Colostomy

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COLOSTOMY Definition •

a surgical procedure that reroute the colon to an opening made in the abdomen.

TEMPORARY COLOSTOMY •

may be used when the part of the colon (typically the lower section) needs to heal, such as after trauma or surgery. After the colon is healed, the colostomy can be reversed, returning the bowel function to normal. In a colostomy reversal, the two ends of the colon are reconnected and the area where the stoma was created in the abdomen is closed. The large intestine is made, once again, into a continuous tube between the small intestine and the rectum. Bowel movements are eliminated through the rectum.

PERMANENT COLOSTOMY •

sometimes also called an end colostomy



commonly used when the rectum needs to be removed because of disease or cancer.



Most of the colon may also be removed, and the remaining portion used to create a stoma.

TYPES OF COLOSTOMY •

Ascending. This colostomy has an opening created from the ascending colon, and is found on the right abdomen. Because the stoma is created from the first section of the colon, stool is more liquid and contains digestive enzymes that irritate the skin. This type of colostomy surgery is the least common.



Transverse. This surgery may have one or two openings in the upper abdomen, middle, or right side that are created from the transverse colon. If there are two openings in the stoma, (called a double–barrel colostomy) one is used to pass stool and the other, mucus. The stool has passed through the ascending colon, so it tends to be liquid to semi-formed.



Descending or sigmoid. In this surgery, the descending or sigmoid colon is used to create a stoma, typically on the left lower abdomen. This is the most common type of colostomy surgery and generally produces stool that is semi-formed to well-formed because it has passed through the ascending and transverse colon.

Purpose: •

Infection of the abdomen, such as perforated diverticulitis or an abscess



Injury to the colon or rectum (for example, a gunshot wound)



Partial or complete blockage of the large bowel (intestinal obstruction)



Rectal or colon cancer



Wounds or fistulas in the perineum -- the area between the anus and vulva (women) or the anus and scrotum (men)

Indication: •

lower large intestine, rectum, or anus is unable to function normally or needs rest from normal functions.



Intestinal obstruction with associated inflammation, as in diverticulitis

BEFORE SURGERY 1. Your physician may ask you to stop some medications as some may inhibit the healing process (such as prednisone) or interact with other drugs. Prednisone is a coticosteroid drug. It closely resembles a substance made by the adrenal glands. Steroids made by the human body work to reduce inflammation and to regulate the intake of salt. More steroids are produced by the body when it is stressed, such as with an illness. 2. You also may need to have certain routine examinations prior to your surgery such as a physical and a chest x-ray. 3. You should also meet with an enterostomal therapy (ET) nurse. An ET nurse will teach you how to take care of your ostomy. 4. Colostomy surgery will often require a bowel prep to clean out the colon. 5. In the day or two prior to surgery, you will follow your surgeon's instructions to remove all stool from your bowel, much as if you were preparing for a colonoscopy. This may be accomplished through fasting, enemas, laxatives. 6. You may also be asked to take antibiotics or other medications to prevent infections prior to, during, and after the surgery. During the Surgery 1. Directly before surgery you will receive an IV to receive fluids and anesthetic. 2. The surgery itself will last several hours.

3. When you awaken, a colostomy bag will be attached to your abdomen over your new stoma, and you may also have one or more drainage tubes. 4. After some time in recovery, you will be moved to your hospital room when the doctor determines that your vital signs (pulse, blood pressure, respiration, etc.) are stable. After Surgery 1. For the first few days after surgery you will continue to receive pain medication through your IV. 2. You will not receive any food until the doctors hear the bowel sounds from your abdomen that indicates your intestines are "waking up." 3. Your nurses may get you out of bed and standing or sitting in a chair a few days after surgery, depending on your condition. Standing and walking as soon as possible is very important to the recovery process, even though it will be uncomfortable at first. 4. After the doctor hears bowel sounds and the stoma begins to function, you may be given some clear liquids to eat such as broth, gelatin, and juice. 5. Your ET nurse may visit you before you leave the hospital to help you learn more about taking care of your stoma and changing your ostomy bag. 6. The hospital staff will advise you about your diet when you first get home, which may be restricted to low fiber. How to Change an Ostomy Bag What You Need: •

adhesiver remover



skin protector



plastic bags



washcloth & towel



wafer

1. Wash your hands! 2. Set out your equipment within easy reach. You will need: adhesiver remover, skin protector, wafer, pencil, measuring guide, stomahesive paste, plastic bags, washcloth, clean towel, new pouch, scissors. 3. Empty your pouch as normal. 4. Wipe the tape surrounding the old wafer with the adhesive remover. Hold skin with one hand, and gently pull wafer off with the other. Use adhesive remover as needed.

5. Put old pouch, wafer and other waste (not the clip!) into a plastic bag for disposal. Sealable sandwich bags work great. 6. Clean the skin and stoma with a washcloth and warm water. This is best done in the shower, but don't use scented soaps, as they will leave a film. Any waste coming out of the stoma can wash down the drain. 7. Pat skin dry, and measure stoma with measuring guide. Leave only 1/8" to 1/16" between the measuring guide and the stoma. 8. Trace the correct size onto the back of the wafer with the starter hole in the middle. Cut out the hole. 9. Apply skin protector to the peristomal skin where the wafer will be. 10. Peel the paper from the wafer and apply stomahesive paste around the cut circle in the wafer. Smooth it out with a wet finger (the water will help to keep it from sticking to your finger). 11. Remove paper backing from tape and apply the entire appliance over the stoma. Make sure the stoma is in the center of the hole. Press firmly and smooth wrinkles. 12. Snap the new pouch onto the wafer, and give it a small tug to be sure it's in place. 13. Press gently on the wafer for a minute to help it get a good seal. 14. Close the bottom of the bag with the clip, and you're off! Tips: 1. Stand over an old towel or some paper towels when changing bags to catch any waste from the stoma. 2. Don't eat late the night before a change. That way, stoma output will be less. 3. Some bleeding is normal when touching your stoma, but report any unusual color, size, shape, or bleeding to your ET nurse. 4. Try different products. Call your ET nurse or ostomy supply companies and ask for free samples. You may have to shop around to find what works for you. 5. Always follow any special instructions provided by your health care professional. This How To is only a guideline.

