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Glossary of terms
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Abdominoperineal excision of rectum (APER/APR)
A surgical procedure involving excision of the rectum and anus with closure of the perineum resulting in a permanent colostomy. Is usually performed for very low rectal/anal cancers. Abscess Absorption
Digested nutrients and fluids are absorbed via the gastrointestinal system into the blood. Disease or surgery may reduce the body's capacity to absorb nutrients and fluids. Acute Abdomen A serious condition within the abdomen characterized by sudden onset, pain, tenderness, and muscular rigidity, and usually requiring emergency surgery. Also called surgical abdomen.
Adenocarcinoma
Cancer that begins in cells that line certain internal organs and that have glandular (secretory) properties. 95% of cancers arising in the large bowel are adenocarcinomas. This term is applied to a tumour, usually benign, in glandular tissue
Scar tissues that attach to the surfaces of organs following surgery or sepsis infection. Bands of this fibrous scar tissue cause the joining together of two surfaces which normally should be separate. For example, loops of bowel.
Adjuvant therapy
Using therapies such as surgery, chemotherapy or radiation therapy in combination to achieve more effective results than using a treatment alone
Adjuvant therapy can be given pre- or post-surgery for the treatment of bowel cancer Alginate wafer Alginates are a naturally occurring substance derived from brown seaweed. Because of their ability to control bleeding they are used in the manufacture of wound dressings.They are able to provide a base for bioactive dressings by incorporating growth factors (naturally occurring proteins) which stimulate cell growth. Oakmed has now adopted this concept to develop a wafer/baseplate which manages sore and broken peristomal skin helping it to heal quickly. Alimentary canal This term is another word for the gastrointestinal tract. It refers to the entire system starting in the mouth and following through the esophagus, stomach, small intestine, colon and rectum.
See Gastro intestinal tract Allergic contact dermatitis Is an inflammation of the skin caused by direct contact with a specific substance causing a sensitivity.
A shortage of red blood cells. Anaemia is associated with pallor, weakness, breathlessness and reduced energy. Iron and erythropoetin can improve the condition.
Anal canal Between the rectum and the anus lies the anal canal which is 2-3 cm long and made up of the upper borders of the internal and external sphincters and the puborectalis muscle. A small tear or cut in the skin around the anus which can cause pain and/or bleeding.
Anal sphincter Comprises the internal sphincters (involuntary muscles) and external sphincters (voluntary constrictive muscles) to control discharge of faeces. The joining together of two ends of healthy bowel after diseased bowel has been cut out (resected) by the surgeon. An anastomosis may be hand sewn or joined by the use of surgical staples
Anismus Antegrade Colonic Enema (ante grade continent enema, ACE) It is a surgical technique where one end of the appendix is re-implanted into the caecum and the other end is brought out onto the abdominal wall as a continent stoma. This provides a catheterisable channel, which facilitates the administration of an enema to empty the colon. Anterior resection
The abdomen (tummy) is usually opened using an up and down cut in the middle of the abdomen. The low part of the sigmoid colon and part of the rectum are removed. The amount of bowel removed depends on the person and their condition.
Joining the two ends together will reconnect the bowel. However, it may not always be possible to join the ends together. In this case, the end of the bowel will be brought through the abdominal wall and opened as a stoma. Sometimes a temporary stoma is formed at the first operation to protect the join (anastomosis), and is usually closed at a further operation 3-6 months later Anterior resections are often categorised as high or low depending on the site of the cancer. High anterior resection is the removal of upper/mid third of rectum and lower sigmoid colon. Following anterior resections varying degrees of bowel dysfunction may be experienced, e.g. incontinence, diarrhoea and constipation. Anus
The natural exit at the end of the gastrointestinal system, where faecal waste leaves the body. Appendicectomy Appendicitis Appendicostomy Appendix A large group of single-cell microorganisms. Some cause infections and disease in animals and humans. The singular of bacteria is bacterium. Some bacteria are harmless or even beneficial.
Ballooning (of stoma appliance) Barium enema
A radiological examination, where a contrast medium (barium) is introduced into the bowel, allowing imaging of the ileum, colon and rectum for diagnosis. Barium meal
A special liquid solution that contains barium, which is highly visible on x-ray film. The patient drinks the solution, waits for a period of time, and then has x-rays taken of the intestines.
Baseplate (wafer/flange) Benign
Non-cancerous/non-malignant. Benign tumour A digestive juice secreted by the liver and stored in the gallbladder; aids in the digestion of fats
The daily volume of bile production averages 600-1000 ml. A method of learning to voluntarily control certain body functions such as heartbeat, blood pressure, and muscle tension with the help of a special machine. This method can help control pain and can help retrain pelvic floor muscles. It involves assessment and education of the patient for the management of constipation and faecal/urinary incontinence.
Removal of tissue from the body for microscopic examination and diagnosis
Most biopsies are performed to determine whether an observed growth of tissue is malignant or benign. Bladder Bladder cancer
Is a malignant growth within the bladder. Bladder cancers usually arise from the transitional cells of the bladder (the cells lining the bladder). These tumours may be classified based on their growth pattern as either papillary tumors (meaning they have a wart-like lesion attached to a stalk) or nonpapillary tumours. Nonpapillary tumors are much less common, but they are more aggressive and have a poorer prognosis. As with most other cancers, the exact cause is uncertain. Bladder cancer spreads by extending into the nearby organs, including the prostate, uterus, ureters, and rectum. Bowel
The bowel is made up of two parts: Bowel Obstruction
A blocking of the space inside the bowel stopping the passage of material through it. Bowel Prep
Usually needed before bowel surgery and certain diagnostic procedures. Consists of taking of a laxative such as Golitely or Fleet Soda - be prepared to live in the toilet for the next few hours after taking it!
Bricker bladder/Bricker loop The ureters are attached to a small segment of small bowel and brought out onto the surface of the abdomen to drain the urine into a small bag adhered to the skin.
See Urostomy Brooke Ileostomy Caecum Abnormal cells that divide without control, which can invade nearby tissues or spread through the bloodstream and lymphatic system to other parts of the body (secondary spread metastases). Normally cell divisions and replications divide to match normal cell loss. On rare occasions there is a defect in this division and a rogue, potentially malignant, cell arises. This is not recognized by the immune system and will continue to divide to produce millions of unwanted cells, thus destroying the function of normal body cells.
