Stoma

This presentation gives a fine description about stoma and ostomy. This contains the details regarding types, complications and the advices that you should give to a patient with a stoma.

1. Stoma / Ostomy
K. Kavindya M. Fernando
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2. Contents
•What is an ostomy
•Types of ostomy
•Attachment of stoma appliance
•Ileostomy vscolostomy
•Loop ileostomy (total procto-colostomy)
•Double baralstoma
•Complications
•Diet
•Colostomy irrigation
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3. What is an ostomy?
•An opening,
•In the small intestine or large intestine,
•Created as an outlet through the anterior abdominal wall,
•In order to pass fecal matter into a bag
•STOMA = part of intestine we use to create this outlet
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4. Purpose of stoma
•It reduces pain and discomfort
•Allows systematic defication
•May help relieve symptoms of intestinal disease
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5. Disease conditions where you might
need stoma
•Inflammatory bowel disease
•Ulcers
•Polyps
•Cancers
•Disorders of bowel function –Hurschprung’sdisease
•Accidental injury
•Congenital deformities of anus and rectum
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6. Type of ostomy
Ostomy
Ileostomy Colostomy
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Stoma of the terminal
part of small intestine
An artificial opening
made in the large bowel
to divert feceasand
flatus to external
environment, where it
can be collected into an
external appliance

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8. Type of ostomy
Stoma
Temporary Permanent
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Stoma of the terminal
part of small intestine
An artificial opening
made in the large bowel
to divert feceasand
flatus to external
environment, where it
can be collected into an
external appliance

9. Attachment of the stoma
appliance
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10. Attachment of the stoma appliance
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11. Attachment of the stoma appliance
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1. Remove the colostomy
bag carefully

12. Attachment of the stoma appliance
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2. Check the stoma for the
colour
If it is black-consult your
doctor
Stoma has to be pink, red
in colour
Clean the stoma well
Let it dry

13. Attachment of the stoma appliance
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3. Try using a skin barrier,
such as stoma powder.
Sprinkle stoma powder
around the stoma.
Be careful not to put the
powder on the stoma itself.
Carefully dust it around
using a dry wipe, and let
the area dry for about 60
seconds.

14. Attachment of the stoma appliance
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4. Place the transparent
stoma template over your
stoma, to assess the
diameter
Opening should match the
diameter –skin irritation

15. Attachment of the stoma appliance
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16. Attachment of the stoma appliance
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5. Remove the sticker of
the wafer and fix it
carefully

17. Attachment of the stoma appliance
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6. Fix the pouch to the
wafer
Clip the other end
Apply microporeplasters
around the wafer
Wafer may be left in place
for 7 days

18. Colostomy vsileostomy
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19. Colostomy vsileostomy
Ileostomy Colostomy
Sprout+ No sprout / flush
Site Usually in RIF Temporarycolostomy –transvers or
right upper quadrant
End colostomy –usually in LIF
Effulent Liquid contain some amount of enzymes
(alkali and proteolyticenzymes) 
excoriation of skin + (Autodigestion)
Solid,hard stools compairedto
ileostomy
Watery liquid stools Hard stools
Oddor Oddor+ Oddoris more
Frequency of
discharge
Higher Lower
Circular foldson the ileum + no
More likely to develop fluid and electrolyte
problems
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20. Total procto-colectomy
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21. Indications
•Familial adenomatous polyposis
•Size >1cm
•Amount >100 polyps
•Microscopy of polyp –villous & tubovillous(less harmful)
•Ulcerative colitis –not responded to medication
•Ulcerative colitis with dysplasia
•UC with perforations
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22. Indications
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Contents are liquid
Create a pouch to
storage function
Artificial pouch

23. Artificial pouch
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•After anastomosis
you have to rest the
anastomosis site
•To prevent that –
make a loop
ileostomy in the RIF
to divert feces
•Can reverse after
6/52 when the
anastomosis is
healed

