Ostomy exam prep: questions and answers 2023/2024

IPAA - Ileal pouch anal anastomosis. Entire colon is removed. Ileum used to create a J pouch, which is then connected to the anus. Done in stages. Stage 1: loop ileostomy and pouch created. Stool diverted through ileostomy while pouch matures (7-10 weeks). Stage 2: reconnected IPAA is most commonly done to treat which condition? - ulcerative colitis What is the best surgical procedure for Crohn's affecting the large intestine? - total proctocolectomy and ileostomy continent ileostomy, kock pouch - Reservoir pouch is created inside the abdomen with a portion of the terminal ileum. A valve is then constructed in the pouch and a stoma is brought through the abdominal wall. A catheter or tube in inserted into the pouch several times a day to drain feces from the reservoir Kock pouch post-op care - pouch connected to cath for 14 days, irrigated 3x/day after 2 weeks start progressive clamping of tube for gradual pouch expansion cath removed on day 24 post-op, continue to irrigate and intubate BCIR - Barnett Continent Intestinal Reservoir improvement upon the Kock continent ileostomy Enteral feeding tube with continuous feedings: how often should it be flushed, and with how much water? - every 4 hours with 30ml of water, also flush before and after med administration Signs of an impending EC fistula - localized erythema, induration. local discomfort With a triple lumen GJ tube, which port should be used for feeding? - The Jejunal port. Gastric port is used for decompression and meds. DC instructions for new nephrostomy tube - change gauze dressing daily for first 2 weeks, then change twice weekly and PRN soiling How do you keep a hemovac drain patent? - Milk or strip it to remove blood clots and tissue shreds ileal conduit stoma site marking - right lower quadrant ileal conduit stoma site marking for an obese patient - right upper quadrant APR (abdominoperineal resection) - removal of rectum, anus and sphincter. Permanent end colostomy of sigmoid colon placed through LLQ. When does stomal necrosis occur? - within first 24 hours of creation treatment of mucocutaneous separation - fill defect with ostomy powder, fit appliance over the defect Which medications should be avoided with an ileostomy or transverse colostomy? - enteric coated or ER After surgical closure of the ileostomy, what happens to the superficial skin? - Left to close by secondary intention How can gas be managed by an ileostomate? - eating small, frequent meals Pouches should be emptied when how full? - 1/3 to 1/2 full normal ileostomy output - after creation: 800-1700 levels off to: 500-1800 IPAA for high risk or acute colitis patients is better to be performed in how many stages? - 3 stages: 1. subtotal colectomy with double ended ileostomy and sigmoidostomy. rectum remains. 2. IPAA, rectum removed, j pouch attached, diverting ileostomy. 3. ileostomy closed When collecting a sterile urine sample from an ileal conduit, how much urine do you need? - 5-10 ml Definitive treatment for mucosal transplantation - surgical excision Management of mucosal transplantation - stoma powder to absorb mucus secreted by the tissue A peristomal bulge that is usually visualized in the standing or sitting position is actually a________________________ - peristomal hernia Which kind of a pouching system should never be used with a peristomal hernia? - Convexity, because it may cause: pressure ulcers, loosening of the system with change in body countours, stoma laceration. A sterile urine sample collected from an ileal conduit should be delivered to the lab within__________ - 1 hour Gold standard surgery for ulcerative colitis - proctocolectomy with IPAA Familial Adenomatous Polyposis (FAP) - An autosomal dominant trait resulting in the development of polyps and benign growths in the colon. Polyps often develop into malignant growths and cause cancer of the colon and/or rectum. Treatment for FAP - proctocolectomy with IPAA The main advantage of the coloanal J pouch reservoir anastomosis compared to a rectosigmoid anastomosis is that is has demonstrated a significant reduction in - fecal urgency and frequency, because rectosigmoid approach means the loss of the rectum reservoir. What is an advantage of using a stapled anastomosis over a hand sewn anastomosis in an Ileal Pouch Anal Anastomosis (IPAA)? - Stapled IPAA gives significantly better nocturnal continence compared with hand-sewn IPAA following proctocolectomy; other postoperative outcomes are similar between groups. After IPAA closure and recovery from postoperative phase, how many bowel movement should be expected per day? - 5-6 bowel movements per day pseudoverrucous lesion etiology - chronic irritation from moisture under the adhesive barrier of the pouching system Management of pseudoverrucous lesions - ID and manage cause of extra moisture. Wear time should be shortened, if erosion of skin barrier is noted at removal. How did BCIR improve upon the Kock Continent Ileostomy? - Encircling the intussuscepted bowel with a "living collar" to better support the continence mechanism What is the most successful version of the continent ileostomy to date? - BCIR With BCIR, how often should the patient intubate the internal reservoir? - 3-4 times per day What size catheter should be used to intubate the Kock pouch for drainage, how often? - 28 Fr, 4-5 times per day Evacuation disorders are most commonly seen with what type of pouch? - S pouch, created if there is excessive tension in the IPAA. High postoperative risk after IPAA surgery? - Dehydration d/t frequent BMs Kock Pouch post op management - connected to straight drainage for 14 days Irrigated 3x/day starting day 1