Colostomy is an artificial opening to divert faeces and flatus.

Bowel diversion surgery for artificial opening in large bowel in order to divert faces to exterior

COLOSTOMY

In simple terms, a colostomy is when the colon is cut in half and the end directive to the stomach is brought finished the surround of the abdomen and attached to the skin. The end of the colon that leads to the rectum is closed soured and becomes dormant. In other words we can say that its a artificial opening made into large bowel in order to divert feces ( & flatus ) to exterior  ,where they may be collected in an adhesive bag.

Usually a colostomy is performed for infection, blockage, or in rare instances, severe trauma of the colon. This is not an activeness to be taken lightly. It is truly quite serious and demands the close attention of both patient and doctor. A colostomy is ofttimes performed so that an incident crapper be stopped and/or the affected colon tissues crapper heal. The alternative to the colostomy is ofttimes pretty grim, death. Just be glad you are here. It is essential actualise that, with a few exceptions, you crapper look forward to having the colostomy reversed.

A colostomy is sometimes necessary for destined upbeat conditions or diseases. Some of these include cancer, diverticular disease, Crohn's disease and trauma or injury. A temporary colostomy may be necessary to allow the colon to rest and ameliorate for a period of time. A temporary colostomy may be in locate for weeks, months, or years. The temporary colostomy module eventually be closed and bowel movements module return to normal. A imperishable colostomy is usually necessary when a part of the colon staleness be distant or cannot be utilised again.

  

This is famous as a "Hartmann's Colostomy". There are other types of colostomy procedures, but this one is the most common.

It may be TEMPORARY or PERMANENT

TEMPORARY COLOSTOMY

A temporary colostomy haw be used when the conception of the colon (typically the lower section) needs to heal, such as after trauma or surgery. After the colon is healed, the colostomy can be reversed, backward the bowel function to normal. In a colostomy reversal, the digit ends of the colon are reconnected and the area where the stoma was created in the cavum is closed. The large gut is made, erst again, into a continuous tube between the small gut and the rectum. Bowel movements are eliminated through the rectum.

  

INDICATIONS to relieve a distal obstruction of sigmoid colon either by a carcinoma or diverticulitis ,vesicocolic fistula ,protection of a low colorectal anastomosis after anterior resection .To prevent fecal peritoniyis developing after traumatic injury to rectum or colon .To facilitate operative treatment of a high fistula-in-ano.

PROCEDURE

The operation usually takes between digit and four hours depending on difficulty, infection, and the severity of trauma if that is the case. Most of the reasons for a colostomy are: diverticulitis, other inflammatory bowel conditions, or cancer.

Since you are having the operation, you should discuss with your student whether or not you should hit the appendix distant at the same time, since they are going to be in there anyway. It is not a necessary organ and, if removed, it crapper never cause you problems in the future.

 It is normal practice to unstoppered the cavum with an incision from meet below track distinction to meet below the sternum. This gives unstoppered admittance to the internal organs. If you have infection, the student module suction and flush out the contaminates until you are clean.

A loop of bowel ( loop colostomy ) is brought to the surface , where it is held in place by a plastic or glass rod passed through mesentry .Bowel is opened & edges of colonic incision stitched to surrounding skin margins.When firm adhesion of colostomy to abdominal wal has taken place after 7 days , then rod can be removed.

Closure of colostomy performed ,following surgical cure of distal lesion .Done when the stoma is matured ,ie after 2 months .Usually performed by an intraperitoneal technique

PERMANENT COLOSTOMY

A imperishable colostomy (sometimes also called an end colostomy) is necessary for some conditions, including most 15% of colon cancer cases. This type of surgery is commonly utilised when the rectum needs to be removed because of disease or cancer. Most of the colon may also be removed, and the remaining assets utilised to create a stoma.

INDICATIONS after excision of rectum for a carcinoma by abdominoperineal technique ,through the lateral edge of rectus sheath 6cm above & medial to bony prominence.

PROCEDURE distal end ( end colostomy ) of divided colon is brought to surface in left iliac fossa ,where it is stitched in place immediately by sutures placed between colonic margin 7 surrounding skin .A colostomy bag is applied without impinging on bony prominence of anterior superior iliac spine.
  

 After the colostomy, squander is composed on the outside of the body with an ostomy appliance. Today’s ostomy appliances become in a variety of shapes, sizes, colors, and materials to meet the wearer’s lifestyle. The aperture and the surrounding wound (peristomal skin) will order primary care that is taught to patients post-surgery by an enterostomal therapy (ET) nurse....... read more

70% adult cases of chronic pancreatitis are caused by chronic alcohol use

Main culprits are heavy alcohol consumption and gallstones for chronic pancreatitis

CHRONIC PANCREATITIS 

is a relapsing disorder which may arise  insidiously or following repeated attacks of acute pancreatitis .The most commonest cause is chronic alcohol consumption and accompanied by a protien and fat rich diet .Other causes include cystic fibrosis ,hypercalcemia ,hyperlipidemiaand a rare familial pancreatitis .Pathological changes include parenchymal destruction ,fibrosis ,loss of acini ,calculi and duct stenosis with dilatation behind the stenosis.At operation the gland feels hard and irregular and may be mistaken for carcinoma .Calcification is often seen on plain abdominal X-ray.This is thought to be due to calcification of protien precipitates in ducts .

