Stoma Care

Jennie Burch is a?Clinical Nurse Specialist at St Mark's Hospital, Harrow, UK.

• List of contributors. Acknowledgements.Preface.Introduction.1 Stomas: The Past, Present and Future (Jennie Burch).Introduction.The history of stomas.Stomas.Stoma care nursing.Roles of the stoma specialist nurse.Present day stoma care.Support groups.The future of stoma care.References.2 Anatomy and Physiology of the Urinary and Gastrointestinal System (Jennie Burch).Introduction.The skin.Wound healing process.The abdominal wall.The peritoneum.The gastrointestinal tract.The digestive process.The bowel wall.Blood supply.Lymphatic supply.Mouth.Oesophagus.Stomach.Small intestine.Duodenum.Jejunum and ileum.Large intestine.Caecum.Ascending colon.Transverse colon.Descending colon.Sigmoid colon.Rectum.Anal canal.Accessory organs associated with the GI tract.The liver.The gallbladder.The pancreas.The spleen.Urinary system.References.3 Colorectal Cancer and Adjunct Therapy (Deep Tolia-Shah).Introduction.Incidence.Possible causal factors.Symptoms and clinical presentations.Assessment, staging investigations and the multidisciplinary team.Multidisciplinary team.Pre-operative staging.Surgery.Histopathology.Adjuvant chemotherapy.Effects of chemotherapy on stomas.Radiotherapy.Palliative chemotherapy.Surveillance and follow-up.Screening.Conclusion.Further information and websites.References.Further reading.4 Infl ammatory Bowel Disease (Jennie Burch).Introduction.Crohn’s disease.Ulcerative colitis.Infl ammatory bowel disease statistics.Signs and symptoms for ulcerative colitis.Crohn’s disease: signs and symptoms.Aetiology of IBD.Diagnosing IBD.Medical therapy for IBD.Dietary therapy for IBD.Surgery for Crohn’s disease.Surgery for ulcerative colitis.Malignancy in ulcerative colitis.Malignancy in Crohn’s disease.Extra-intestinal manifestations.Other medical issues in IBD.Fertility in IBD.Patient education.Conclusion.References.5 Familial Adenomatous Polyposis (Jacquie Wright and Kay Neale).Introduction.The Polyposis Registry and research.Diagnosing FAP.Bowel screening of relatives ‘at-risk’.Surgery.Colectomy with IRA.Restorative proctocolectomy.Total/panproctocolectomy.Upper GI disease.Extra-colonic manifestations (ECMs).Desmoid disease.An accessible expert centre.References.6 Continence (Julie Duncan and Christine Norton).Introduction.Normal bladder and bowel control.Risk factors for incontinence.Obstetric trauma to the pelvic floor.Age.Investigations.Treatment of incontinence.Practical management.Surgical interventions.Conclusion.Useful websites.References.7 Other Conditions Leading to Stoma Formation (Jennie Burch).Introduction.Congenital malformations/anomalies.Cystic fi brosis.Diverticular disease.Ehlers Danlos.Gynaecological tumour.Hereditary non-polyposis colon cancer (HNPCC).Hirschsprung’s disease.Interstitial cystitis.Intussusception.Irradiation damage.Ischaemic bowel.Meconium ileus.Megarectum.Necrotising enterocolitis.Necrotising fasciitis.Obstruction.Perforated bowel.Solitary rectal ulcer.Spina bifida.Spinal cord injury.Trauma.Visceral myopathy.Volvulus.Conclusion.References.8 Surgery (Alistair Windsor and Gemma Conn).Introduction.Temporary stomas.Permanent stomas.Stoma formation.Surgical technique.Surgical alternatives.Complications.Enhanced recovery after surgery (ERAS).Conclusion.References and further reading.9 Pre- and Post-operative Care (Steve Wright and Jennie Burch).Introduction.Referral to health care professionals.Pre-operative assessment and investigations.Pre-operative information.Bowel preparation.Meeting another ostomate.Informed consent.Stoma siting assessment.Cultural/religious issues related to siting.Stoma siting.Pre-operative fasting.Post-operative aims.Post-operative care.Blood tests.Nausea and vomiting.Nutrition.Post-operative analgesia.Post-operative exercises.Post-operative appliances.Post-operative stoma