Examination of a Stoma - Podcast Version 0:00 / 0:00 1x 0.25x 0.5x 0.75x 1x 1.25x 1.5x 1.75x 2x OSCE Checklist for Examination of a Stoma Introduce yourself to the patient Wash your hands Briefly explain to the patient what the examination involves and ask their permission to examine them Position the patient at 45o Before starting any examination of a stoma, ask the patient if they have any pain in their abdomen and if they have had any problems with their stoma (such as pain around the stoma or a change in output). Inspection CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0)], from Wikimedia Commons Figure 1A healthy ileostomy Ask the patient to fully expose their stoma site (ideally you should ask the patient if they would be able to remove their stoma bag). Most of the examination of a stoma comes from inspection, in which you should be commenting on the: Site If situated in the left iliac fossa, it is probably a colostomy If situated in the right iliac fossa, it is probably an ileostomy Spout A spouted stoma will be an ileostomy (or urostomy) as small bowel contents are an irritant to the skin, whereas a stoma flush with the skin will be a colostomy Consistency Colostomy output is generally thick and sludgy (like faeces), whereas an ileostomy is waterier and often greener, and a urostomy will produce urine Number of lumens Loop stomas will have two lumens, whilst end stomas will have one lumen Observe for any potential common complications of a stoma, such as parastomal hernia (common with colostomies), prolapse, retraction, or infarction (whereby the stoma is turning jet black). Check the surrounding skin for any evidence of erythema, ulceration, or fistulation. Palpation Gently feel around the stoma site for any tenderness Ask the patient to cough and feel for a cough impulse for any obvious parastomal hernia Gently digitate the stoma to assess for any stenosis and check patency Completing the Examination Remember, if you have forgotten something important, you can go back and complete this. To finish the examination, stand back from the patient and state to the examiner that to complete your examination, you would like to perform a full GI examination. Frequent questions What is a stoma in medical terms? A stoma is a surgically created opening into a hollow organ, typically covered by a removable pouching system that collects bodily output for disposal. Common types include colostomy, ileostomy, and urostomy. How should a patient be positioned for a stoma examination? The patient should be positioned at a 45-degree angle to facilitate a thorough examination of the stoma. It is also essential to ensure the patient is comfortable and has fully exposed the stoma site. What are the key aspects to inspect during a stoma examination? During a stoma examination, key aspects to inspect include the site of the stoma, its spout, output consistency, and the number of lumens. Additionally, it is important to check for any complications such as parastomal hernia or skin irritation. What complications should be looked for during a stoma examination? Common complications to observe during a stoma examination include parastomal hernia, prolapse, retraction, and infarction. Surrounding skin should also be checked for signs of erythema, ulceration, or fistulation. How can palpation contribute to the examination of a stoma? Palpation allows the examiner to assess for tenderness around the stoma site and to check for any signs of stenosis or parastomal hernia. Feeling for a cough impulse during palpation can also provide valuable information about the stoma's integrity. Rate This Article