 Pancreatic duct obstruction : due to Stricture e.g.after trauma or acute pancreatitis.Occlusion by pancreatic cancer.

 Hyperparathyroidism ,cystic fibrosis ,Hereditory pancreatitis ,Infantile malnutrition ,Idiopathic ,Stenosis of ampulla of vater . In 12 % of adults ,etiology is unknown.

 Initially pancreas may appear normal.Later pancreas enlarges and becomes hard due to sclerosis ,while the ducts become distorted and dilated with areas of ectasia .Calcified stones ,weighing from a few mg 200 g ,may form within ducts .Ducts become occluded with gelatinous protein-rich fluid and debris ,to form cysts.

Lesions affect a particular lobule producing ,Ductular metaplasia and hyperplasia ,Atrophy of acini ,Interlobular fibrosis .

In clinical features there is symptom of discompose in epigastrium ,which alter to left and correct hypochondrium and finished to back .boring discompose to biliary colic in character .duration about 3-4 days ,and exacerbated by beverage consumption.Vomiting ,anorexia ,Steatorrhea ,and Weight loss ( results from anorexia ,malabsorption steatorrhea and vomiting .It can cause some symptoms of diabetes mellitus ,these are late feature and includes polyuria ,polydipsia ,weight loss and imperfectness.

Signs of jaundice haw be present ( due to narrowing of retropancreatic bile duct ) A protective ,hard epigastric mass haw indicate formation of a sac . ( best way to palpate pancreas is to invoke the enduring to correct and hips and knees are flexed .Left costal margin is deeply palpated.This will evoke tendrness in accent and habitual pancreatitis ( Mallet-Guy's sign ).

DIAGNOSTIC INVESTIGATIONS

The identification of habitual pancreatitis is typically based on tests on pancreatic structure and function, as direct biopsy of the pancreas is thoughtful excessively risky. Serum amylase and lipase may well not be elevated in cases of advanced habitual pancreatitis, but are often utilised as markers for sleuthing pancreatic inflammation in acute pancreatitis. A secretin stimulation effort is thoughtful the gold standard functional effort for identification of habitual pancreatitis but not often utilised clinically. The observation that bi-carbonate production is impaired early in habitual pancreatitis has led to the rationale of ingest of this effort in early stages of disease (sensitivity of 95%). Other ordinary tests utilised to determine habitual pancreatitis are faecal elastase measurement in stool, serum trypsinogen, Computed tomography (CT) scans, ultrasounds, EUS, MRI's, ERCP and MRCP's. Pancreatic calcification crapper often be seen on plain abdominal X-rays, as well as CT scans.

There are other non-specific laboratory studies useful in identification of habitual pancreatitis. Serum bilirubin and alkaline phosphatase crapper be elevated, indicating stricturing of the ordinary bile funiculus cod to edema, fibrosis or cancer. When the habitual pancreatitis is cod to an autoimmune process, elevations in ESR, IgG4, rheumatoid factor, ANA and antismooth hooligan antibody may be seen. The ordinary symptom of habitual pancreatits, steatorrhea, crapper be diagnosed by two assorted studies: Sudden staining of feces or soiled fruitful organic over 24hr on a 100g fruitful diet. To check for pancreatic exocrine dysfunction, the most sensitive and specific effort is the measurement of soiled elastase, which crapper be done with a azygos crap sample, and a value of inferior than 200 ug/g indicates pancreatic insufficiency.

TREATMENT

MEDICAL TREATMENT  

Aimed at controlling discompose and malabsorption .Intermittent attacks treated like accent pancreatitis.Alcohol and super fatty meals must be avoided .Narcotics for severe discompose ,but subsequent addiction is common ,Patients unable to maintain adequate hydration should be hospitalized ,while those with milder symptoms crapper be managed on an ambulatory basis. Surgery haw curb discompose if there is a ductal stricture .Subtotal pancreatectomy haw also curb discompose but at the outlay of exocrine insufficiency and diabetes .Malabsorption is managed with a low fat diet and pancreatic enzymes equal ( 8 customary tablets or 3 viscus glazed tablets with meals ).Because pancreatic enzymes are inactivated by Elvis ,agents that turn Elvis creation ( e.g . omeperazole or sodium bicarbonate ) haw improve their efficacy ( but should not be presented with viscus glazed preparation ) Insulin haw be needed to curb serum glucose .

SURGICAL TREATMENT

Traditional Surgery for Chronic Pancreatitis tends to be divided into two areas - resectional and drainage procedures.New and proven transplantation options preclude the patient from decent diabetic following the surgical removal (resection) of their pancreas. This is achieved by transplanting backwards in the patients own insulin-producing beta cells.

DISTAL PANCREATOMY it consist of distal pancreatic resection up to portal vein ,and it is performed if head of pancreas is relatively normal .

PANCREATODUDENECTOMY it is performed if head of pancreas is mainly involved .

LONGITUDINAL  PANCREATOJEJUNOSTOMY  it is performed if pancreatic duct is grossly dilated .

COMPLICATIONS  

Vitamin B6 malabsorption in 40 % of alcohol induced and all cystic fibrosis cases.Impaired glucose tolerance .Nondiabetic retinopathy due to vitamin A and/ or zinc deficiency,Gastrointestinal bleeding ,icterus ,effusion ,subcutaneous fat necrosis and bone pain occasionally occur .Increased risk for pancreatic carcinoma .Narcotic addiction common.