Carboxy Methyl Cellulose (CMC) Catheter Chemical (irritant) dermatitis Treatment with anticancer drugs. Chemotherapy may be taken by mouth or it may be put into the body by a needle inserted into a vein or muscle
Chronic papillomatous dermatitis
Greyish nodules/warty papules occurring on the skin around urostomies as a reaction to urine irritation of the skin. If contact with urine is stopped the condition resolves within a few weeks. Coeliac disease is caused by gluten, a protein that is found in wheat, and other similar proteins that are found in rye and barley. In some people these proteins cause damage to the tiny projections - or villi - that line the small intestine. Villi play a significant role in the digestion process. However, when damaged they become inflamed. This renders them unable to absorb food properly, and can lead to diarrhoea and malnutrition.
In small children with Coeliac disease can cause chronic diarrhoea, distension of the abdomen and muscle wasting. Infants with the disease are likely to be poor feeders, fail to put on weight in the normal way and fail to thrive. Adults suffer from chronic diarrhoea, weight loss, weakness, fatigue, breathlessness and anaemia. Colectomy Subtotal colectomy: Surgical removal of part of the colon with either an anastomosis or a temporary/ permanent ileostomy.
Total colectomy: Surgical removal of the whole colon with either the small intestine (ileum) joined to the rectum or an ileostomy. Proctocolectomy: Surgical removal of colon and rectum with a permanent ileostomy. Or if performed in conjunction with an ileo/anal pouch a temporary loop ileostomy may be required.
Pan proctocolectomy: Surgical removal of colon, rectum and anus resulting in a permanent Ileostomy. Other colonic resections include:
Sigmoid colectomy: Surgical removal of sigmoid colon. Right hemicolectomy: Surgical removal of ascending colon. Extended right hemicolectomy: Surgical removal of ascending and part/all of transverse colon. Left hemicolectomy: Surgical removal of descending colon. Extended left hemicolectomy: Surgical removal of descending and part/all of transverse/sigmoid colon. Hartmanns procedure: See Hartmanns procedure High anterior resection: See Anterior resection Low anterior resection: See Anterior resection A term describing abdominal pain usually associated with muscle spasm often in the abdomen.
When the rectum is removed surgically the colon can be attached to the anus but to create satisfactory bowel function a pouch is often formed for the collection of faeces prior to evacuation. This can reduce the need to defaecate from 4-6 times a day to approximately 2.
Colon (large intestine/large bowel)
Another name for the large intestine. The section of the large intestine extending from the caecum to the rectum. An adult colon is approximately five to six feet in length and is responsible for absorbing water and forming, storing and expelling waste.
Colonic Inertia Colonic inertia is a condition in which the nerves and/or muscles of the colon do not work normally. As a result, the contents of the colon are not propelled through the colon normally. The cause of colonic inertia is unclear. In some cases, the muscles or nerves of the colon are diseased. Colonic inertia can also be the result of the chronic use of stimulant laxatives. In most cases, however, there is no clear cause.
See Slow Transit Constipation Colonic irrigation Is a bowel management and washout technique (water/saline) used in the treatment of constipation and faecal incontinence. It is self-administered, via a plastic tube, through the anus. Medical advice should be obtained prior to education and training of procedure. Colonoscopy A test to look into the rectum and the colon that uses a long thin flexible tube with a tiny light and camera on it.This tube is called a colonoscope. The test checks for any abnormalities in the bowel including colitis, polyps and cancer. If abnormalities are seen then biopsies are taken to look at the tissue microscopically. Part of the large bowel (colon) is brought out onto the surface of the abdomen. A pouch/bag is sealed over the colostomy to collect the faeces. Once the bowel has settled down after the surgery the frequency of bowel movements may approximately be between twice a day to every other day. Generally the faeces will be semi solid so closed bags (with no opening at the bottom to drain the faeces) are used by most patients.
Congenital disease
Conditions/defects that arise during foetal development or at birth; for example, Imperforate anus or Hirschprungs disease Connect 2 A range of 2 piece products from Oakmed which have a choice of wafers/base plates (alginate, microskin and hydrocolloid) which the closed or drainable pouch can stick too and be removed from without having to remove the baseplate. A condition in which bowel movements happen less frequently than is normal for the particular individual, or the stool is small, hard, and difficult or painful to pass.
Continent urinary diversion Continent urinary diversion describes all forms of urinary diversion that enable the patient to urinate at his or her own discretion without the use of any form of appliance or collecting device. This form of urinary diversion can be broadly divided into two categories: cutaneous and orthotopic.
Cutaneous continent urinary diversion refers to use of the gastrointestinal tract to create a new bladder, which is attached to the skin inside the body. This form of urinary diversion does not require the use of a collection appliance, however the patient is required to place a catheter or small plastic tube into their new bladder four to five times per day to empty the reservoir. Orthotopic continent urinary diversion, commonly referred to as neobladder, most closely resembles the normal urinary anatomy. The intestinal tract is used to fashion a new bladder, which is then attached to the urethra in the pelvis. Patients then urinate spontaneously via the urethra and may be required to catheterize to ensure complete bladder emptying. This form of continent urinary diversion has been used in both men and women requiring cystectomy.
See Mitrofanoff, Kock pouch
Convexity (Convex stoma appliances) Convexity is defined as the outward curving of a base plate (wafer) or skin barrier. The convexity allows for continuous contact between the skin and the pouching system. When in contact with the skin the convexity creates pressure on the peristomal area to partly evert a retracted or flush stoma. This helps to provide security and prevents leakages. Convexity products are made as one- and two-piece appliances, manufactured in both hard and soft materials. A range of depths is available between 2 and 7 mm. Patients should be carefully assessed for the appropriate use of hard convex products which should only be used under the guidance of a trained competent stoma care nurse. Deep, hard convex products have been known to trigger peristomal skin problems like pressure ulcers or the onset of Pyoderma Gangrenosum. Crohns Disease
This is a chronic inflammatory disease which causes stomach pains, diarrhoea, and weight loss.
