- Intestinal stomas are surgically created openings of the small or large intestine onto the abdominal wall. There are three main types: colostomy, ileostomy, and loop stoma.
- Complications include prolapse, herniation, stenosis, dermatitis from effluent, and obstruction. Dietary advice focuses on reducing gas, bulk and odorous foods. Management involves properly attaching collection bags and monitoring for complications.
This presentation gives a fine description about stoma and ostomy. This contains the details regarding types, complications and the advices that you should give to a patient with a stoma.
This presentation gives a fine description about stoma and ostomy. This contains the details regarding types, complications and the advices that you should give to a patient with a stoma.
SIGMOID VOLVULUS- GENERALISED ABDOMINAL PAIN
#surgicaleducator #generalisedabdominalpain #sigmoidvolvuus #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today I have uploaded a video on Sigmoid Volvulus- a didactic lecture.
• It is one of the life-threatening surgical problems you see in surgical wards.
• I have discussed the various causes for Generalised Abdominal Pain, epidemiology, etiology, pathology, clinical features, investigations, and treatment of Sigmoid volvulus.
• I have also included a mind map, diagnostic algorithm and a treatment algorithm for Sigmoid Volvulus.
• I hope the video will be very useful and you will enjoy it.
• You can watch all my surgical teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the video.
LAPAROSCOPIC CHOLECYSTECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparoscopiccholecystectomy #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and Open Cholecystectomy.
• In this video today, I have discussed Laparoscopic Cholecystectomy- the flagship procedure for laparoscopic surgeries.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and the links are:
• https://www.youtube.com/watch?v=VStEzI1jL8Y
• https://www.youtube.com/watch?v=O8j4kwpzd24
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
OPEN INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy
• In this video today, I have discussed Open Inguinal Hernia Repair.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Rectal prolapse (Surgical anatomy of rectum, pathology and management0sunil kumar daha
Please find the powerpoint on Rectal prolapse. I tried present it on understandable way and all the contents are reviewed by experts and from very reliable references.
SIGMOID VOLVULUS- GENERALISED ABDOMINAL PAIN
#surgicaleducator #generalisedabdominalpain #sigmoidvolvuus #usmle #babysurgeon #surgicaltutor
Subscription Link: http://youtube.com/c/surgicaleducator...
Surgical Educator Android App link: https://play.google.com/store/apps/de...
• Dear Viewers,
• Greetings from “Surgical Educator”
• Today I have uploaded a video on Sigmoid Volvulus- a didactic lecture.
• It is one of the life-threatening surgical problems you see in surgical wards.
• I have discussed the various causes for Generalised Abdominal Pain, epidemiology, etiology, pathology, clinical features, investigations, and treatment of Sigmoid volvulus.
• I have also included a mind map, diagnostic algorithm and a treatment algorithm for Sigmoid Volvulus.
• I hope the video will be very useful and you will enjoy it.
• You can watch all my surgical teaching videos in the following link:
• youtube.com/c/surgicaleducator
• Thank you for watching the video.
LAPAROSCOPIC CHOLECYSTECTOMY- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #laparoscopiccholecystectomy #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and Open Cholecystectomy.
• In this video today, I have discussed Laparoscopic Cholecystectomy- the flagship procedure for laparoscopic surgeries.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and the links are:
• https://www.youtube.com/watch?v=VStEzI1jL8Y
• https://www.youtube.com/watch?v=O8j4kwpzd24
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
OPEN INGUINAL HERNIA REPAIR- OPERATIVE SURGERY
#surgicaleducator #operativesurgery #openinguinalherniarepair #usmle #babysurgeon #surgicaltutor
Dear viewers,
• Greetings from “Surgical Educator”
• Because of the popular demand by viewers of the YouTube channel “Surgical Educator”, I have decided to create and upload videos on common surgeries.
• I have already uploaded videos on open and Laparoscopic Appendicectomy, Thyroidectomy, Modified Radical Mastectomy and open and
Laparoscopic Cholecystectomy
• In this video today, I have discussed Open Inguinal Hernia Repair.
• However, these videos are not real surgeries but the theoretical aspect of operative surgery like going through an atlas of operative surgery.
• Along with these videos, I recommend you to watch real operative surgery videos as well and I will give a link for each surgery in the end of the video as end-cards, which I think will be very useful.
• This will give a very good opportunity for the surgical trainees to mentally rehearse various surgical steps in a sequential manner prior to actual surgery. You can watch the video in the following links:
• surgicaleducator.blogspot.com
• youtube.com/c/surgicaleducator
• Thank you for watching the videos.
Rectal prolapse (Surgical anatomy of rectum, pathology and management0sunil kumar daha
Please find the powerpoint on Rectal prolapse. I tried present it on understandable way and all the contents are reviewed by experts and from very reliable references.
