Malu a tshimpitshimpi a ostomie: Stoma ischémique noir ou violet, prolapse mukole, ne dijimija dia mâyi mu ileostomie wa bungi¶

Dipanda dia mala (colostomie, ileostomie, anyi urostomie) didi difila tshilamba tshimpe anyi ndekelu wa mala mu tshimanu tshia difu bua bintu bia bukoya bipatuke mu tshibombi tshia pambelu. Bu mudi stoma muikale tshitupa tshia munda tshia mala tshidi tshikudimune munda ne pambelu, kena ne dikoba dia pambelu didi dikuba ne udi wimanyina bikole pa mijilu ya bungi idi ipitshila mu tshina tshikole tshia mu mifuba ya mu difu. Shi tshitupa tshia mubidi tshidi tshilua tshikunze, tshifiike, anyi tshifiike, tshivula too ne paditshi tshikuata kudi tshilamba tshia plastique, tshipatuka mu difu ne kanyinganyinga kakole, anyi tshipatula mayi mapite pa 1500 too ne ku 2000 mililitre (1,5 anyi 2 quarts) ya mâyi ku dituku, ubikile muaba uudi musombele nomba ya tshimpitshimpi anyi kukeba luondapu lua lukasa lua lukasa. Bua malu a tshimpitshimpi a mu difu ne a mayi, bala dikanga dia mala, hernie strangulated, ne volvulus, disama dia tshiadi ne disama dia mala, ne disama dia tshiadi, disama dia mu tshifu, ne dipanga dia mâyi mu mubidi.

Kumanya mua kutangila dikala ne luya lua stoma, dîba dia kukosa diakamue tshintu tshidi tshikanga dikoba, mushindu wa kuela nsukadi wa mesa bua kukepesha stoma udi ne edematous prolapsed ku diambuluisha dia osmosis paudi mulale panshi, ne bua tshinyi kunua mâyi malelela kudi kunyangakaja dijimija dia mâyi mu mala didi mua kusungila muoyo wa mubedi ne bitupa bia mala.

Enza nunku mpindieu¶

1. Tangila dikala dia stoma diakamue pa kumumbusha anyi kutangila mu tshibombi tshitoke. Stoma muimpe udi mutoke wa nyama anyi rose-pink, mutoke, mutoke, ne mutoke (muomumue ne munda mua ditama diebe). Shi tshitupa tshia stoma tshilua mutoke mutoke, bule bua mabala, tshitoka tshia prune-violet, tshitoke, anyi tshifiike tshifiike, anyi tshiumvua mashika ne tshiume/tshikole ku munu udi ne tshianza, mashi ende adi apita mu mishipa adi ajika (stoma ischemia anyi necrosis). Bikila nimero ya lukasa ya muaba unudi (911 mu États-Unis/Canada, 112 mu UE, 999 mu UK) bua kukuambuluisha diakamue.
2. Bikala stoma wenda unyunguluka anyi wenda upatuka pambelu (prolapse), umbusha tshilamba tshikole anyi ukose tshibuelelu tshia tshibuikidiji diakamue. Kulekedi tshintu tshikole tshidi tshibuikila, tshiamu tshia plastique tshidi tshikanga, anyi tshibuikidiji tshia dikoba tshikole tshikosa pabuipi ne stoma udi uvula anyi udi upatuka. Tshilamba tshikole tshia plastique tshidi tshienza mudimu bu tshilamba tshidi tshinyunguluka kuinshi kua mala, tshishipa mijilu ne mijilu mu minite mikese. Umbusha tshitupa tshijima tshia wafer ku difu (anyi ushintulule mu tshibombi tshinene tshia tshitupa tshimue tshidi mua kupatuka mâyi ne tshina tshidibu bakose tshidi ne bunene bua milimetre 3 anyi 6 [0,12 too ne ku 0,25 inches] kupita tshitupa tshia stoma tshidi tshiuwule).
3. Bua stoma udi kayi ne lutatu, udi ne disama dia rose, enza bua mubedi alale panshi pa mukolo ne ulengeje stoma ne sukadi mutoke wa mesa. Bikala tshitupa tshile tshia mala a mubidi wa rose tshidi ne luya tshipatuke mu stoma kakuyi kanyinganyinga kakole anyi dishintuluka dia dikala difiike, lala mubedi panshi ne binu bikese bikese bua kupuekesha mu tshitupa tshia dikala, muaba kampanda tshilamba tshitoke anyi tshibombi tshia mashika tshibuikila mu tshilamba tshia kuowa nabi mâyi bitekete bitekete pa mutu pa tshibombi munkatshi mua minite 10, anyi ela ½ anyi 1 wa dikopo dia sucrose mutoke (sukadi wa ku mesa) buludiludi pa mucosa mutoke udi mupatuke munkatshi mua minite 15 anyi 20. Nsukadi mukola udi ukoka mayi mu tshimanu tshia mala tshidi tshiuwule ku diambuluisha dia osmosis (Desai osmotic reduction maneuver), udi upuekesha stoma nunku misangu ya bungi udi upingana munda nkayende.
4. Bikala dipatuka dia ileostomie dipite pa 1,500 too ne ku 2,000 mL (1,5 too ne ku 2 quarts) mu meba 24, LEKELA kunua mayi, tshiayi, anyi mayi a bimuma bia mupuya muimpe ne ushintulule diakamue ku tshintu tshidi ne sodium wa bungi wa Oral Rehydration Solution (ORS). Mu mubedi udi ne disama dia tshiadi tshikese anyi ileostomie, kunua mâyi a hypotomique anyi ileostomie anyi soda wa nsukadi mu bulelela udi upatula sodium ne mayi mu tshibombi tshia ostomy, wenza bua disama dia hypovolemic ne disama dia mfyo dienzeke lukasa. Nua ORS wa osmolarity mukese wa Bulongolodi bua Bukola bua mubidi pa buloba bujima (OMS) anyi tshiamu tshia electrolyte tshia St. Mark tshienza ku nzubu (tshidi ne bungi bulelela bua mukele, bicarbonate de soude ne glucose mu litre umua wa mayi).
5. Tangila ni stoma udi ne disama dia tshifu dikole ne disama dia tshifu. Shi ileostomy kena upatula mayi anyi kapepe munkatshi mua mêba 4 too ne ku 6 (anyi colostomie kayi upatula tshintu nansha tshimue munkatshi mua mêba 24 too ne ku 48 pamue ne mavuala makole a disama dia mu tshifu, disama dia mu tshifu dikole, disama dia mu tshifu, anyi disama dia tshifu), umbusha tshiamu tshia wafer, lomba mubedi bua kuikisha mu mâyi a kapia anyi mu dikasa dia tshiadi, ne uya mu nzubu wa lupitadi lua lukasa. Kuena nansha mua kunua manga a dilengeja dia mubidi bua disama dia stoma didibu bela meji ne: didi dikanga.
6. Kulama mashi adi apatuka mu tshitupa tshia mubidi tshidi pa mutu pa mubidi ne dikuma dia buludiludi, anyi uya ku lupitadi bua disama dia mashi adi apatuka mu tshifu. Ditontolola dia mashi makunze paudi ukupula tshifu didi diakane; Ino, shi mashi apueka nansha awuja tshibombi lukasa (nangananga kudi babedi badi ne disama dia tshiadi ne parastomal varices), fina tshiamu tshia mashika anyi gaze muela mu oxymetazoline nasal spray bikole pa muaba udi mashi apatuka ne ubikile bena mudimu ba lukasa.