The disease is characterised by periods of activity and remissions. It typically affects the lower part of the small intestine (ileum) or the large intestine (colon), but it can affect any part of the digestive system. The affected areas become red and swollen and ulceration may occur. As the ulcers heal, the formation of scar tissue makes the intestine increasingly narrow, leading to obstruction. There is no cure for Crohn's disease, but the symptoms can be treated and the periods of remission can be made to last several years. See Inflammatory Bowel Disease CT (CAT scan)
Also called Computerized tomography, a sophisticated diagnostic imaging procedure that uses a computer and x-rays to present cross-section slices of areas of the body.
Cutaneous ureterostomy The ureters are brought directly onto the skin surface to drain the urine. This type of diversion is mainly performed in babies or children as a temporary intervention until extensive surgery can be performed. It can also be used as a palliative measure in terminally ill patients with obstructed ureters. Cutaneous vesicostomy
A urinary diversion directly from the bladder to the skin. More common in infants and young children as the bladder is located more abdominally than in adults. The bladder mucosa is sutured to the skin and a pouch/bag is worn Cystectomy Cystic fibrosis
A common hereditary disease in which exocrine (secretory) glands produce abnormally thick mucus. This mucus can cause problems in digestion, breathing, and body cooling.
In the newborn, this condition results in the meconium being very thick and tenacious. This can result in intestinal obstruction which may necessitate surgery Defecation Defunctioning stoma An inflammation of the skin caused by an allergic reaction or contact with an irritant. Typical symptoms of dermatitis include redness and itching
See Allergic contact dermatitis, Chemical irritant dermatitis The skin is comprised of two layers, the outer layer which is the epidermis, and the inner layer which is the dermis. The dermis contains the blood supply, nerve endings and hair follicles.
Descending Colon A portion of the large bowel located in the left side of the abdomen between the transverse colon and the sigmoid colon. Stool is stored here. Desmoid tumour Fibrous tissue tumours which may grow on the anterior abdominal wall in the abdomen. The cause is unknown, but they occur in about 9% of Familial Adenomatous Polyposis patients. They do not metastasise but can grow to varying sizes. Due to their sheer bulk and location they may require surgery, only if symptomatic. An increase in frequency, liquidity and weight of bowel motions
Process the body uses to break down food into simple substances for energy, growth, and cell repair. Digestion is accomplished through the mechanical and chemical breakdown of food into small molecules, which can then be absorbed into the bloodstream.
The organs in the body that break down and absorb food. Organs that make up the digestive system are the mouth, oesophagus, stomach, small intestine, large intestine, rectum, and anus. Organs that help with digestion but are not part of the digestive tract are the tongue, glands in the mouth that make saliva, pancreas, liver, and gallbladder.
Dilate Refers to a part of the body that is farther away from the center of the body than another part. The anus is distal to the rectum.
Distension Diverticular disease (or diverticulosis) is a condition of the large intestine (colon) which means having diverticula, or small sacs or pouches that form in the wall of the large intestine, and includes diverticulitis which is when these pouches or sacs become infected. Complications arising from diverticular disease include fistula formation, abscess, stricture, haemorrhage and perforation leading to peritonitis. These complications can result in surgery and sometimes stoma formation.
Where both ends of the bowel are brought out onto the surface of the abdomen, usually to different locations. The proximal end will produce waste matter and the distal end may produce a small amount of mucous and residual faecal matter
See Mucous fistula Double barrelled stoma (Paul Mickulitz) Dukes staging/classification The first 25cm portion of the small intestine, attached to the stomach.
It plays a vital part in digestion due to the digestive enzymes being delivered from the liver/gallbladder and pancreas. Dyspepsia
Alternative term for indigestion and heartburn Dysplasia
Abnormal changes of mature cells that indicate possible development of cancer. These may be graded as mild, moderate and severe dysplasia. Electrolyte
Chemical compounds (such as salt) which dissolve in body fluids to form particles with an electric charge. They are needed in small amounts and in the right balance to maintain normal body functioning. If electrolytes are out of balance, a person may become weak and ill, and may need electrolyte supplementation by mouth or through a vein.
Elimination
The process of excretion of waste products from the body (eg urine, faeces) End Stoma Endoscopy is the examination of the inside of the body using a lighted, flexible instrument called an endoscope. In general, an endoscope is placed into the body through a natural opening like the mouth or anus. The most common endoscopic procedures evaluate the oesophagus (swallowing tube), stomach, and portions of the intestine, colon, or airway (bronchoscopy).
The procedure is performed to find the cause of bleeding, diarrhea, abdominal pain and/or constipation also to detect signs of cancer, bleeding, inflammation, abnormal growths, and ulcers. Enteral tube feeding Nasogastric: Via the nose and into the stomach. A protein that speeds up chemical processes and reactions in the body
The tough outer protective layer of the skin.It doesnt contain any blood vessels
The covering of the internal and external organs of the body. Also the lining of vessels, body cavities, glands, and organs. It consists of cells bound together by connective material and varies in the number of layers and the kinds of cells.
Erosion Redness of the skin caused by blood clogging in small blood vessels.
Evacuation The process of emptying the bowel or bladder (elimination). Excise To surgically cut out/ remove a part e.g. bowel or bladder. Excoriation A term used in stoma care to describe a superficial loss of skin around the stoma. This results in the skin integrity being broken, leading to a moist, bleeding area. See Erosion , Alginate wafer
Extenteretion (pelvic) Condition where faeces become firmly wedged in the bowel and cannot naturally pass out through the anus because it is too hard and dry causing a grossly dilated colon. Treatments include conservative management and/or surgery.
See Stecoral perforation and mega colon A term for blood present in the faeces that is not visibly apparent
The semi solid waste matter left after digestion of food. It is formed in the part of the large intestine (bowel) called the colon and contains indigestible food, some excess water, cells and bacteria. It is discharged from the body through the anus, when it may be referred to as stools.