Risks/ Complications: Risks for any anesthesia include: •

Problems breathing



Reactions to medications

Risks for any surgery include: •

Bleeding

Other risks include: •

Bleeding inside your belly



Damage to nearby organs



Development of a hernia at the site of the surgical cut



Infection, especially in the lungs, urinary tract, or belly



Narrowing or obstruction of the colostomy opening (stoma)



Scar tissue forming in your belly and causing intestinal blockage



Skin irritation



Wound breaking open

HEMORRHOIDECTOMY Definition: •

surgical removal of a hemorrhoid, which is an enlarged, swollen and inflamed cluster of vascular tissue combined with smooth muscle and connective tissue located in the lower part of the rectum or around the anus.

HEMORRHOID: • •

is not a varicose vein in the strict sense also known as piles.

External hemorrhoids •

develop under the skin surrounding the anus



they may cause pain and bleeding when the vein in the hemorrhoid forms a clot. This is known as a thrombosed hemorrhoid.



the piece of skin, known as a skin tag, that is left behind when a thrombosed hemorrhoid heals often causes problems for the patient's hygiene.

Internal hemorrhoids •

develop inside the anus.



They can cause pain when they prolapse (fall down toward the outside of the body) and cause the anal sphincter to go into spasm.



They may bleed or release mucus that can cause irritation of the skin surrounding the anus.



may become incarcerated or strangulated.

Normal Results: •

Hemorrhoidectomies have a high rate of success



most patients have an uncomplicated recovery with no recurrence of the hemorrhoids.



Complete recovery is typically expected with a maximum period of two weeks.

Purpose •

relieve the symptoms associated with hemorrhoids that have not responded to more conservative treatments (bleeding and pain)

Indication: •

patients with hemorrhoids

patients who do not respond to more conservative therapies and who have severe problems with external hemorrhoids or skin tags. Contraindication:  Bleeding diathesis (relative)  Pregnancy or immediate postpartum period (less than 8 weeks)  Inflammatory bowel disease  Anorectal fissures  Active anorectal infections  AIDS or other immunodeficiency states  Portal hypertension (relative)  Rectal wall mucosal prolapse  Anorectal tumors Preparation 1. Always tell your doctor or nurse: •

If you could be pregnant



What drugs you are taking, even drugs or herbs you bought without a prescription

2. Several days before surgery, you may be asked to stop taking aspirin, ibuprofen (Advil, Motrin, naproxen (Aleve, Naprosyn), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot. 3. A few days prior to surgery, blood and urine tests may be performed. 4. You should not eat or drink 12 hours before the procedure.

Procedure: 1. They are given small-volume saline enemas to cleanse the rectal area and lower part of the large intestine. This preparation provides the surgeon with a clean operating field. 2. Patients who are scheduled for a surgical hemorrhoidectomy are given a sedative intravenously before the procedure. With local anesthesia, you will lose sensation around the operated area. With general anesthesia, you will be asleep during surgery.

3. Patient will rest in a position that exposes the rectal area. 4. The hemorrhoid is clamped and tied off. 5. Then, the hemorrhoid is cut away. 6. Gauze may be inserted to stop bleeding. After the procedure 1. Maintaining a high-fiber diet and drinking plenty of fluids is recommended to avoid constipation. 2. Avoid any straining during bowel movement or urination. 3. Gradually return to your normal activities. Avoid lifting, pulling, or strenuous activity until your bottom has healed. 4. Soaking in a warm bath may reduce pain. You may be given a container to give yourself “sitz baths” (sitting in 3 to 4 inches of warm water) a few times a day. 5. The doctor may also prescribe medication and stool softeners. Risks: •

infection



bleeding



allergic reaction to the anesthetic



stenosis (narrowing) of the anus



recurrence of the hemorrhoid



fistula formation



nonhealing wounds.

Hemorrhoids can occur inside the rectum, or at its opening (A). To remove them, the surgeon feeds a gauze swab into the anus and removes it slowly. A hemorrhoid will adhere to the gauze, allowing its exposure (B). The outer layers of skin and tissue are removed (C), and then the hemorrhoid itself (D). The tissues and skin are then repaired (E).

Normal Anatomy

A colostomy creates an opening on the abdomen (stoma) for the drainage of stool (feces) from the large intestine (colon). Colostomies are usually performed after the diseased colon has been removed. Colostomies may be temporary or permanent. While the patient is deep asleep and pain-free (general anesthesia), an incision is made in the abdomen. The diseased colon is removed.

The proximal end of the healthy colon is then brought out to the skin of the abdominal wall, where it is sutured in place. An adhesive drainage bag (stoma appliance) is placed around the opening. The abdominal incision is then closed.

In more than 90% of the cases, the surgery is successful. The patient may experience considerable pain after surgery as the anus tightens and relaxes. Medications to relieve pain may be used. To avoid straining, stool softeners will be used. Avoid any straining during bowel movement or urination. Soaking in a warm bath can bring additional comfort. Depending on the disease process being treated, colostomies can be "taken down" and the colon reconnected in a second operation within weeks to months after the first operation.

OSTOMY BAG

ASCENDING COLOSTOMY

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