Mutshi wa dipangadika: disungula dia lukasa dia ostomy¶

flowchart TD
    A["Tshilumbu tshia lukasa tshia dipanda dia tshiadi (Ileostomy, Colostomy, anyi Urostomy)"] --> B{"Tangila dikala dia stoma ne tshimuenekelu tshiende"}
    B -->|"Mufike, violet mufike, gris wa ardoise, mashika, anyi muume"| C["ACUTE STOMA ISCHEMIA / NECROSE: Umbusha tshintu tshikole diakamue"]
    C --> D["Lama NPO wa mubedi (kakuyi bualu ku mishiku) ne ubikile EMS bua dikonkonona dia lukasa dia dipanda"]
    B -->|"Stoma mutangile ku bule bua 5 too ne ku 20 cm (Prolapse)"| E{"Mala adi mapatuke adi a rose/a kapia anyi a mîdima/a kanyinganyinga?"}
    E -->|"Disama dia mu difu dia violet/difiike, dikole anyi dikole"| C
    E -->|"Mutoke/mukunze, mupepele, ne kayi ne kanyinganyinga"| F["Umbusha tshilamba tshikole tshia tshiamu tshia mitaku diakamue bua tshingoma katshiyi mua kutapa tshishimikidi"]
    F --> G["Teka mubedi panshi pa nyima + ela nsukadi mutoke wa mesa pa mutu pa tshifu munkatshi mua minite 20"]
    B -->|"Dipatuka dia mayi > 1,500 too ne ku 2,000 mL/dituku + mashi a tshiji/mafiika"| H["DISHIPA DIA MU STOMA: Imana kunua mayi ne maluvu adi ne nsukadi"]
    H --> I["Nua St. Mark's anyi WHO Oral Rehydration Solution; ndaku ku ER shi udi ne mutu, udi ne tshiadi, anyi udi ne oliguric"]
    B -->|"Tshintu tshidi tshipatuka mu mêba 4 too ne ku 6 (ileostomie) + disama dia nsukadi/diela dia nsukadi"| J["DISHIPA DIA STOMA: Wela tshilamba tshialabale, kunua tshintu nansha tshimue pikala udila, KUENA laxatives"]
    J --> K["Teta kuowa mâyi a kapia ne kuimana ku binu too ne ku tshiadi; ndaku ku ER bua dipuekesha dia katetere"]

Mukanda wa dikala dia stoma: dishilangana dia mucosa muimpe ne ischémie artérielle ne necrose¶

Bualu mucosa wa mu mala kena ne tshitupa tshia pambelu tshia dikoba tshidi ne keratine to (stratum corneum), bulalu buende bua kapila budi bumueneka buludiludi ne dîsu dia patupu. Kukonkonona dikala dia stoma ke mushindu mutambe buimpe wa kukonkonona dienda dia mashi mu tshifu.

