27

28. COMPLICATIONS OF GIT STOMAS CONTD… 3. Stoma Retraction Complications : Stoma sinking below the skin level, making appliance fitting difficult and increasing risk of leakage. Management : Ensure proper appliance fit. Use convex appliances or accessories. Surgical revision may be needed for significant retractions. 4. Parastomal Hernia Complications : Protrusion of abdominal contents around the stoma, leading to pain, obstruction, or strangulation. Management : Supportive garments or hernia belts. Surgical repair in symptomatic cases. Prevention with prophylactic mesh placement during stoma creation. 28

29. COMPLICATIONS OF GIT STOMAS CONTD… 5. Stoma Necrosis Complications : Death of stoma tissue, often due to ischemia, leading to potential loss of stoma function. Management : Immediate medical attention. Address underlying causes (e.g., vascular compromise). Surgical revision or creation of a new stoma if necessary. 6. Stoma Stenosis Complications : Narrowing of the stoma opening, causing obstruction and difficulty in appliance placement. Management : Gentle dilation under medical supervision. Surgical revision for severe cases. Address underlying causes such as inflammation or scarring. 29

30. PSYCHOLOGICAL AND EMOTIONAL IMPACT OF LIVING WITH A STOMA Anxiety and Depression Social Isolation Impact : Fear of stoma-related complications, social stigma, or changes in lifestyle Management : Psychological Support : Assigning mental health professionals for counseling or therapy. Medication : In some cases, antidepressants or anti-anxiety medications may be prescribed. Education : Educating friends, family, and colleagues about stomas to reduce stigma and promote understanding. Peer Support : Engaging with support groups or online communities of individuals living with stomas. Motivational Speakers 30

31. NUTRITION AND DIET CONSIDERATIONS Stay Hydrated: Drink plenty of fluids throughout the day to prevent dehydration, especially if you have an ileostomy. Avoid excessive caffeine and alcohol. Balanced Diet: Aim for a balanced diet rich in fruits, vegetables, whole grains, lean proteins, and healthy fats to ensure adequate nutrition. 31

32. Fiber Intake: Depending on the stoma type and medical advice, the patient may need to adjust their fiber intake. Some people benefit from a low-fiber diet initially, while others can gradually reintroduce fiber. Monitor Output: Pay attention to the stoma output consistency and frequency. 32

33. EXERCISE AND PHYSICAL ACTIVITY Benefits: Regular exercise helps maintain overall health, improves mood, boosts energy levels, and can enhance stoma function. Considerations: Choose activities that are comfortable and do not put excessive pressure on your stoma. Start slowly and gradually increase intensity. 33

34. Ostomy Support: Patients should use ostomy support belts or wraps during physical activity for added security and comfort. Consultation: Encourage patients to consult their healthcare providers for any adjustments 34

35. OSTOMY SUPPLIES AND ACCESSORIES Pouching Systems: One-piece and two-piece systems are available, each with its advantages. Experiment to find what works best for the patient in terms of comfort, security, and ease of use. 35

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37. Adhesives: Proper skin preparation and use of adhesives or skin barrier products are crucial for maintaining a secure seal and preventing leaks. Support Garments: Ostomy support belts or wraps can provide additional support and confidence, especially during physical activities. 37

38. LIVING WELL WITH STOMAS Emotional Adjustment: Give yourself time to adjust emotionally to life with a stoma. Seek support from healthcare professionals, support groups, or online communities. Independence: Learn proper stoma care techniques and how to manage ostomy supplies independently to maintain your independence and confidence. 38

39. SUPPORT RESOURCES Utilize resources such as ostomy nurses, dietitians, and peer support networks for guidance, information, and emotional support. By focusing on these areas, individuals with gastrointestinal stomas can maintain optimal nutrition and hydration, stay active, effectively manage their ostomy supplies, and live well with a stoma while maintaining independence and accessing support resources as needed. 39

40. CONCLUSION Gastrointestinal stomas require effective management for improved patient quality of life. Tailored education, support, and innovative care approaches empower patients to adapt and thrive. By prioritizing patient-centered care and interdisciplinary collaboration, we advance stoma care practices and provide holistic support. 40

41. REFERENCES 1. Thigpen J, “Gastrointestinal System” in Kenner C and Lott JW (eds.), Comprehensive Neonatal Care: an Interdisciplinary Approach, 4th edition. (Elsevier Saunders, 2007), pp. 102. 2. Porrett T, “Changing a Stoma Appliance” in Porrett T and Mc Grath A (eds.), Stoma Care, (Blackwell Publishing Ltd., 2005), pp. 95-103. 3. Bowden VR and Greenberg CS, “Ostomy Care” in Bowden V and Greenberg C (eds.), Pediatric Nursing Procedures, second edition (Philadelphia: Lippincott Williams and Wilkins, 2008), pp. 516-519. https://www.Medscape.com https://www.chat.openai.com 41

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