Amount of faeces evacuated is approximately 150-250 grams daily. Familial adenomatous polyposis (FAP)
A hereditary condition where large numbers (100-1000) of pre-malignant polyps develop in the large bowel from puberty and onwards. Malignant changes will occur if left untreated. Treatment will include surgical removal of the colon and rectum. Fibre An abnormal passage leading from an abscess or hollow organ to the body surface or from one hollow organ to another and permitting passage of fluids or secretions
Involved structures:
1: Colo- Colon 2: Entero- Small bowel 3: Vesico- Bladder 4: Vaginal- Vagina 5: Cutaneous- Skin 6: Recto- Rectum E.g. a colovaginal fistula will be from the large bowel to the vagina. Common causes of fistulae include Diverticular disease, Crohns disease and radiotherapy. A large proportion of fistulae occur as a complication of surgery and are more common in malnourished patients. Flatus Flush stoma
Where the stoma mucosa is at a level with the skin, either circumferential or partially. A stoma may be flush because of surgical technique/difficulties, recurrent malignancy or weight gain. This may cause problems in obtaining and maintaining a secure and leak proof seal particularly in the management of an ileostomy or urostomy, due to the liquid nature of the output. A variety of stoma products are available to manage this problem. See Retraction , convexity FOB (faecal occult blood) Folliculitis Gall bladder The death of body tissue, usually from lack of blood flow or infection.
Is a term for anything pertaining to the stomach
See Stomach Gastro-colic reflex Gastrointestinal system (GI tract/Alimentary canal/Digestive system/Gut) Gastroscopy
Inspection of the upper gastrointestinal tract, including the oesophagus, stomach and duodenum. See Endoscopy Gastrostomy An artificial opening from the stomach to a hole (stoma) in the abdomen where a feeding tube is inserted. See also enteral nutrition
Gelatine Granulomas
A term used to describe small, reddish raised areas/nodules on the stoma or on the peristomal skin. Commonly caused by local irritation from stoma appliances, suture sites and/or leakage of effluent The section of the gastrointestinal tract from the throat to the stomach. Also known as the oesophagus
See Oesophagus Haemorrhage Escape of blood from blood vessels, normally due to injury. The bleeding may be internal or external
Haemorrhoids Enlargement of the blood vessels inside the anus. These can become like varicose veins in the anus, and may bleed and cause pain when defecating.
Hartmann's procedure Hemicolectomy
Hernia (parastomal hernia)
Most common in the abdominal wall, a hernia is a bulge of tissue caused by a weak area or tear in the muscle through which tissue protrudes
A parastomal hernia appears as a bulge around the stoma. The bulge contains loops of intestine that protrude through the muscle around the stoma and into the subcutaneous tissue. Causes include surgical technique, muscle weakness and coughing/straining. Parastomal herniation is a common complication which may occur weeks, months or years after stoma surgery. The patient often experiences discomfort, problems with stoma appliances/clothing and can find the appearance of the hernia very distressing. Management can include fitting an abdominal support,appliance advice and occasionally surgical repair. A rare complication is if the bowel segment becomes strangulated. The patient will have symptoms of an acute abdomen (bowel obstruction, ischaemic bowel, abdominal pain, distension, vomiting) and would require urgent surgery. Hirshsprung's disease Hirschsprungs Disease affects 1:5000 live births, and is more prevalent in males than females 4:1. Histology
Microscopic study of the structure of cells and tissues to assist diagnosis. HNPCC (Hereditary non polyposis colon cancer) Hydrocolloid
Hydro means water, colloid means stable solution of particles in water. It is a synthetic carboxy methyl cellulose substance bound with copolymers, gelatine, pectin and/or cotton. The particles absorb water and form a gel. Hydrocolloids are used in the pharmaceutical, cosmetic and chemical industry. Hydrocolloids are an important ingredient in the manufacturing of stoma skin barriers. Hydronephrosis
Enlargement of one or both kidneys, caused by urine that has not passed freely.
Hypoallergenic
A material with minimal risk of allergy
Hypersensitivity An exaggerated response by the immune system to a substance or drug Ileal conduit (Urostomy/Brickers loop or Bricker bladder) An ileal conduit, or ileal loop as it is sometimes called, is a way of diverting urine outside of the body when the urinary bladder has been removed. A piece of small intestine is used to form a conduit. A short section of the small intestine is separated and the intestine is sewn back together with no change in bowel movements. One end of the separated section is closed and the ureters, which normally carry urine from the kidneys to the bladder are sewn into the piece of small intestine. The open end of the intestine section is brought out to the right side of the abdomen where it opens to the outside as a stoma. Urine will now pass through this conduit and out through the opening in the abdomen.
See Urostomy Ileo Anal pouch (Ileo Anal reservoir, Ileal pouch anal anastomosis (IPAA), Restorative proctocolectomy) Ileo anal pouch function Ileo-caecal valve An operation in which the end of the small intestine, the ileum., is brought out through an opening in the abdomen, everted to form a spout and sutured to the skin. The contents of the intestine, unformed stool, are expelled through this opening into a bag called an appliance.
The stoma does not posses any nerve endings; therefore any trauma to the stoma will be painless but harmfull. E.g. injury from an ill-fitting stoma appliance. Ileostomy blockage An ileostomy may stop functioning due to a blockage caused by adhesions or undigested food. The patient may experience abdominal pain, distension, nausea and vomiting. There will be minimal or no output from the stoma. Management will include fluids only, relaxation and abdominal massage. A food blockage will in most cases resolve spontaneously, but if symptoms persist the patient may require admission to hospital for conservative or surgical treatment.
Ileostomy function Over a period of days or weeks, following surgery, the proximal small bowel increases fluid absorption. There is a gradual reduction in the volume of output and a thickening of stool to a "tooth paste" consistency will occur. This may vary according to the amounts/type of food and drink consumed. After this "adaptation " period the average amount produced by an ileostomy decreases to between 500 -800 ml per 24 hours. An ileostomy will function intermittently throughout the day. The effluent from an ileostomy contains enzymes, and if in contact with the peristomal skin, excoriation and soreness will occur. Ileum
The final and longest segment of the small intestine. It extends about 4 m (13 ft), from the jejunum (middle section of the small intestine) to the ileocaecal valve, where it joins the large intestine ( colon ) It is the site of absorption of fluids, nutrients, vitamin B12 and re-absorption of about 90% of conjugated bile salts. A condition in which there is an absence of muscular contractions of the intestine which normally move the food through the system; can result in an intestinal obstruction.
See Paralytic ileus Infants with imperforate anus defect, have malformations of the rectum and anus in which abnormal development leads to growth of skin over the anus and incomplete development of the rectum.