Bua tshinyi disama dia stoma didi dienzeka¶

Padi munganga wenza ileostomie anyi colostomie, badi benza mudimu ne tshilamba anyi ndekelu wa mala pamue ne mashi adi afumina mu tshifu tshidi tshienza bu tshipepele ne baakoka mu tshibuelelu tshienza ne dipanda (trephine) mu mushipa wa rectus abdominis, mu fascia ne mu dikoba. Mashi a mu mishipa adi mua kufika ku stoma adi mua kupangila bua malu anayi:

1. Tension mesenterique précoce post-opératoire ou thrombose artérielle (mêba 24 to ne 72 a kumpala kunyima kua dipanda): Shi mesentery mukola bikole, udi mua kukosa (volvulus), anyi mufina kudi disama dia tshimanu tshia difu panyima pa dipanda, anyi pikala mashi makese (hypotension) ne manga a vasopressor adi ashipa mishipa ya splanchnic ne nzala, nsongo ya stoma idi kule idi ijimija mashi.
2. Dishipa dia tshiadi ku diambuluisha dia tshiamu tshikese: Stoma udi uvula mu mbingu 6 anyi 8 ya kumpala kunyima kua dipanda, ne udi kabidi uvula bua tshitupa tshîpi mu bikondo bia gastroenterite, prolapse, anyi dikanga dia mala. Shi mubedi utungunuka ne kuela tshiamu tshia kukanga natshi dikoba tshidi mpindieu tshikese kupita diamètre wa stoma, tshiamu tshia hydrocolloïde anyi tshiamu tshia plastique tshidi tshikosa muinshi mua stoma bu tshilamba tshia tshiamu tshia caoutchouc.
3. Incarcerated parastomal hernia: Tshitupa tshia mala tshidi tshifina ku luseke lua stoma kupitshila ku tshibuelelu tshia fascial mu mafuta a muinshi mua dikoba ne tshidi tshikuata ne tshikosa.
4. Tromboembolisme systémique ou non-occlusive mesentérique ischémie: Ku ndekelu kua muoyo, disama dia fibrillation atriale, dipanga dia muoyo dikole, anyi dikosolola dia aorte bidi mua kukanga mushipa wa mesentérique wa ku mutu anyi wa kuinshi (tangila ischémie mesenterique acute).

Disama dia stoma dia pa mutu (pa mutu pa fascia) ne dia munda (kuinshi kua fascia)¶

Padi baminganga ba mu tshimpitshimpi bakonkonona stoma mufike anyi mufiike, mikalu ya mubidi idi ne mushinga wa bungi idi anterior rectus fascia (tshitupa tshia mishipa mikole tshidi muinshi mua dikoba dia difu dia santimetre 2 too ne ku 4):

• Ischémie mucosale superficiale (confinée au-dessus de la fascia): Anu nsongo ya stoma idi mipatuke pambelu pa mushipa wa difu ke idi mifiike anyi mifiike, eku tshitupa tshia munda tshia mala tshidi munda mua tshina tshia muscle tshidi tshishala tshikunze. Misangu ya bungi, bilumbu ebi bitu binyangakaja tshitupa tshia pambelu tshidi tshifua ne biondapa padibu babitangila bimpe (nansha mudibi misangu ya bungi bipeta stomal stenosis anyi dinyanguka).
• Deep transmural necrosis (extending below the fascia into the peritoneal cavity): Shi dishintuluka dia dikala difiike, dia violet, anyi dia gris dienda dikola kupita tshitupa tshia fascia munda mua tshimanu tshia difu, tshimanu tshia mala tshidi tshifue munda mua difu netshipatuke lukasa ne netshipatule bintu bia munda buludiludi mu tshina tshia munda mua tshifu (****), tshidi tshilomba dipatuka dia lukasa dia peritoneal laparotomie ne dilongolola dia stoma.

Tshiamu tshia diteta ("tshiamu tshia makala") tshidi tshitangila butoke tshienza mudimu mu ER¶

Mu tshibambalu tshia malu a mpukapuka, baminganga batu bela manyi bitekete bitekete mu tshiamu tshia mashi tshidi tshitoka (Vacutainer), tshibombi tshia tshiamu tshia nzembu tshia plastique tshitoke, anyi tshiamu tshia nzembu tshia bana, tshibueja 3 too ne ku 5 santimetre (1,2 anyi 2 inches) mu lumen wa stoma, ne ukenkesha butoke bua pen ku luseke lua tshiamu tshia nzembu. Shi tshitupa tshia munda tshia mubidi tshidi tshilua tshia rose mutoke 1 centimètre kuinshi kua tshitupa tshia mubidi, disama dia ischémie didi dia pa mutu pa mutu. Shi tshitupa tshia mubidi tshidi tshishala tshifiike, tshitoke, anyi tshikunze kuinshi kua tshitupa tshia tshimanu tshia difu, badi baya ne mubedi diakamue mu nzubu wa dipanda. Kuena ne bua kubueja tupoyi tua makala anyi bintu bia buitshi mu stoma kumbelu to; lekela dikonkonona dia munda kudi baminganga ba malu a lukasa.

