Thursday, March 3, 2011

SHORTCASE : STOMA EXAMINATION





THIS IS MOCK SHORTCASE ONLINE.
please try to answer orally in front of your screen. timing yourself.
when you are done, look for the suggested answer below.

Inspect the patient's abdomen.
Do running commentary.



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GENERAL
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This is scaphoid abdomen.

I can see a stoma at the right lumbar region, but i'm not sure whether it is from ileum or transverse colon.

There is midline scar extended from xiphisternum to umbilicus. It may be recent scar because pink color and well healed. [ask patient to cough] There is no incisional hernia noted.

There is a covered area by the gauze at the left iliac fossa region.

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I would like to focus my examination on the stoma.
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SITE : I can see a stoma at the right lumbar region, but i'm not sure whether it is from ileum or transverse colon.

TYPE : It is a single lumen stoma.

POUT : I can see there is pout presence.
[pout-ileostomy; flush/flat-colostomy; retracted-complication)

COLOR : The stoma is pink in color indicate viable.

COMING OUT : I can see there is fluid coming out from the stoma, so it is functioning.

PARASTOMA AREA : There is no parastoma herniation (intestine) or fluid coming out from parastoma area. No suture noted (if there is suture, it may indicate new stoma).

BAG : It is one piece bag.

CONTENT OF BAG : There is greenish semisolid fluid in the bag.

SKIN : I would like to examine the skin. [open the stoma bag]. There is no erythema or excoriation of the skin.

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I would like to check for the midline scar.
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SITE :
SIZE :
COLOR :
SUTURE :
HEALING :
HYPERTHROPHY / KELOID :
TENDERNESS :

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I would like to examine the covered area.
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[open the gauze]
examine it depends on what you see under the covered area.

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I have finished my examination
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Q : How do you evaluate functioning of stoma?

1. History : ask patient whether any content come out from stoma
2. PE : look for sign of intestinal obstruction such as distended abdomen
3. Per stoma examination : gangrene, intussusception, mass, external compression, etc..
4. Contrast study : barium meal, barium enema (depend on site and situation)
5. Endoscopy through stoma : hartmann procedure, etc...

Q : Type of stoma?

1. Single Lumen
2. Double lumen
3. Loop colostomy

Q : Color of stoma?

1. Pink : Viable
2. Dusky / pale : ischemic
3. Blackish : gangrenous

Q : What can coming out from stoma?

1. Affluent : fluid, faeces, blood, gas, pus, mucus, etc..
2. Consistency : fluid, semisolid, solid

Q : How do you determine severity of skin excoriation?

1. Erythema : more eryhthemaous, more severe
2. Amount : single < multiple (multiple : more severe)
3. Size / extension of excoriation : larger size, more severe
4. Distance from stoma : closer to stoma, more severe
5. Associated pus, discharge, blood : if presence, more severe

source : teaching with ms dayang on march 2011.

4 comments:

izian said...

1.So,from ur inspection,what is the stoma?.What operation require the stoma mentioned above?
2.*do not tell this is a single lumen stoma on inspection, unless u say u want to put ur finger inside to determine it is double barrel or end stoma.
REMINDER: MUST put ur little finger inside to tell what type stoma .

izian said...

The midline scar best describe as: There is a midline supra & infra umbilicus incision.
(refer to my picture album teaching mr zamri on fcbook)

FaDhLi said...

ms dayang suruh masukkan jari utk check patency je..takde plak dia suruh masukkan jari utk check type of stoma..dia kata by inspection dah boleh tau, cuma kalau xsure, bolehlah try buat per stoma.. ayat yang kat atas (khusus bahagian stoma tu) adalah sebijik dari ms dayang..dia show camne nak present dgn btol dan concise.. :)

anyway, if xsure, cakap xsure..jgn make up sign.. :)

izian said...

Ok, xpe..trima kasih...=) sy top up dr mr zamrin je..

correction:
"determine it is double barrel or end stoma."

sebenarnyer.. " bezakan between end stoma and loop stoma" bukan double barrel.
kalo inspect je both ada 1 lubang kan..so, kena masukkan jari nak bezakan dua type stoma tu ..

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