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Stoma Examination

 

NOTE to the READER: this article should be read after/inconjunction with the article on 'STOMAs' in order to gain a background knowledge of stomas.

Introduction

  • name and role
  • explain to the patient what you will be doing
  • explain to the patient why you want to do it
  • gain full consent from the patient
  • confirm the patients name and age

 

Preparation

  • wash your hands
  • put on gloves
  • appropriate patient exposure

 

EXTRA: ideally, examination of a stoma would be a part of an abdominal exam, in which the patient is ideally exposed from 'nipples to knees'.  However, in order to preserve patient dignity, exposure of the whole of the abdomen may be all that is required. 

 

Examination

 

  • ask the patient if they are in any pain before beginning and be sensitive to this

 

EXTRA: asking the patient about pain shows good clinical care to the patient and avoids you looking incompetent infront of the examiner (and the patient!) if later on pain is ellicited to your surprise.

 

  • INSPECT from the end of the bed to see if the patient looks well, abdominal contour, scars, swellings and the site of the stoma

 

EXTRA: a general inspection allows one to ascertain the sick from the well patient and to pick up clues as to the possible underlying disease/s that the patient may be suffering from, while assessing its site allows one to begin to build up clinical information to differentiate between ileostomies, colostomies and urostomies.

 

  • INSPECT the stoma closely noting its colour, number of lumens, presence of a spout or flush with the skin, presence of blood, mucus or leakage of faeces

 

EXTRA: stomas should be a healthy pink/red colour and should be moist and glistening.  Darker and matter hues may indicate ischaemia while a pallor may suggest anaemia.  Sometimes the number of lumens is difficult to determine by inspection alone and a digital examination may be required.  The number of lumens detected will allow distinction between an end, loop or double barrelled stoma.  The presence of a spout identifies an ileostomy while a stoma flush with the skin is usually a colostomy.

 

  • INSPECT the stoma bag noting the colour, consistency and the volume of the contents

 

EXTRA: brown fully formed contents suggest a colostomy.  Semi-solid or liquid contents dark green in colour suggest and ileostomy.  Ribbon like stools may indicate stenosis.  Yellow liquid suggests a urostomy and hence urine in the bag.  The volume of the stoma bag contents is extremely important as a common complication of stomas is high output loss and fluid and electrolyte imbalance.  Large volumes passed may therefore require adequate fluid management, while reductions in volume may indicate stenosis and therefore an impending obstruction.

 

  • INSPECT the surrounding skin for erythema, rash, ulceration and mucocutaneous junction seperation
  • PALPATE the surrounding area for tenderness and masses such as parastomal hernias

 

EXTRA: stomas cause a range of complications such as skin changes that include erythema, fissuring and allergic reactions due to the materials used in the stoma equipment, necessitating the use of barrier creams and seals.  Other complications include bleeding, separation between the mucocutaneous edge and skin, prolapse,  parastomal hernias, narrowing and subsequently obstruction.

 

  • PERCUSSION of the abdomen
  • AUSCULTATION to ensure bowel sounds are present and therefore an indication of a working bowel

 

EXTRA: Digital examination of the stoma

This is not routinely done in a stoma examination and is more often left to a senior or more experienced member of the team to carry out when indicated. For completion, it includes the insertion of a gloved lubricated index finger into the stoma lumen.  At times, this may be all that is needed to relieve an obstruction due to adhesions or fibrosis.  The removed gloved finger is then inspected for faeces, blood or mucus.

 

Documentation

 

  • Record your findings in the sequential order of your examination with necessary diagrams
  • Sign and date your entry

 

EXTRA: accurate documentation allows any progress or deterioration in the patients condition to be recorded, allows all health professionals to be up to date with the patients condition and is important medico-legally.

 

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