Disama dia stoma ne tshienzedi tshia sukadi wa ku mesa wa mu nzubu (dipuekesha dia osmotic)¶

Dibutuka dia stoma didi dienzeka padi tshitupa tshia mala tshidi ne bunene buonso tshibuela mu mala (teleskope munda muadi) ne tshipatuka pambelu kupitshila ku tshibuelelu tshia stoma, tshilenga pambelu pa difu bu mutshi wa ntambue udi ne bule bua santimetre 5 too ne ku 25 (2 too ne ku 10 inches). Dipatuka didi ditamba kumueneka mu loop colostomies (nangananga transverse loop colostomies, mudi dikasa dia kule "didi kadiyi dienza mudimu" ditangila pambelu) ne ileostomies ya ndekelu padi tension wa mu difu ubanda bua dikokola, dibandisha dia bintu bikole, didila dia bana, anyi dikola dia mubidi.

Bua tshinyi tshitupa tshia stoma tshidi tshipatuka tshidi tshikuata pambelu pa mubidi¶

Padi santimetre 10 too ne ku 15 (4 too ne ku 6 inches) ya mala ipatuka mu tshijengu tshikese tshia mu tshimanu tshia difu, tshijengu tshia misunya tshikole ne tshiamu tshia plastique tshia ostomie bidi bifina mijilu ya mu tshifu idi ne bukole bukese eku mijilu idi ne bukole bua bungi itungunuka ne kupompa mashi mu mala adi apatuka. Mashi adi apita lukasa mu bitupa bia mubidi (interstitial edema). Mu minite 30 to ne ku 60, tshifu tshidi tshipatuka tshidi tshivula misangu ibidi anyi isatu kupita bunene buatshi, tshilua tshia mafuta ne tshia tshisuku tshidi katshiyi mua kupingana mu tshina tshia tshimanu tshia difu. Bikalabu kabayi batekeshe, disama edi didi ndekelu wa bionso dinyangakaja mashi adi apita mu mishipa, dishintulula tshitupa tshia mubidi tshidi katshiyi ne disama dia rose tshilua disama dia gangrene, dia tshimpitshimpi dia dipanda dia tshimpitshimpi.

Dipuekesha dia nzubu ku kakese ku kakese ku diambuluisha dia mushindu wa sukadi wa ku mesa wa Desai¶

Shi tshitupa tshia stoma tshidi tshipatuka tshidi tshikunze anyi tshikunze, tshikole, tshitekete, ne katshiyi tshifila kanyinganyinga kakole mu difu, udi mua kuenza mudimu ne luondapu lua osmotic lua mu lupitadi kumbelu paudi ulongolola dikonkonona dia munganga:

1. Umbusha tshilamba tshidi tshikosa anyi unzulula tshibombi tshia bitupa bibidi diakamue. Bikala tshilamba tshia plastique anyi tshina tshia hydrocolloid tshidi tshibuela muinshi mua mala adi mapatuke, umbusha tshilamba etshi bitekete bitekete ku dikoba bua muinshi mua stoma kawuyi ukosa.
2. Lala mubedi pa mukolo (supine). Teka tshilamba tshia kulala muinshi mua binu biabu bua misunya ya mu difu ikale mikole ne bukole budi bukokela bintu panshi budi bulekela kukoka mala panshi.
3. Ela sukadi mutoke wa mesa (sucrose) ne muoyo mujima pa mutu pa stoma mujima udi mupatuke.
4. Ela ½ too ne ku 1 nkopo (100 too ne ku 200 grammes) wa sukadi mutoke muume buludiludi pa tshitupa tshia mubidi tshidi tshiuwule tente ne mâyi tshia mala adi mapatuke bua ikale mubuikila bimpe menemene. (Kuena ne bua kuenza mudimu ne sukadi wa bukula, udi ne tshintu tshia mabele, ne kuena ne bua kuanji kuela sukadi mu mâyi to; udi ne bua kuikala mabue maume.)
5. Mushindu udi fisike wa osmose wenza mudimu: Mucosa wa mu mala udi ne tshitupa tshia munda tshidi tshiuwule tente ne mâyi a hypotonic edema. Biamu bia sucrose biume bidi bienza tshipepele tshikole tshia osmotique pa mutu pa mucosal, bikoka ne lukasa luonso mâyi adibu bakuate mu tshimanu tshia mala tshidi tshiuwule bua kubuela mu tshilamba tshia sukadi.
6. Indila minite 15 to ne ku 20 paudi ulama mubedi mutekete. Sukadi mutoke muume udi unyunguluka mu tshintu tshitoke padi mayi apatuka mu tshimanu tshia stoma. Mu minite 15 to ne ku 20, tshifu tshidi tshikole tshidi tshienda tshipueka ne tshipueka ne bia pa lukama 30 anyi 50 mu bunene.
7. Lekela dipuekesha dia patupu anyi buludiki bua tshianza tshitekete.
8. Misangu ya bungi, diakamue padi edema ukepela ne mubedi upatula luya padiye mulale panshi, mala adi mapatuke adi apingana bimpe munda mua difu nkayawu.
9. Shi munganga weba anyi munganga udi wenza mudimu wa dipanda udi mua kukuambila kumpala, udi mua kuteka tshianza tshidi ne bianza, tshidi tshibuikila mu mayi ne tshidi ne lubricant bitekete bitekete ku nsongo ya stoma udi kayi ne luya ne kuenza mudimu ne butoke bua munda padi mubedi upuyakana. Kuena ne bukole nansha kakese, kuela munu mu tshimanu tshia mala, ne imana diakamue wewa mumvue dikanda anyi kanyinganyinga.
10. Ela tshibombi tshinene tshia tshitupa tshimue tshidi mua kupatuka kunyima kua dipuekesha. Sukula tshintu tshia nsukadi ne mayi a kapia, upuekesha dikoba didi dinyunguluke, ne wela tshibombi tshia tshitupa tshimue tshipepele tshikosa bua kukumbaja stoma ne 2 too ne ku 3 millimètres (0.1 inches) ya tshitupa. Udi mua kuyukila ne munganga webe anyi munganga wa mputa, wa dipanda dia mifuba ne wa dikuba dia mubidi (WOC).

