Stomas

• Ostomy: A surgical opening made into the bowel to allow for the elimination of stool.

• • Stoma: The part of the bowel or urinary system visible on the abdomen•  • Colostomy• Indications:• Colon cancer• Diverticular disease.• Truma• Hirschurprung's disease• Anorectal malformations• High anal fistula

• Description:• The stoma is light pink in color, moist and has no feeling and has less wrinkled. • Situated on the left side of the abdomen below the waistline.• Flat with skin.• Its content is solid and brown.

iliostomy

• Indications:• IBD

• Description:• Usually on the right side of the abdomen.• The output will be soft to liquid greenish in color.• more dark pink to red and more wrinkled

• Complications (for both):• Anatomical: para-stomal hernia, stricture of bowel, bowel prolapse.• Functional: decrease absorption of nutrients, increase in secretions

of intestine (become 6 liters) which may leak outside and cause skin irritation and ulceration.

Central venous line

• Neck (internal jagular)• Chest (subclavian)• Groin (femoral)

Types:• Tunneled catheter• Implanted port• peripherally inserted central catheter, or PICC line

Indications:• Monitoring of the central venous pressure (CVP) in acutely ill patients to quantify fluid

balance• Long-term Intravenous antibiotics• Long-term Parenteral nutrition especially in chronically ill patients• Long-term pain medications• Chemotherapy• Plasmapheresis• Dialysis

•

Complications:• Pneumothorax (for central lines placed in the chest);

the incidence is thought to be higher with subclavian vein catheterization. In catheterization of the internal jugular vein, the risk of pneumothorax can be minimized by the use of ultrasound guidance.

• Infection: Staphylococcus aureus and Staphylococcus epidermidis sepsis (highest in femoral)

• Air embolism• Hemorrhage• Arrhythmia may occur during the insertion process

when the wire comes in contact with the endocardium

Foley's Catheter

• Insertion "completely aseptic technique":• Take a consent• Clean the perineum• Lubricate & insert it all the way, to know its in the bladder u'll see the urine coming

out• Inflate the balloon & pull it until u feel a resistance (balloon at the bladder neck)• Then fix it to the thigh

Indications:• Diagnostic: • Urine output monitoring• To collect urine specimen• Study anatomy of the urinary tract (ascending cystourethrogram)• Therapeutic:• Acute urinary retention• Chronic obstruction causing hydronephrosis• Intermittent bladder decompression for neurogenic bladder• Chronically bed-ridden patients for hygiene• Inject chemotherapy

• Contraindications:• Urethral injury

• Complications:• Trauma (bleeding, urethral rupture)• Urethral stricture• UTI

• Types:• Rubber: for < 3 weeks, change it every 3 weeks• Silicon: stay up to 3 months but more expensive• Usually there are 2 lumens: 1 for drainage of urine & 1 for balloon inflation

NasoGastric Tube

Inserstion:• Take a conset• Put patient in 45o, neck extended• Ensure that patient doesn’t have nasal blockage or bleeding• Lubricate the tube with xylocane Jel• Insert, when patient feels Gag reflex ask him to swallow• Ensure its in the stomach(flush with 50cc air & auscultate

epigastric area)• Tube is marked:• Mark 1: in the Eso.• Mark 2: Gastro-eso junction• Mark 3: in the stomach it between mark 2 & mark 3• Mark 4: in the duo.

Indications:a)Diagnostic: • patient presenting with melena to know if there is UGIB• esophagio-tracheal malformation (Eso. Atresia)• small bowel enema• Toxicology

b)Therapeutic: • Feeding• Decompression (intestinal obstruction, vomiting)

Complications:• Trauma• Necrosis of nostril (epistaxis)• GERD

Sengstaken-Blakemore tube:

• Is an oro- or nasogastric tube used occasionally in the management of upper gastrointestinal hemorrhage due to bleeding from esophageal varices when bleeding can't be contolled by medications.

• It is passed down into the oesophagus and the distal balloon is inflated in the stomach. Distension of the proximal balloon is used to stop bleeding from the varices.

• It is a temporary measure: ulceration and rupture of the esophagus and stomach are recognized complications.

Endoscopic Retrograde Cholangiopancreatography (ERCP)

ERCP showing dilated CBD with multiple filling defects (CBD stones)

Indications:

• Diagnostic:• Diagnosis of possible tumor at the ampulla • Assessment of chronic pancreatitis • Diagnosis of possible pancreatic tumor • Biliary disease with jaundice or abnormal liver function tests • A dilated biliary tree on ultrasonography

• Therapeutic:• Biliary duct stone extraction or lithotripsy • Placement of stent • Endoscopic sphincterotomy of the sphincter of Oddi • Ampullary balloon dilatation

• Complications:• Pancreatitis• Ascending cholangitis• Perforation (duodenum)• Bleeding

• In cholangiogram we are looking for:• Filling defect (stone or tumor)• Stricture (benign: inflammatory, malignant:

cholangiocarcinoma)• Dilatation (intra or extra)• Leak of contrast

Double J stent

Indications: • to relieve obstruction (benign or malignant),

adjunct to stone therapy (ESWL), for ureteral instrumentation, management of urine leak after trauma

Complications:• dislocation, infection and blockage by

encrustation 

 Done By:

Dana Saud ALEssaBest wishes ;)