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Alongside a good abdominal examination it’s important to remember that many patients you encounter in hospital may already have abdominal pathology. Stomas are common things to come across and examination can be a skill frequently assessed in OSCEs.  If you aren’t really sure what a stoma is, a good place to start is with our summary of the different stoma types. 

Check out the stoma examination OSCE mark scheme here.

First of all, stomas are tougher than they look! A gentle examination of a patient’s stoma isn’t going to cause the bag to fall off or cause the patient any pain or discomfort; if these bags have to stay in place and not leak as the patient goes about their daily routine they are going to be able to withstand some gentle movement by medical students and in all honesty you won’t have to touch it that much anyway.



Introduction

Introduce yourself to the patient

Confirm patient details – name / DOB

Explain procedure and obtain consent

Wash hands

Expose patient adequately

Position patient supine at a 45 degree angle

 

Ask the patient:

Do you have any pain in your tummy?

Have you had any problems with your stoma?


Inspection

Site

LIF: Colostomy

RIF: Ileostomy or urostomy

 

Number of lumens

1 and in RIF: End ileostomy or urostomy

1 and in LIF: End colostomy

2 joined and in RIF: Loop ileostomy

2 joined and in LIF: Loop colostomy

 

Spout

Spout present:

  • Ileostomy (contents toxic to skin)
  • Urostomy

 

No spout: Colostomy

 

Effluent (what’s coming out)

Hard stool – Colostomy

Soft stool – Ileostomy

Urine – Urostomy

Remember to feel the bag!

 

Surrounding skin quality

Any inflammation or excoriations?infection / poor stoma maintenance 

 

Any evidence of complications?

Haemorrhage – Peristomal skin inflammation

Parastomal hernia – Risk of bowel strangulation and necrosis

Prolapse – High output

Retraction – Obstruction


Auscultation

Auscultate for bowel sounds:

  • Absent bowel sounds – ileus
  • High pitched tinkling indicates obstruction

To complete the examination…

Wash hands

Thank patient

 

Summarise findings

“Some Naughty Surgeons Never Stay in the Evenings and Like Porches”

  • Site
  • Number of lumens
  • Spout
  • Nature of effluent
  • State of surrounding skin
  • Evidence of complication
  • Likely type of stoma
  • Possible pathology/procedure

 

Example

This patient has a stoma in the left iliac fossa with one lumen and no spout. The effluent is solid faeces and the surrounding skin is intact with no evidence of inflammation. There is no evidence of complications. This is most likely an end colostomy. To complete my examination I would perform a full gastrointestinal exam.


References

1. Flesh and Bones of Surgery – page 58-59, 2007

2. 2nd edition Essential Examination –  page 104-106, 2010


 

Assessment

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