Dijimija dia mayi mu ileostomie dia bungi: bua tshinyi mayi a patupu adi enza bua ikale mibi menemene¶

Bu mudi mala manene (colon) ne mudimu wa kupingaja 1,000 too ne ku 1,500 millilitres (1 to 1.5 quarts) ya mayi ne sodium dituku dionso, mubedi udi ne colostomy utu utamba kupatula tshintu tshidi tshienza tshitupa anyi tshienza ne njiwu mikese ya dijimija dia mâyi mu mubidi. Kadi, mubedi udi ne ileostomy (anyi jejunostomy / syndrome wa mala muipi) mmupite anyi mumbushe tshifu tshijima.

Bungi bua bintu bidi bipatuka mu ileostomy wa pa tshibidilu anyi wa njiwu¶

• Tshipeta tshia ileostomy tshia pa tshibidilu: 500 too ne ku 1200 millilitres (0.5 too ne ku 1.2 quarts) ku mêba 24 a tshipeta tshia oatmeal-thick anyi toothpaste-consistency (kupatula mu tshibombi misangu 4 too ne ku 6 ku dituku).
• High-Output Stoma (HOS) threshold: Dipatuka dipite pa 1,500 millilitres (1.5 quarts) mu mêba 24 mu matuku abidi, anyi dipita 2,000 millilitres (2 quarts) mu tshikondo tshimue tshia mêba 24 (kupatula mu tshibombi tshiuwule tente ne mâyi kunyima kua mêba 21 anyi 21 anyi 21+ misangu ku dituku).

Tshiamu tshia jejuno-ileal sodium-glucose cotransport trap (Bua tshinyi mayi malelela adi apatula mukele)¶

Litre yonso wa mayi a mu ileostomie udi ne 90 too ne ku 120 millimoles (2,000 to ne 2,700 milligrams) ya sodium, pamue ne potassium, magnésium, ne bicarbonate.

Bishilangane na tshifu, mala makese a kuulu (jejunum) udi na "leaky" intercellular tight junctions idi kayiyi mua kunua mayi poso sodium ne glucose bikale bienda pamue kupitshila ku SGLT1 (Sodium-Glucose Linked Transporter 1) protein, udi ulomba bungi bua sodium bua 60 too ne ku 90 mmol/L munda mua lumen.

• Ntshinyi tshidi tshienzeka padi mubedi wa ileostomie unua mayi a patupu, tshiayi tshitekete, kafe, soda wa didia, anyi maluvu a manaya a bungenda: Mâyi a patupu adi ne 0 mmol/L wa sodium, ne maluvu a manaya a pa tshibidilu (bu mudi Gatorade anyi Powerade) adi anu ne 18 to ne 20 mmol/L ya sodium pamue ne sukadi wa bungi. Padi mayi adi ne sodium mukese abuela mu jejunum, sodium udi unyema lukasa mu mashi a mubedi uya mu lumen bua kuenza bua osmotic gradient ikale muomumue, ne bungi buonso bua mayi pamue ne sodium mu mubidi udi upatuka buludiludi mu tshibombi tshia ileostomy minite 20 pashishe. Padi mubedi upeta nyota ya bungi ne padiye unua mayi a bungi, udi ujimija mâyi mu mubidi lukasa (dijimija dia mâyi a mubidi).
• Ntshinyi tshidi tshienzeka padibu banua mayi a bimuma, soda wa pa tshibidilu, anyi maluvu adi ne bukole bua kudia: Nsukadi wa hyperosmolar udi ukoka mâyi a bungi mu mashi bua kuya mu mala ku diambuluisha dia osmosis (osmotic diarrhea), kuvudija dipatuka dia stoma misangu ibidi mu dîba dimue.