As a result, these infants have either no opening through which stool can pass, or a very small opening that allows only a small amount of stool to pass out of the rectum. This very small opening is often accompanied by fistulas, which are abnormal channels that connect skin to bowel. A baby born with this condition will need surgery to create an opening (anus) to allow for the passage of stool. This initially requires the formation of a stoma, and then further reconstructive surgery at a later date depending on the severity of their condition Feeling of nausea, bloating, gas, and/or heartburn caused by poor digestion
It differs from person to person and is related to diet, physical and psychological circumstances. Also called heartburn. Invasion and multiplication of germs in the body. Infections can occur in any part of the body, and can be localized or systemic (spread throughout the body). The germs may be bacteria, viruses, yeast, or fungi. They can cause a fever and other problems, depending on the site of the infection. When the body's natural defense system is strong, it can often fight the germs and prevent infection.
Infection (parastomal) Inflammation
The body's reaction to infection, irritation or other injury. The symptoms include redness, warmth, swelling, pain and impaired function. Inflammatory bowel disease is a condition in which the innner lining of the gastrointestinal tract becomes inflamed, leading to ulcers and bleeding. The colon is most often the site of this inflammation. Patients with inflammatory bowel disease have symptoms that include diarrhea, abdominal pain, infections, and bleeding. Inflammatory bowel disease falls under two main headings: Crohn's disease, which involves the entire gastrointestinal tract, and ulcerative colitis, which involves only the colon and rectum. The cause of inflammatory bowel disease is unknown. The primary treatment for inflammatory bowel disease involves medications, such as steroids, which can decrease inflammation and resolve symptoms. Occasionally, if segments of bowel are very inflamed and are not responding to medication, surgery to remove these segments may be necessary
Internal pouch Intestinal bacteria
The intestine, especially the colon, contains millions (over 400 species) of helpful bacteria that assist the digestive process and maintain intestinal function. Anaerobic bacteria present in the colon serve to putrefy remaining proteins and indigestible residue. This bacterial action also creates intestinal gas.
Intestinal gas
Intestinal gas is typically caused by the fermentation of undigested food, such as plant fiber, in the colon. Gas can also form when the intestines have difficulty breaking down certain components in foods, such as the sugar in dairy products and fruit.
Other sources of intestinal gas may include:
Food residue in the colon
Swallowed air that migrates to the colon
Constipation (The longer food particles remain in the colon, the more time they have to ferment.) Sometimes, gas indicates a digestive disorder such as irritable bowel syndrome or coeliac disease.
See Flatus Intestinal secretions
These secretions are necessary for the process of digestion of food. The major characteristic is the high content of digestive enzymes. Secretions enter the duodenum from the pancreas, the liver and the glands in the bowel (intestinal) wall. Intestine
A part of the alimentary canal extending from the stomach to the anus. See Gastrointestinal system Intravenous Introduction of material into or through a vein Intussusceptions Refers to the infolding of one part of the intestine into itself. Clinical symptoms (colic pain and the "red currant jelly" stool), together with physical and radiographic examination helps diagnosing this condition. It can occur at any age but more than 60 % of the cases are encountered from birth up to 4 years. Intravenous Pyleogram (IVP)
Dye is injected into the veins, which allows the kidneys, ureters and bladder to be seen on xray.
Irrigation Irritable bowel syndrome (IBS) is a chronic disorder, featuring recurrent abdominal pain and intermittent diarrhoea, often alternating with constipation. There is normally no obvious cause.
This disorder most commonly affects people between the ages of 20 and 30 and is twice as common in women as in men. The syndrome can be divided into four types depending on which is the main symptom - abdominal pain, diarrhoea, constipation or diarrhoea alternating with constipation. Ischaemia Jejunostomy Jejunostomy function Jejunum Karaya Gum
Is produced in India and is a polysaccharide taken from the "Sterculia urens" tree. Karaya gum has a special buffering action which keeps the skin pH slightly acidic (4.5-4.7). Due to its excellent water holding capacity it is used in ice creams, sausages and breads to improve consistency as well as being the active ingredient of the Karaya paste and the Karaya skin barrier for stoma management. Kidneys
The pair of bean-shaped organs in the abdomen that filter out waste products from the blood and make urine.
See Urinary tract Kock Pouch (continent ileostomy)
The Kock Pouch is an example of a
Whilst the need for a stoma appliance has been eliminated, a stoma cap or dressing may be required to absorb any mucus from the stoma. The Kock pouch is not considered to be the first surgical choice when internal pouch surgery is an option (see Ileo anal pouch), but may be offered to patients who have had their anal sphincters removed. Kock pouch (continent urostomy) Laceration (of the stoma)
A cut/tear to the stoma, usually due to friction from the stoma appliance or it may develop in conjunction with trauma to the stoma. It usually appears as a yellow to white linear discoloration of the stoma lining.
It can be severe enough to penetrate the bowel wall, but is commonly superficial. Due to the fact that the stoma does not contain nerve endings, the patient may not experience any pain. The insertion of a long, thin, lighted, telescope-like instrument called a laparoscope into the abdomen through an incision usually in the navel to visually inspect the contents of the pelvic and abdominal cavities. Other small incisions may also be made and additional instruments inserted to facilitate diagnosis and allow surgical correction of abnormalities.
The procedure is carried out under video control and minimises trauma, post-operative pain and length of hospital stay. A variety of surgical procedures (colectomy, stoma formation, ACE procedure) can now be performed in some specialised centres. Laparotomy
A surgical incision of the abdominal wall used in exploratory emergency surgery and elective colorectal procedures. Large bowel (Intestine) The largest internal organ in the body, the liver is located in the upper right portion of the abdomen, beneath the diaphragm and above most of the stomach, intestines and pancreas. The liver has many functions, including secreting bile, neutralizing poisons, synthesizing proteins, and storing glycogen and certain vitamins and minerals
It plays a vital role in digestion. Loop stoma
During surgery a loop of intestine is brought out onto the surface of the abdomen This diverts the faecal flow from diseased, traumatized, obstructed intestine or from the site of an anastomosis. When the stoma is constructed the bowel is not completely divided but is opened along the anterior surface. The opened edges are then everted and sutured to the skin. This stoma has two distinct openings, the proximal functional opening and the distal non-functional opening, that remain connected by the undivided posterior section of the bowel wall. Loop stomas are sometimes supported in position by a bridge/rod of plastic, rubber or glass. The bridge/rod prevents the stoma from retracting and remains in position 5-10 days following surgery. The construction of a loop stoma means that faeces may sometimes overflow from the functional proximal opening into the non-functional distal opening.