Anatomy of the breast for medical/dental students. This presentation also contains MCQs to test your knowledge as well as clinical scenario to apply your knowledge.
Also known as GP note, "Pol" note, PP note
Medical students/ pre-interns/ Family physicians use various notes to guide their general practice at the begining, specially drug doses, common treatments for common diseases etc. These "guides" have been used by many seniors but need to be careful revision before prescribing. Hope to update once I go through them completely.
Also known as GP note, "Pol" note, PP note
Medical students/ pre-interns/ Family physicians use various notes to guide their general practice at the begining, specially drug doses, common treatments for common diseases etc. These "guides" have been used by many seniors but need to be careful revision before prescribing. Hope to update once I go through them completely.
Also known as GP note, "Pol" note, PP note
Medical students/ pre-interns/ Family physicians use various notes to guide their general practice at the begining, specially drug doses, common treatments for common diseases etc. These "guides" have been used by many seniors but need to be careful revision before prescribing. Hope to update once I go through them completely.
Medical students/ pre-interns/ Family physicians use various notes to guide their general practice at the begining, specially drug doses, common treatments for common diseases etc. These "guides" have been used by many seniors but need to be careful revision before prescribing. Hope to update once I go through them completely.
The original teachings of Jesus Christ were an outcome of
Buddhism, says Holger Kersten, a German theology teacher.
Hence one of the titles of the chapters in his book, "The
Original Jesus" (sub-titled 'Buddhist sources of Christianity') is 'Jesus the Buddhist'!
Examination of lower limb in neurology-Short case approach for Final MBBSYapa
Examination of lower limb in neurology-medicine short case approach.
This document was prepared based on the teachings of Dr.Kahathuduwa.
Fonts in blue indicate sample way of presenting the case.
By: Ajaan Mahā Boowa Ñānasampanno
Translated by: Ajaan Paññāvaddho
A senior disciple of Ajaan Mun, Ajaan Khao Anālayo was one of the foremost meditation masters of our time. He always preferred to practice in remote, secluded locations and with such single-minded resolve that his diligence in that respect was unrivaled among his peers in the circle of Thai forest monks. In his frequent encounters with wild animals, Ajaan Khao exhibited a special affinity for elephants.
“The Gift of Dhamma Excels All Other Gifts”
—The Lord Buddha
Dhamma should not be sold like goods in the market place.
Permission to reproduce this publication in any way for free distribution,as a gift of Dhamma, is hereby granted and
no further permission need be obtained.
Reproduction in any way for commercial gain is strictly prohibited.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
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6. Principles of stoma formation
1. Discussion –
Discuss the possibility of a stoma with patients
undergoing elective or emergency colorectal
surgery.
Principles of stoma formation
7. 2. Assessment – by stoma therapist
Assess the patient preoperatively – lying down
sitting
standing
Mark the best site for a stoma.
• Area should be easy to see and access.
• Avoid bony prominences (e.g. iliac crest, rib cage),
scars, skin creases, anticipated surgical wounds &
belt line.
Principles of stoma formation
8. Principles of stoma formation
3. Stoma creation
Create an opening (about the width of 2 fingertips) in
anterior abdominal wall.
Deliver well-vascularized, tension-free segment of
bowel through the rectus abdominis.
Close any other wounds
Open bowel & secure to skin with evenly spaced
absorbable sutures.
10. Principles of stoma formation
3. Stoma creation – Ileostomy
• Elevate the ileostomy opening 2-3 cm from skin
to ensure the effluent passes directly into a
stoma bag with minimal contact with skin.
• Ileum is everted on itself to form a spout.
12. Principles of stoma formation
3. Stoma creation – Colostomy
Colostomy effluent-
• Formed faeces.
• Discharged intermittently.
• Not directly corrosive to skin.
• Usually falls directly into stoma bag.
13. Principles of stoma formation
3. Stoma creation – Colostomy
• Colostomies are sutured flush with skin.
• Allowed to pout slightly to prevent retraction after
weight gain.
15. • In right iliac fossa
• Usually a permanent stoma
Electively - Proctocolectomy for:
► inflammatory bowel disease or
► familial adenomatous polyposis coli
END STOMAS - End ileostomy
16. • Usually temporary in the emergency setting
►Subtotal colectomy with end ileostomy-
in fulminant or perforated ulcerative colitis.
in distal obstruction of large bowel where
caecum is non viable or perforated.