Mushindu kayi wa kusangila tshintu tshia St. Mark anyi tshintu tshia WHO Oral Rehydration Solution kumbelu¶

Bua kupingaja dijimija dia mayi a bungi ku nzubu, mikenji ya kudi Société britannique de Gastroenterologie (BSG), ESPEN, ne St. Mark's Hospital Intestinal Failure Unit idi ileja ne: badi ne bua kukandika dijimija dia mayi a hypotonique (mayi a patupu, tshiayi, kafe) muinshi mua 500 too ne ku 100 mL, ne kupingana ne dijimija dia Glucose wa bungi wa sodium-electrolyte Oral Rehydration Solution (75 to 90 mmol/L sodium):

1. Commercial WHO Reduced-Osmolarity Oral Rehydration Salts: Sangila packet umua wa ORS wa WHO (anyi bibombi bibidi bia Dioralyte double-strength bu mudibu balomba kudi tshisumbu tshia stoma, anyi CeraLyte 70/90, DripDrop, anyi Pedialyte Sport) mu bungi bulelela bua mâyi malelela adibu baleje (338. onze]).
2. St. Mark's Electrolyte Mix (Official Hospital Formula for 1 Litre [4.2 US Cups] of Water):
3. 6 niveau teaspoons (20 grams) of niveau glucose powder (anyi 6 niveau teaspoons of table sugar si glucose/dextrose powder mukezuke kayiku, nansha mudi glucose powder muikale muimpe bua osmolarite muimpe)
4. 1 tshitupa tshia tshiayi (3.5 grammes) tshia mukele wa ku mesa (chloride de sodium)
5. ½ wa lupwa lua tshiayi (2.5 grame) wa bicarbonate de soude (sodium bicarbonate) (anyi trisodium citrate)
6. Ela bionso mu 1 litre (1,000 mL) ya mayi mashika. Nua bitekete bitekete mu difuku dijima (kumuteka mu mashika anyi kumuela ka-tshintu kakese ka mupuya wa nsukadi udi kayi ne nsukadi udi wenza bua dipembu dia mukele dikale dipepele bua kutantamena).
7. Tapulula bintu bikole ne bintu bia mayi paudi udia: Kunua bintu bia mayi minite 30 kumpala kua kudia, mu tshikondo anyi minite 30 panyima pa wewe mumane kudia biakudia bikole, nunku biakudia bikole bidi bienda bitekete bitekete mu mala makese. Dya bya kudya bidi na amidon ya bungi bidi bikolesha dipatuka dia ileostomie: mpunga mutoke, makaroni a patupu, bimuma bia blé bikuate, mampa matoke, nkunde, manteka a nkunde mimpe, pome, ne marshmallows.

Dikanga dia stoma (dipanga dia biakudia anyi dikanga dia tshiamu)¶

Bu mudi ileostomie upitshila mu tshibuelelu tshikese tshia mu tshimanu tshia misunya ya mu difu, biakudia bidi ne mionji, bidi kabiyi bitamba kutafuna bimpe (popcorn, nkunde, mionji ya seleri, nkunde, bimuma biume, nkunde, anyi tshisuku tshia agrume) bidi mua kusambakena pamue bua kulua tshintu tshikole tshidi panyima pa tshitupa tshia difu (** obstruction **). Dilamakaja, dikoseka (volvulus), anyi tshipupu tshia parastomal tshidi kabidi mua kunyanga mala munda.

Kujingulula tshitupa anyi tshitupa tshijima tshia stoma¶

• Dikanga dia tshitupa tshia stoma: Stoma udi ulekela kupitshisha tshintu tshikole tshia pa tshibidilu ne udi upatula mashi adi ne mupuya mubi mu tshienzedi pamue ne mutoyi mukole wa gurgling, disama dia mu difu dikese, ne tshitupa tshia stoma tshidi tshiuwule tente ne edematose.
• Dikanga dia stoma dijima: Kakuyi tshintu tshia munda ne kakuyi kapepe kubuela mu tshibombi munkatshi mua mêba 4 too ne ku 6 mu ileostomy (anyi mêba 24 too ne ku 48 ne kanyinganyinga mu colostomy). Difu didi divula, mavuala a kanyinganyinga kakole kadi kakola kunyima kua minite mikese, tshifu tshidi tshivula, ne mubedi udi utuadija kuela mâyi a bile a vert anyi a mvinyo mufiike.

Malu mimpe a ku nzubu bua tshiamu tshia bolus tshia biakudia (bikala mubedi kayi utua)¶

1. Umbusha tshiamu tshia wafer tshidiku mpindieu ne wela tshibombi tshidi ne tshibuelelu tshinene bua kujikija disama dia stoma.
2. Lekela kudia biakudia bionso bia bukole diakamue. Shi mubedi kayi wela manyi, udi mua kunua tshiamu tshia dilengeja natshi mubidi. Shi udi ne tshiji anyi udi upela, ikala ne nil ku mishiku (NPO).
3. Uteke mu mayi a kapia munkatshi mua minite 15 to ne 20 anyi ela tshilamba tshia kapia pa difu bua kujikija disama dia misunya ya mu difu.
4. Enza diteka dia binu too ne ku tshiadi ne dilengeja dia tshiadi: Lala ku luseke ne binu bikoka ku tshiadi, anyi unyunguluke bitekete bitekete ku bianza ne ku maboko paudi wenda ulengeja difu dinyunguluke stoma bua kumbusha tshintu tshidi tshikuata biakudia panyima pa fascia.
5. KANUANYI manga a ku mishiku bua dikanga dia ileostomie. Malu a kuondopa adi asaka peristalsis wa tshikisu ku tshibuikidiji tshia tshiamu tshikanga, adi afila njiwu ya dibutuka dia mala ne dijimija dia mâyi mu mubidi.
6. Ndaku ku tshibambalu tshia malu a mpukapuka pikala dipatuka kadiyi dipingana mu mêba 4 to ne 6 anyi pikala tshipupu tshituadija. Baminganga ne benze tshikebelu tshia stoma tshia ku Enternete ne nebabueje tshiamu tshia 14-France anyi 16-France red-rubber catheter mu stoma santimetre mikese bua kuela mâyi mu stoma ne tshiakudia tshiakane.

