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Understanding Stomas: Types and Management

Apr 21, 2025

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Stomas Lecture Notes

Introduction to Stomas

  • Stomas are artificial openings of a hollow organ onto the surface of the abdomen.
  • Used to bypass the distal portions of the bowel or urinary tract.
  • A stoma bag is used to collect waste products.

Types of Stomas

Colostomy

  • The large bowel or colon is brought onto the skin.
  • Drains more solid stools as water is reabsorbed in the large intestine.
  • Typically located in the left iliac fossa.

Ileostomy

  • End portion of the small bowel (ileum) is brought onto the skin.
  • Stools are more liquid due to the absence of water reabsorption.
  • Have a spout to prevent skin irritation.
  • Typically located in the right iliac fossa.

Gastrostomy

  • Creates a connection between the stomach and abdominal wall.
  • Used for feeding rather than drainage.
  • Percutaneous Endoscopic Gastrostomy (PEG) is a method for fitting a gastrostomy.

Urostomy

  • Opening from the urinary system onto the skin.
  • Has a spout to prevent urine contact with the skin.
  • Typically located in the right iliac fossa.

Management and Training

  • Patients should have training on stoma management.
  • Regular follow-up with a specialist stoma nurse is essential.

Specific Stoma Types

End Colostomies and End Ileostomies

  • Created after bowel section removal.
  • End colostomy may be reversed later unless after an abdominal perineal resection (APR) which is permanent.
  • Ileostomies are permanent after total colectomy or panproctocolectomy.

Ilioanal Anastomosis

  • Alternative to permanent end ileostomy.
  • The ileum is fashioned into a pouch (J-pouch) and attached to the anus.

Loop Colostomies and Loop Ileostomies

  • Used to allow healing of bowel and anastomosis.
  • Features two openings; a productive proximal end with a spout and a flat distal end.

Urostomy Details

  • Drains urine from the kidney bypassing bladder and urethra.
  • Involves creating an ileal conduit using a section of ileum.
  • Anastomoses of ureters to the separated portion of ileum which is brought to the skin as a stoma.

Complications of Stomas

  • Psychosocial Impact: Major lifestyle change.
  • Localized Skin Irritation: Due to waste contact.
  • Parastomal Hernias: Weakness and bulging around stoma.
  • High Output/Dysfunction: Less water reabsorption leads to dehydration and malnutrition.
  • Constipation: Particularly with colostomies.
  • Stenosis and Obstruction: Narrowing or blockage of stoma.
  • Retraction and Prolapse: Stoma sinks into or telescopes out of the skin.
  • Bleeding and Granulomas: Raised red lumps around the stoma.

For more detailed notes, illustrations, and questions, visit Zero to Finals at zero2finals.com. Additional resources such as books and flashcards are available to aid in medical studies.

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