24. Loop ileostomy
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25. Loop ileostomy
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26. Mucous fistula / Double
barrel stoma
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27. Double barrel stoma
•Bowel is surgically severed and 2 ends are
brought out into the abdomen as 2 separate
stomas
•Proximal end –functional stoma
•Distal end –non functioning (mucus fistula)
•Used in temporary diversion –cases where
resection is required due to perforation or
necrosis
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28. Complications of stoma
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29. Complications
Complications
Early Late
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1.Ischemia
2.Bleeding
3.Retraction
4.Skin excoriation
1.Prolapse
2.Peristromalhernia
3.Recurrent disease
4.Bowel obstruction

30. Ischemia
•Due to impaired blood flow
•Poor blood supply when stoma is formed
•Too tight stoma bag
•Too tight dresses over storma
•Management
•Close observation during post op period
•A clear plastic appliance should be fitted
•Avoid tight clothing
•Inform your surgeon if you notice any colourchange
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31. Bleeding
•Overenthusuasticcleaning
•When using template for measurement
•Bleeding from lumen is more serious
•Portal HPT in cirrhosis
•Recurrence of colonic CA
•Management
•Do not rub your stoma
•Be careful when applying the bag
•Compress with guaze
•Usually resolve without interventions
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32. Retraction
•Recession of the stoma
•away from the skin surface
•due to excess tension of the stoma
•Insufficiantfixation
•Post op weight gain
•Management
•Use and appliance with rigid flange
•Apply stoma adhesive paste before fixing appliance
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33. Herniation vsprolapse
Herniation Stoma prolapse
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34. Excoriation of skin
•Make sure the wafer and the pouch are well fixed
•Control excessive mucus discharge
•Be cautious of the size of the stoma and the wafer
•Use lukewarm water and mild soap to clean the peristomal
skin
•Never use alcohol agents, savlon, creams, powder or
chemical agents to clean
•Never use artificial drying methods. Ex: hair driers
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35. Excoriation of skin
•Management
•Educate the patient about appliance change
•Consider a 2 piece appliance to allow healing
•Use stoma adhesive powder or pase
•Do not use antiseptics for cleaning peristomalskin
•Change the base plate as soon as it leaks
•A methyl cellulose skin wafer is helpful
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36. Excoriation of skin
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37. Ostomyand your diet
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38. Avoid
•Vegetables –raddish, cabbage, garlic, cucumber, kno-kol
•Are known to result in offensive odour
•Carbanotedbeverages, chewing gum and smokinh
•Causes excess gas in stoma appliance
•High and moderate fiber diet
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39. Low fiber diet (0-10%)
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Vegetables
1.Beans
2.Carrot
3.Onion
4.Chillies
5.Tomato
6.Cabbage
7.Kankun
Fruits
1.Orange
2.Dates (dried)
3.Passion fruit
Animal products
1.Eggs
2.Prawns
3.Milk
4.Cheese
5.Butter
Pulses
1.Green gram
2.Dhal
3.Soya bean
4.Cowpee
Cereal
1.Barley
2.Maize
3.Kurakkan
4.Rice (raw-
white)
5.Rice (parboiled-
white)

40. Advices
•Chew your food well and consume adequate amounts of water
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41. Colostomy irrigation
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42. Colostomy irrigation
•Normally done in patients with a
•Permementcolostomy
•Who need bowel preparation for special investigations –colonoscopy
•Usually done it after 1 year of stoma creation
•Takes about 45 minutes
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43. Contraindications
•Ileostomy
•Ascending colon stoma
•Transverse colon stoma
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44. Requirement for stoma irrigation
•1.5 –2 L of lukewarm
water
•Resoviorbag
•A tube with a
controller and a funnel
shaped introducer,
which prevents damage
to stoma
•2 clips to close the bag
•Bag to discard feces
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45. Requirement for stoma irrigation
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46. Requirement for stoma irrigation
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47. Thank You!
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