Stoma examination

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Surgical Short Case; Stoma examination

 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

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)  How to know whether stoma is functioning or not?

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

4)  When to remove the stoma?

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 ?

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 ?

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.