[Applause] [Music] hi this is tom from zero2finals.com in this video i'm going to be going through stomas and you can find written notes on this topic at zero to finals dot com slash stomas or in the general surgery section of the zero to finals surgery book so let's jump straight in stomas are artificial openings of a hollow organ for example the bowel the bowel or urinary system is artificially opened onto the surface of the abdomen allowing feces or urine to drain and this allows it to bypass the distal portions of the bowel or the urinary tract a specially adapted bag called a stoma bag is fitted around the stoma on the abdomen to collect the waste products and is emptied as required a colostomy is where the large bowel or the colon is brought onto the skin colostomies drain more solid stools as much of the water is reabsorbed in the remaining large intestine colostomies can be flatter to the skin compared with ileostomies which have to have a spout as the solid contents are less irritating to the surrounding skin colostomies are typically located in the left iliac fossa an ileostomy is where the end portion of the small bowel or the ileum is brought onto the skin the stools that come out of an ileostomy are more liquid because the fluid content of the stool is normally reabsorbed in the large intestine ileostomies have a spout which allows them to drain directly into a tight-fitting stoma bag without the contents coming into contact with the surrounding skin this is because the liquid stools are very irritating to the skin they're typically located in the right iliac fossa a gastrostomy involves creating an artificial connection between the stomach and the abdominal wall this is used to put things in rather than to drain things out and it's used for providing feeds directly into the stomach in patients that cannot meet their nutritional needs by mouth a percutaneous endoscopic gastrostomy or peg refers to when the gastrostomy is fitted during an endoscopic procedure a urostomy involves creating an opening from the urinary system onto the skin urostomies have a spout and are typically located in the right iliac fossa the spout is used in order to avoid the urine coming into contact with the skin so that the urine drains directly into the bag as urine in contact with the skin will cause a lot of irritation all patients with stoma should have training on how to manage the stoma and regular follow-up and contact with a specialist stoma nurse let's talk about end colostomies and end ileostomies an end colostomy is created after the removal of a section of bowel where the end part of the proximal portion of bowel is brought onto the skin feces are able to drain out of an end colostomy into the stoma bag the other end of the remaining bowel the distal part of bowel is sutured and left inside the abdomen an end colostomy may be reversed at a later date where the two ends are sutured together to create an anastomosis end colostomies will be permanent after an abdominal perineal resection or apr because the entire rectum and anus have been removed end colostomy's after an abdominal perineal resection or apr procedure are usually located in the lower left abdomen and ileostomies are permanent after a pan proctocolectomy which is a total colectomy with removal of the large bowel rectum and anus and this procedure may be performed in the treatment of inflammatory bowel disease or familial adenomatose polyposis or fap an alternative to creating a permanent end ileostomy is to create something called an ilioanal anastomosis or a j pouch and this is where the ielum is folded back on itself and fashioned into a larger pouch that functions a bit like a rectum this j pouch is then attached to the anus and collects stools prior to the person passing a motion let's talk about loop colostomys and loop ileostomies a loop colostomy is a colostomy which is used to allow the distal portion of the bowel and the anastomosis to heal after surgery before the loop colostomy is reversed around six to eight weeks later the bowel is partially opened and folded so that there are two openings on the skin side by side which are attached to each other in the middle the word loop is used because a loop of bowel has been taken through the abdominal wall the looped middle section has been removed and the two ends the proximal and the distal end are left open the proximal end which is productive meaning stools come out of it is turned inside out to form a spout to protect the surrounding skin the distal end is more flat and this allows you to tell which end is proximal and distal when you're looking at a loop ileostomy let's talk about a urostomy a urostomy is used to drain urine from the kidney bypassing the ureters the bladder and the urethra this may be used after a cystectomy which is removal of the bladder forming a urostomy involves creating an ileal conduit so let's talk in more detail about how an ileal conduit is created a 15 to 20 centimeter section of the ileum which is the distal portion of the small bowel is removed and an end-to-end anastomosis is created so that the bowel remains continuous and the bowel function is not affected then the ends of the ureters are anastomosed to this new separated portion of the ielium the end of this section of ileum is brought to the skin as a stoma and it drains urine directly from the ureters into a stoma bag so what happens is the kidneys drain urine into the ureters this drains into this separated section of the ielium called the ileal conduit and then this drains out of a stoma into a urostomy bag the urostomy bags need to be tightly fitted around the urostomy to avoid urine coming in contact with the skin urine in contact with the skin will cause irritation and skin damage let's talk about the complications of stomas stomas have a number of possible complications there's a significant psychosocial impact there can be localized skin irritation parastomal hernias can form with weakness in the abdominal wall around the hernia and bulging of the abdominal contents around the hernia loss of the length of bowel distal to the stoma means there's less water reabsorbed from the stools which can lead to a high output from the stoma dehydration and malnutrition patients can develop constipation with stomas particularly with colostomies there can be stenosis of the stoma obstruction retraction which is where the stoma sinks into the skin prolapse which is where the bowel telescopes through the hernia site bleeding and granulomas can form which cause raised red lumps around the stoma thank you for watching this video if you liked the video left a comment or subscribe to the channel thank you so much it really helps zero to finals is not just a youtube channel there's also a website with detailed notes illustrations and questions an instagram account where new questions are posted every day to help you test your knowledge books flash cards and much more i also have a personal channel where i share my thoughts and tips on learning medicine and you can find links to everything in the description of this video see you next time