Disama dia hernie parastomal, mashi adi apatuka, ne ditapuluka dia mucocutaneous¶

Parastomal hernia incarceration vs. reducible bulge¶

Bantu batue ku 30 too ne ku 50 pa lukama badi ne disama dia ostomie batu ndekelu wa bionso bapeta parastomal hernia, tshitupa tshidi tshipatuka muinshi mua dikoba ku luseke lua stoma mudi tshitupa tshikuabu tshia mala tshienda tshienda tshilonda stoma kupitshila ku tshibuelelu tshia mifuba tshidi tshivula.

• Bulge budi kabuyi bupatuka: Bulge budi bupatuka padi muntu muimane anyi ukokola, budi bumvua butekete ne kabuyi ne kanyinganyinga, budi bunyanguka padibu balala panshi, ne stoma udi ushala mutoke padiye upatuka bimpe.
• Strangulated / incarcerated parastomal hernia (Surgical Emergency): Tshitupa tshidi tshipatuka ku luseke lua stoma tshidi tshilua tshikole bu dibue, tshikole, tshitekete, ne katshiena mua kuikala tshipepele padibu balala panshi; kikoba pa mutu pa tshitupa tshidi tshipatuka tshidi tshilua tshikunze anyi tshikunze; stoma udi ulua violet anyi ulekela kupatula bintu; ne mubedi udi upeta kanyinganyinga kakole ka mu difu ne utua mikemu. Umbusha tshibombi diakamue, ulale panshi, kuela tshitupa tshidi tshisama munda, ne ubikile bena mudimu ba lukasa.

Dipatuka dia mashi mu stoma: dikokangana dia mucose vs. portal-hypertension varices parastomales¶

• Mucosal oozing mukese: Kusukula bikole padibu bashintulula tshibombi anyi kusukula tshibombi tshikole ku stoma kudi misangu ya bungi kufikisha mashi makunze pa tshiamu tshia gaze. Kufina tshilamba tshia mashika, tshitoke bitekete bitekete pa muaba au munkatshi mua minite 2 anyi 3 kudi kuimanyika tshishiki.
• Parastomal variceal hemorrhage (Life-Threatening): Mu babedi badi ne cirrhose wa tshifu anyi tension wa tshiibi, mijilu ya mu tshifu idi ne bukole bua bungi idi yenza tshijengu tshia mijilu mikole anu muaba udi stoma usambakena ne dikoba dia mu difu (caput medusae, udi umueneka misangu ya bungi bu tshintu tshia bule pa dikoba dia tshifu). Bintu ebi bidi mua kupatuka nkayabi ne kupompa millilitre nkama ne nkama ya mashi mafiike anyi makunze mu tshibombi tshia ostomy mu minite mikese, ne kufikisha ku tshipupu tshia mashi.
• Diambuluisha dia kumpala dia lukasa: Umbusha tshibombi, keba muaba udi tshintu tshipatuka ku muelelu wa dikoba ne stoma, ne ufina tshilamba tshia gaze tshidi katshiyi ne disama (anyi gaze mutokesha ne oxymetazoline 0.05% wa mu mishiku) buludiludi ne bikole pa muaba wa mashi ne munu umue paudi ubikila 911/112/999. Lama mubedi mutekete ne maulu mabandisha (tangila mashi adi apatuka mu tshifu ne cirrhose).

Ditapulula dia mucocutaneous ne dipingaja dia stoma¶

Mu mbingu 2 anyi inayi ya kumpala kunyima kua dipanda, milonda idi mikuate muelelu wa stoma ku dikoba dia mu difu idi mua kukoka (mucocutaneous separation), anyi stoma udi mua kukuluka muinshi mua dikoba (retraction).

• Dishilangana dia njiwu: Ditapulula dia pa mutu dia dikoba didi dilombodibua kudi munganga wa WOC wenza mudimu ne alginate wa calcium anyi lupuishi lua hydrofibre. Ino, shi stoma mutapuluke bionso pabuipi ne 360 ​​degrés ne upueka panshi kuinshi kua fascia wa muscle mu tshina tshia peritoneal, bintu bia munda bidi bibuela buludiludi mu difu (peritonitis). Wewe mumone tshina tshikole tshidi katshiyi ne tshintu ne disama dikole dia mu difu ne kapia, bikila ambulanse diakamue.

