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ileostomy disease and procedure
crohn's, ulcerative colitis, familial adenomatous polyposis, trauma, necrotizing
enterocolitis, cancer, ischemic bowel
total proctocolectomy with end ileostomy, total proctocolectomy with
continent ileostomy, temporary ileostomy, temporary loop ileostomy for ileal
pouch-anal anastomosis
ileostomy function and management
*function begins in 24-48 hours
*initially gas, then liquid output for several days, then becomes mushy
*output of 500-600 ml/day (higher output the higher up in the ileum stoma is)
*empty pouch when 1/3 to 1/2 full
*protect peristomal skin
*watch for fluid and electrolyte imbalance
ileostomy complications
*high risk for bowel obstruction-instruct pt to chew food thoroughly and
drink lots of water
*potential risk for vitamin B12 deficiency
,transverse colostomy location
RUQ or LUQ
transverse colostomy disease and procedure
diverticulitis, colon cancer, crohn's, perforated bowel, congenital disease
(Hirschprung's)
diversion of large bowel at the transverse colon, with or without colectomy,
usually temporary loop stoma
transverse colostomy function and management
*function begins within 48 hours
*initially gas, then mushy or semi-formed
*may have urge to poop with mucous from rectum
*no effect on nutritional absorption
transverse colostomy complications
*waistline location can be difficult to manage
descending colostomy location
LLQ
, descending colostomy disease and procedure
colorectal cancer, trauma, bowel perforation, ischemic bowel
permanent end colostomy with rectum and anus removed, temporary or
permanent end colostomy with Hartmann's pouch (sewing shut top of
rectum with ability to
reconnect to GI tract later)
descending colostomy function and management
*function may not begin for up to 5 days post-op
*initially gas, then liquid, then semi-formed to formed
*odor and gas of concern due to higher amounts of bacteria
*may need colostomy irrigation routinely
descending colostomy complications
*monitor, prevent, and manage constipation
*may cause erectile dysfunction
continent ileostomy (kock pouch)
total proctocolectomy performed and abdominal ileal pouch is made. The
continence mechanism is a nipple valve constructed in the pouch by
intussusception.