assessment.Normal stomas.Normal stoma outputs.Post-operative urostomies.Post-operative faecal stomas.Wound care.Post-operative stoma care teaching.Teaching plan.Stoma closure.Small bowel obstruction.Wound infection.Abdominal sepsis.References.10 Intestinal Pouches (Zarah Perry-Woodford).Introduction.The coloanal or colonic ‘J’ pouch.The Kock pouch/reservoir.The ileoanal pouch.Patient suitability and selection.The ‘S’, ‘J’ or ‘W’ pouch.Pre-operative counselling (surgical vs. medical approach).Post-operative care.Anal skin care.Fertility, pregnancy and childbirth.Pouch absorption and diet.Problems following RPC.Research and current development.Laparoscopic surgery.Probiotics.Quality of life.Nursing developments.References.11 Urinary Diversion (Sharon Fillingham).Introduction.Reasons for urinary diversion.Urostomy.Colonic conduit.The ileal conduit.Internal urinary pouches.Neobladder.Urinary drainage.The Mainz Sigma II pouch (modified ureterosigmoidostomy).Support groups.References.12 Appliances (Jo Sica and Jennie Burch).Introduction.History of stoma care products.Modern pouches.Colostomy appliances.Ileostomy appliances.Urostomy appliances.Additional drainage bags.One- and two-piece appliances.Adhesive coupling system.Toilet fl ushable colostomy appliances.Stoma caps.Stoma plug.Appliances for high-output stomas.Fistula appliances.Convex fl anges.Stoma accessories.Protective wafers/sheets.Skin cleansers.Paste.Seals and washers.Flange securing tape.Ostomy belts.Adhesive.Adhesive removers.Odour treatment options.Protective powder.Protective film.Protective cream.Pancaking prevention agents.Discharge solidifying agents.Pouch clips and soft ties.Pouch covers.Flatus fi lters.Hernia support garments.Protective shields.Clothing.Stoma appliance costing.Conclusion.References.13 Discharge to the Community (Jennie Burch).Introduction.Discharge criteria.Stoma supplies.Disposal of appliances.Obtaining further supplies.Nurse prescribing.Appliances.Follow-up visits.Post-operative psychological adjustment.Returning to work.Resuming social activities and hobbies.Exercises.Driving.Clothing.Alcohol.Support garments.Travel.Long-term follow-up.References.14 Nutrition (Morag Pearson).Introduction.Digestion and absorption of nutrients.‘The Balance of Good Health’.Colostomy.Dietary management of functional problems post-colostomy formation.Ileostomy.Dietary management of functional problems post-ileostomy formation.Ileoanal pouch.Dietary management of functional problems post-ileoanal pouch formation.Urostomy.Dietary management of functional problems following urostomy formation.Peri-operative nutrition.Provision of nutrition support.Monitoring.Conclusion.References.Further reading.15 Complications (Jennie Burch).Introduction.Short-term complications.Long-term complications.Allergy and skin sensitivities.Bleeding.Cancer recurrence locally.Crohn’s disease.Constipation.Diarrhoea.Discolouration of the stoma.Flatus.Granulomas/overgranulation.Hernia.High-output stoma.Ileus (paralytic ileus).Infection.Melanosis coli.Mucocutaneous separation.Necrosis.Obstruction.Odour.Pancaking.Phantom bladder/rectum.Prolapse.Pyoderma gangrenosum.Retraction.Skin problems.Stenosis.Stoma trauma.Urine crystal formation.Varices.Conclusion.References.16 Fistulae and Intestinal Failure (Jennie Burch).Introduction.Defi ning fi stulae.Intestinal failure.Parenteral nutrition (PN).Fistuloclysis.Conclusion.References.17 Bowel Irrigation (Jennie Burch and Julie Duncan).Introduction.Rectal irrigation.Colonic irrigation.Colostomy irrigation.Travel.Antegrade colonic enemas (ACEs).Percutaneous endoscopic colostomy (PEC).Conclusion.References.18 Other Stoma Issues (Jennie Burch).Introduction.Age related issues.Drugs.Exercise.Psychological issues.Body image.Sexual issues.Specialist clothing.Toilet access.Cultural issues.Religious issues.Travel.Quality of life.Conclusion.References.Index.