A loop stoma can either be temporary or permanent. A loop stoma can be constructed as part of a major surgical procedure (laporotomy) or a minimal surgical procedure (laparoscopic).
Loop colostomy (1)
A loop colostomy is formed in the large bowel and common sites are in the transverse colon or sigmoid colon . Loop ileostomy (2) Lymph Malabsorption A dark green, almost black, material normally found in the baby's intestines at birth; this is the first stool the baby will pass.
Meconium Ileus Mega Colon Mesentery
Tissue in the abdominal cavity that connect the bowel to the back wall of the abdomen. It contains blood vessels, lymphatic ducts, and nerve supply. Metastases (secondary) Microskin Wafer The Mitrofanoff procedure creates a channel into the bladder, usually using the appendix, through which a catheter (thin, plastic tube) can be inserted to empty the bladder of urine, instead of passing urine through the urethra. This channel - which looks like an extra tummy button - is usually referred to as a Mitrofanoff and is created in an operation under general anaesthetic.
MRI (magnetic resonance imaging) MRI is a non-invasive procedure that uses powerful magnets and radio waves to construct cross sectional pictures of the body. Frequently used to assist in treatment planning of rectal cancers.
Mucocutaneous junction
Sutured junction of a stoma between the bowel (mucosa) and the skin (cutaneous). Mucocutaneous separation
Breakdown of the suture line between the bowel mucosa and the skin securing the stoma to the abdominal surface. There are many ways to manage this problem, and a nurse who is experienced in the management of wounds and stomas should carefully assess the patient. Mucous discharge The non-working stoma in a loop ileostomy or colostomy. The mucous fistula can be the second of two stomas in a temporary split ostomy. The mucous fistula can be placed anywhere on the abdomen in this case, even at the bottom of the surgical wound. The second opening in a single loop ostomy stoma which are next to each other would also be called a mucous fistula. It may discharge some mucous.
A mucous fistula can be permanent or temporary and will require the use of a stoma cap or small dressing. see Hartmanns
Mucous membrane Mucous Nausea Death of cells or tissues through injury or disease, especially in a localized area of the body
Also See Stoma necrosis Necrotising Enterocolitis (NEC) Neo-adjuvant therapy Nodules A fold of the peritoneum (the thin tissue that lines the abdomen) that surrounds the stomach and other organs in the abdomen
This is also known as the "fatty apron" because it hangs down in front of the stomach where large amounts of fat accumulate in and between its double folds. The neobladder operation creates a new bladder using a portion of the patients intestines. Once trained, the patient will be able to urinate through their own urethra, and they wont have to wear a bag to collect the urine.
Ostomist/ostomate Ostomy Pancaking (of stoma appliance)
Refers to the presence of faeces staying on top of the stoma, and not dropping/moving down into the bottom of the pouch/bag. Most commonly seen in colostomy management. There are several reasons for this including when the filter on the stoma pouch/bag eliminates all air in the appliance, creating a 'vacuum'/'sucking in' of the appliance onto the mucosa of the stoma preventing movement of the faeces down into the pouch. It also can be caused by the faeces being too 'sticky' due to lack of fluid and fibre. It is not an easy problem to solve, but primarily the use of an adhesive cover over the filter and the intake of extra fluid and fibre can help to minimise the problem A gland that makes enzymes that help the body break down and use nutrients in food. It also produces the hormone insulin and releases it into the bloodstream to help the body control blood sugar levels.
Panproctocolectomy Excision of the entire rectum and colon, with creation of an ileostomy or ileoanalpouch.
see Coloectomy
Papules A small solid and usually conical elevation of the skin caused by inflammation, accumulated secretion or hypertrophy of tissue elements. Paralytic ileus Loss of movement in the small intestine (peristalsis), resulting in gas and fluid build-up
It manifests itself by absence of bowel sounds and absence of stool. The patient can experience varying degrees of colic/spasmodic type pain, distension, nausea and projectile vomiting. Following surgery peristalsis usually resumes in the small intestine within about 48 hours and the large intestine within 72 hours. However, the "ileus" may be prolonged following lengthy surgical procedures. Parastomal
Beside the stoma Pectin Is a polysaccharide extracted from lemons, apples, orange or grape. Pectin absorbs moisture and forms a gel and is used in food, cosmetic, drugs and stoma skin barriers and pastes. Pelvic Cavity The space bounded by the pelvic bones and contains the pelvic organs Perforation Is a complete penetration of the intestinal wall resulting in the potential for bacterial decontamination of the abdominal cavity (peritonitis) Perineum The region of skin between the scrotum and the anus in males and between the vagina and anus in females Peristalsis Successive wavelike, involuntary muscular contractions along the wall of the intestine. This propels the digested products along the length of the gastrointestinal tract. Peristomal A thin membrane that covers the abdominal cavity and partially covers some of the abdominal organs
It is a flexible sheet of tissue that holds the organs of the digestive tract in position and conveys nerves, blood vessels and lymphatic ducts to the organs. Peritonitis Inflammation of the peritoneal cavity, which includes the serosa, mesentery and omentum. It is categorized as either localized or generalized. Localized peritonitis involves the inflammation of the bowel (e.g. appendicitis, diverticulitis). This may progress into a generalised peritonitis due to perforation of the bowel (e.g. perforated appendix/diverticulum). This is a life threatening situation. Common symptoms include pain, nausea, fever, abdominal distension and difficulty in passing faeces or gas. Treatment involves antibiotics and/or surgery. Phantom rectum
A painful sensation experienced in the perineum. This can occur following abdominoperineal excision of rectum. Piles
A term meaning haemorrhoid
Polyisobutylene (PIB) Is a clear/yellowish soft rubber like substance. It is used in the skin barrier/flange on a stoma bag/pouch. It is very sticky and with high viscosity. It does not absorb water and will not dissolve in it. PIB binds/gives inner strength to the skin barrier and helps the skin barrier to adhere on dry skin. It is also used in chewing gum. Polyps (in the bowel) Small growths in the bowel that vary in shape and size. These polyps are usually benign but can undergo malignant changes over a long period of time (5-10 yrs). Polyps in the bowel are more common after middle age. It is suggested that patients undergo routine colonoscopy after the age of 50 years to have any polyps removed and microscopically examined for malignant changes. Symptoms, if any, can include bleeding, pain and altered bowel habit depending on location in the bowel and size of the polyp. Pouch (internal) Pouchitis Pre-malignancy Prebiotics
These are non-digestable food ingredients that have a beneficial effect on the gut. They stimulate the growth of some colonic bacteria. E.g. fructose favours the fermentation of bifidobacteria. Probiotics Proctalgia fugax Inflammation of the rectum; marked by bloody stools and a frequent urge to defecate; frequently associated with Crohn's disease or ulcerative colitis. Proctitis can also be associated with infections Radiation proctitis is the most common complication of pelvic radiation often occurring years after treatment. Symptoms of severe proctitis will include profuse watery diarrhoea, bleeding and tenesmus.