►After a segmental resection of small bowel where
primary anastomosis is unsafe.
e.g. perforated Crohn’s disease,
thromboembolic bowel ischamia
END STOMAS - End ileostomy
17. END STOMAS - End ileostomy
• In temporary end ileostomy:
Distal bowel
closed &
left in abdomen
exteriorized
as a mucous fistula
18. END STOMAS - End ileostomy
• In temporary end ileostomy:
19. END STOMAS - End ileostomy
• In temporary end ileostomy:
Relaparotomy to restore intestinal continuity when
the patient has recovered (after 3-4 months).
20. END STOMAS - End colostomy
• Usually in left iliac fossa.
• Frequently sigmoid colostomies.
21. END STOMAS - End colostomy
Abdominoperineal excision for anorectal tumours
• a permanent end colostomy
• an elective surgery
23. END STOMAS - End colostomy
Hartmann’s procedure
• In emergency setting.
• For ischaemia, perforation or obstruction of
distal colon or rectum.
• Potentially reversible 3-4 months later.
• Patients are often elderly & frail. 40% never
undergo reversal.
25. • Most common in terminal ileum, transverse
colon & sigmoid colon.
• A loop of bowel is brought to the anterior
abdominal wall & held in place by a plastic
bridge passed through the mesentery.
• Bowel wall is incised & edges are sutured to
skin.
• Plastic bridge is removed when mucocutaneous
anastomosis has matured (after 5-7 days).
LOOP STOMAS
27. • In general, temporary stomas.
• Can be reversed via the stoma site 2-3 months
after formation.
• Used to divert faecal stream to protect -
►a distal anastomosis after low anterior
resection.
►Difficult anal sphincter repairs.
►Complex perianal fistula procedures.
LOOP STOMAS
28. A loop transverse colostomy
can be done to
defunction an anastomosis
after an anterior resection.
LOOP STOMAS
29. Stoma appliance
Pouch (Bag)Protective skin barrier
Closed-end Drainable
Remains on the skin
between bag changes &
needs to be changed
every few days.
30. • Cut the central hole of the
skin barrier to match the
diameter of the stoma.
Attachment of the stoma appliance
• Gently clean the stoma & peristomal skin.
• Dry the peristomal skin & apply filling paste
on it.
31. • Remove the sticker of the
skin barrier.
• Fix the skin barrier to the
peristomal skin.
Attachment of the stoma appliance
32. • Clip the other end of the pouch.
• Finally apply plaster around the skin barrier.
Attachment of the stoma appliance
• Fix the pouch to the skin
barrier.
34. Complications of intestinal stomas
Early
1. Ischaemia
2. Retraction
Late
1. Stenosis
2. Prolapse
3. Parastomal
herniation
4. Obstruction of small
bowel
5. Haemorrhage
6. Diversion colitis
7. Dermatitis
8. Psychological
35. • Ischaemia
Stoma should be pink & moist.
When ischaemic grey / black & dry
Complications of intestinal stomas
36. Complications of intestinal stomas
Complete retraction into
peritoneal cavity
Peritonitis
Partial retraction
Subcutaneous tissue is
exposed to faecal
contents
Peristomal cellulitis,
abscesses & fistulae
• Retraction
37. Complications of intestinal stomas
Predisposing causes:
►Aponeurotic opening
too small
►Stomal ischaemia
►Recurrence – Crohn’s
disease
Severe stenosis
Intestinal obstruction
• Stenosis
38. Complications of intestinal stomas
• Stomal prolapse
Predisposing factors:
►Aponeurotic opening too large
►Excessive mobilization of redundant bowel
►Raised intra-abdominal pressure
Common in loop colostomies.
39. Complications of intestinal stomas
• Parastomal herniation
The most common late complication of end
colostomies.
Occurs in up to 30% of stomas.
Incidence increases with time.
Predisposing factors – similar to those for
prolapse.
40. Complications of intestinal stomas
• Obstruction of the small bowel
Occur particularly in loop stomas. (10-15%)
Attributed to intra-abdominal adhesions.
41. Complications of intestinal stomas
• Haemorrhage
Can be due to:
►A trvial bleed from a fragile granuloma
►Recurrent / novel gastrointestinal disease
►Parastomal varices between the veins of
mesenteric & anterior abdominal wall –
in patients with portal hypertension
42. Complications of intestinal stomas
• Diversion colitis
Chronic inflammation of the distal bowel left in
situ when faecal stream is diverted away.
May develop bloody discharge from rectum.
48. Dietary advice to ostomates
• Take low fibre food to reduce bulk in stool
& help prevent intestinal obstruction.
• Avoid vegetables known to result in
offensive odour.
×Raddish
×Cabbage
×Garlic
×Cucumber
49. • To reduce flatus, avoid:
× carbonated beverages
× chewing gum
× smoking
• Chew food well.
• Drink adequate amounts of water.
Dietary advice to ostomates