An operation which removes the colon and the rectum. see Colectomy
Proctology Refers to the medical speciality that deals with the diagnosis and treatment of disorders of the rectum and anus. Prolapse (of stoma) Prolapse (rectal) In medicine, refers to a part of the body that is closer to the center of the body than another part. For example, the knee is proximal to the toes. The opposite is distal.
In loop stomas, distal end goes down to anus, proximal end goes up to mouth. Psoriasis
A skin condition that is characterized by the presence of rounded, silvery scaly patches of skin. These can appear on the scalp, elbows, knees and genital region. Nail changes are common and include pitting and a yellowish discoloration that resembles a fungal infection. Psoriasis may also cause hair loss.
Psoriasis may become active (Koebner's phenomenon) following surgery or as a result of localised chemical or mechanical irritation and may appear in the peristomal area Active psoriasis may impair bag adhesion, but can be treated effectively with topical corticosteroids. Pus Pustule Pyoderma Gangrenosum Radiation proctitis Radiotherapy (DXT)
This is the use of radiation to destroy cancer or other abnormal cells in the body. During radiotherapy, a significant amount of healthy normal tissue is irradiated. To reduce the side effects caused by this, the radiation dose is split into a number of treatments, in theory enabling the normal healthy tissue to recover before the next treatment is given
Radiotherapy can also be given post-operatively as an adjuvant/definitive/palliative measure and where surgery is not an option. The terminal part of the colon that includes the anal canal. The rectum is the final storage place for feces prior to elimination
The rectum is usually empty and collapsed until just before defecation, when fully distended it can hold up to 400 ml. Refashioning (of the stoma) Surgically changing the shape and sometimes the position of the stoma because of complications such as stomal stenosis, retraction and hernia. Retraction Where the stoma mucosa is below skin level, either all the way round or partial. Retraction may be caused by surgical technique/difficulticulties, recurrent malignancy or weight gain. Retraction may cause problems in obtaining and maintaining a secure and leak proof seal around the stoma, necessitating an in-depth assessment by the trained competent stoma care nurse. A variety of products are available to manage this problem. Rheumatoid Arthritis
A usually chronic disease in which the bodys immune system attacks the joints causing hot, painful swelling and sometimes deformity and destruction of the joints. Sepsis The presence of toxins in the blood or other tissues; the toxins are produced by bacteria or other microorganisms.
Sepsis may be associated with clinical symptoms of systemic (bodywide) illness, such as fever, chills, malaise (generally feeling "rotten"), low blood pressure, and mental status changes. Sepsis can be a serious situation, a life threatening disease calling for urgent and comprehensive care. Serosa, Serous membrane The serosa is the outermost layer of the GI tract. It is also found as the very thin connective tissue layer which covers the structures within the abdominal cavity. These cells secrete a serous fluid to keep the membranes moistened. Short bowel syndrome Short bowel syndrome refers to malabsorption and malnutrition following surgical removal of large sections of the small bowel/intestines It occurs when disease or surgery destroys the capacity and absorption of the small bowel. If some, or all of the entire colon has been resected, the problems may become more complicated. Patients require assessment for additional nutritional supplements either orally, via a gastrostomy or total parenteral nutrition. Sigmoid Colon
The sigmoid colon is the part of the large intestine after the descending colon and before the rectum. The name sigmoid means S-shaped. The walls of the sigmoid colon are muscular, and contract to increase the pressure inside the colon, causing the stool to move into the rectum.
Sigmoid colostomy This type of stoma is formed from the sigmoid part of the colon. It is situated on the left hand side of the abdomen and can either be an end or a loop stoma (see colostomy). The sigmoid colostomy can take the longest to regain its normal peristalsis, although some flatus and faecal liquid may be seen by the third or fourth day. A normal output is expected to be a soft-formed stool which may take between five days to a few weeks to establish after surgery. Once output has become normal generally patients will use a closed stoma bag to collect the contents. Sigmoid colostomy function A procedure in which the doctor looks inside the rectum and the lower part of the colon (sigmoid colon) through a lighted tube. The doctor may collect samples of tissue or cells for closer examination. Also called proctosigmoidoscopy.
see Endoscopy/ Colonoscopy Skin cleansers These are available in a variety of applications such as liquids, wipes, sprays and foams. They are all water-based preparations and may contain varying amounts of lanolin, urea, propylene glycol, fragrance and artificial colours. Ostomates use them to completely remove all faecal or urinary residue around the parastomal area. After use, rinsing with clean water may be required prior to pouch application. Skin protectors Skin sealants: Skin barriers: It is important to note that any preparations containing alcohol will cause a stinging or burning sensation in patients with sore/broken skin. Delayed passage of bowel contents (slow transit) is the most common form of constipation. Lack of fibre and dehydration are common causes of slow transit constipation
Thought to be due to a muscular disorder of the colon (colonic inertia). Treatment options include laxatives, biofeedback and surgery. Small intestine Solitary Rectal Ulcer Sphincter Split stoma Stenosis Stomal stenosis:
Stenosis, the narrowing of the lumen of the stoma, can occur at either just below skin level or at skin level. Extreme narrowing may threaten normal stomal function, impairing the output of the effluent. Stenosis results from stoma construction techniques, excessive scar formation, prior irradiation to bowel segment, or from trauma resulting from an ill-fitting pouching system
Manual dilation may be considered depending on the cause; if this is not successful, re-fashioning of the stoma may be required to avoid obstruction. Stents Stercoral perforation A temporary opening in the abdominal wall that allows the end of the small or large intestine or ureters to be brought through the abdomen and fastened onto the surface of the skin. This enables waste materials from the intestines to pass through the stoma and empty into a bag called an ileostomy bag, colostomy bag or urostomy bag. This flexible bag is fastened to the skin around the stoma and fits close to the body
From the Greek word for mouth. Denotes a new opening into or out of the body. see ileostomy, colostomy or urostomy A collective term referring to pouches/bags worn over a stoma. Bags come in all shapes and sizes but for faecal stomas they generally have a charcoal filter to allow flatus to slowly discharge from the bag. The bags can be clear for careful observation of the stoma or they can have an attached cover. All the bags are designed to be as 'skin friendly' as possible although some patients do get a skin reaction to some bags. They are also designed to stay on in water so a patient can swim or have a shower/bath with the bag on (no harm is done to the stoma by showering/bathing with the bag off)
They are generally divided into 3 categories: Bags which are worn over a colostomy tend to be closed, ie there is no opening to drain the effluent out - the bag is changed when full and a new bag applied.
Drainable appliance is worn for a more liquid output and in ileostomy management. This bag has an opening at the bottom to allow the emptying of faecal matter. Once drained the bag can be resealed.
Urostomists tend to use a bag that has a one way valve to prevent urine re entering the stoma and a tap at the bottom for easier emptying. The tap is designed to attach to a night bag via a tube that has a greater capacity to lessen the need to get up at night.
All categories of appliances are available in both 1-piece and 2-piece. 1-piece is where the pouch/bag and baseplate/wafer are integral. The 2-piece product has a detachable pouch/bag from the baseplate/wafer. This enables the person with a stoma to change the pouch/bag without removing the baseplate/wafer.
Stoma cap The smallest closed pouch. Can be worn following colostomy irrigation, during intimacy and sex or when bathing. Very useful in the appliance management of a mucous fistula Stoma complications For peristomal complications - see allergic contact and chemical irritant dermatitis, erythema,macerated,eroded, ulcerated, granuloma, folliculitis, pyoderma gangrenosum, chronic papillomatous dermatitis. Stoma necrosis A muscular, sac-like organ that churns and breaks food into smaller pieces. Gastric juices including acid and enzymes from the lining of the stomach help break food particles down further
The stomach acts as a reservoir for swallowed food, which remains here for 3-5 hours. Another important function of the stomach is secretion of the intrinsic factor necessary for the effective absorption of vitamin B12 in the terminal ileum. Stomal bleeding Bleeding can occur from small vessels of the stoma mucosa, the mesentery or at the stoma exit site on the abdomen because of a number of reasons including a problem stopping blood flow after surgery, traume to the stoma or recurrent disease (IBD, Pyoderma gangrenosum, polyps, diverticula or cancer) Stomal laceration Strangulation (of the bowel) TAR (Trans-anal resection) TEM (Trans-anal endoscopic microsurgery) Painful straining; a distressing but especially ineffectual urge to evacuate the rectum or urinary bladder
This symptom may be experienced by people with a low rectal cancer, with irritable bowel disease or other inflammation. TME (Total mesorectal excision) TNM (Tumor node and metastasis) Total colectomy
Total Parenteral Nutrition (TPN) Transverse colon Transverse colostomy Transverse colostomy function Ulcer Chronic inflammation of the colon and rectum that produces ulcers in its lining. This condition is marked by abdominal pain, cramps, and loose discharges of pus, blood, and mucus from the bowel
See Inflammatory bowel disease Ultrasound Ureter
The tubes which carry the urine form the kidneys to the bladder Urethra The tube which carries urine from the bladder to the outside of the body Urethral sphincter The muscular mechanism that controls the retention and release of urine from the bladder Urinary tract The urinary tract consists of the kidneys, ureter, bladder and urethra. The kidneys are reddish-brown, bean shaped organs and are approximately 12 cm in length. The kidneys excrete waste products as urine and regulate fluid and electrolyte balance. The ureters carry urine from the kidneys to the bladder. The tube shaped ureters are 24-30 cm in length, approximately 3 cm diameter and pass from the kidneys to the bladder. The urinary bladder is a hollow, muscular lined organ located in the pelvis. It acts as a reservoir for urine. Its shape varies with the amount of urine it contains. The urethra extends from the bladder neck to the exit of the body. It has a sphincter mechanism that serves the dual purpose of preventing urinary leakage and acts as a channel during passing urine. Urine Urostomy (Ileal conduit/Bricker's loop)
An ileal conduit (urostomy) is a surgical procedure that removes a diseased or damaged bladder and creates a channel (urinary diversion) for urine to flow to the outside of the body through an opening in the abdomen. Part of the ureters may also be removed. A small segment of the small or large intestine is used to create the channel, and this segment is brought to the opening in the abdominal skin. This opening is known as the urostomy, and the end of the exposed intestine is known as the stoma
A urostomy pouch/bag is then applied to allow for the collection of urine.
The kidneys will be constantly producing urine, therefore function from the ileal conduit will be immediate. Urostomy function
Discharge from a urostomy is normal urine and output depends on the intake. Because the urostomy is constructed from a part of the intestines there is also a continuous production of mucous from the stoma. The urostomate is recommended to drink about 1800-2500 ml of liquid every day. Enough and adequate fluid intake is the single most important factor in prevention of complications such as urinary tract infections and stone formation. The stoma is red and moist; there are no nerve endings in the stoma and therefore no sensation. Volvulus Twisting of the stomach or intestine, which often has the effect of cutting off the blood supply to it
A volvulus can occur in people who have long-standing constipation or chronic laxative abuse. It is often possible to decompress and untwist the bowel by passing a rectal (flatus) tube, but a recurrent volvulus may require surgery (Sigmoid resection or Hartmann's). Wound Is a physical trauma where the skin is torn, cut or punctured. Oakmed has an extensive range of wound care products available Wafer
The base plate of a two-piece stoma appliance. The wafer, which consists of an adhesive skin barrier with a pre-cut hole, is placed over the stoma and adheres to the skin. The wafer will also have an attachment system where the pouch/bag can be secured onto the wafer. This allows for frequent pouch changing without having to remove the wafer. The wafer can remain in place for an average of 3-7 days. The term "wafer" also refers to a protective sheet. Oakmed offer three different types (see alginate,hydrocolloid, microskin) used as a skin barrier in stoma management. |