Nomba ya tshimpitshimpi ya mu tshijengu ne mikenji ya bibambalu¶

• États-Unis ne Canada: Bikila 911 bua disama dia stoma noir/purple, hernie parastomale incarcerée, dipatuka dia mashi a bungi mu stoma, anyi dipanga dia mâyi mu mubidi dikole ne disama dia syncope. Tshisumbu tshia baminganga ba mputa, tshia dipanda dia mifuba ne tshia tshifu (WOCN) ne tshisumbu tshia baminganga ba mu tshifu tshia mu tshifu ne tshia mu tshifu (ASCRS) badi bitaba bua kumbusha diakamue bipese bia mu tshifu bidi bikuata, dipuekesha dia osmotic supine ne sucrose wa granulated bua stomas idi mipatuke, ne luondapu lua dipingaja mâyi ku mishiku bua mputa idi mipatuke bikole.
• Royaume-Uni: Bikila 999 bua disama dia peritonite dikole, stoma mufue, anyi tshipupu tshikole, anyi bikila 111 / NHS Stoma Care Nurse Specialist webe bua disungula dia lukasa dia mu lupitadi dia prolapse anyi dipatuka dia bungi. Société britannique de gastroenterologie (BSG) ne mikenji ya lupitadi lua St. Mark idi ileja mudi St. Mark's electrolyte solution ne hypotonic fluid restriction bua stomas ya bungi.
• Union européenne: Bikila ku 112. Société européenne pour la nutrition et métabolisme (ESPEN) ne European Crohn's and Colitis Organization (ECCO) badi bafila mikenji ya kumpala ya isotonic/high-sodium ORS (90 mmol/L sodium), loperamide/antisecretory titration muinshi mua dilombola dia baminganga, ne dikonkonona dia lukasa dia dipanda dia ischemic anyi obstructed stomas.
• Australie ne Nouvelle-Zélande: Bikila 000 mu Australie anyi 111 mu Nouvelle-Zélande. Mikenji ya tshisumbu tshia baminganga ba mu tshifu tshia mu Australie (AASTN) idi ileja dikola dia lukasa dia tshiamu tshia mudimu bua stoma udi ne edematous/prolapsed ne dipingaja dia mâyi mu mishipa ne lukasa bua ileostomie wa bungi udi ne oliguria.
• India ne Asia-Pacific: Bikila 112 mu Inde, 995 mu Singapour, 119 mu Japon ne mu Corée du Sud, anyi 999 mu Malaysie ne mu Hong Kong. Tangila liste wetu mujima wa nomba ya njiwu ya pa buloba bujima.

Nkonko itubu bela misangu ya bungi¶

Bua tshinyi kuela sukadi mutoke wa pa mesa pa tshifu tshidi tshipatuka kudi kuenza bua tshikepe?¶

Tshitupa tshidi tshipatuka tshia stoma ntshitupa tshia munda tshia mala, tshidi tshienza mudimu bu tshibuikidiji tshidi katshiyi tshipita. Padi stoma upatuka mu difu, dikanga dia mijilu didi dikuata mayi a bungi munda mua tshitupa tshia mubidi, tshienza bua tshikale tshiuwule bikole bua kupingana mu tshibuelelu tshia mubidi. Kubuikila tshitupa tshia mubidi tshidi tshiume ne mabue a sucrose maume kudi kuenza tshintu tshikole tshidi tshikoka mâyi adi makuate lukasa mu tshimanu tshia mala tshidi tshiuwule bua kubuela mu nsukadi, ne tshidi tshipatula mu tshitupa tshia mubidi mu minite 15 anyi 20 bua tshikale mua kupingana bimpe munda paditshi tshilala panshi.

Bua tshinyi muntu udi ne ileostomie kena mua kunua anu mayi a bungi padi tshibombi tshienda tshiuwule tente ne mayi?¶

Bishilangane na tshifu tshimpe, tshifu tshikese tshia kuulu katshiena mua kunua mayi nkayatshi to; selile yende idi dijinga ne sodium wa bungi (60 too ne ku 90 millimole ku litre) pamue ne ndambu wa glucose bua kukoka mâyi ku tshimanu tshia mala bua kubuela mu mashi. Padi mubedi wa ileostomie unua mayi a patupu, tshiayi, anyi maluvu a manaya adi ne sodium mukese, sodium udi upatuka mu mashi ende uya mu bitupa bia munda bua kuenza bua bungi bua mukele buikale bumue, wela mâyi adiye mufuma ku dinua ne mukele wa mubidi wende buludiludi mu tshibombi tshia ostomy ne wenza bua dipanga dia mâyi mu mubidi dikale dikole.

Mmunyi mundi mua kumanya dishilangana pankatshi pa dikala dia beetroot/biakudia ne mashi malelela anyi stoma udi wenda ufua?¶

Kudia bimuma bia beet bikunze, gelatine mukunze, dikala dia biakudia bikunze, licorice, anyi ma tablette a tshiamu tshia mitaku kutu misangu ya bungi kukudimuna tshisuku anyi mâyi adi munda mua tshibombi tshia ostomy tshikunze anyi tshifiike menemene, bidi mua kumueneka bu bualu budi buenza buôwa. Ino, bya kudya ne tshiamu tshia mitaku bidi anu bilengeja tshidi tshipatuka munda mua tshibombi; Kabena mua kushintulula dikala dia tshitupa tshia stoma tshidi ne muoyo to. Kupula bitekete bitekete pa mutu pa tshitupa tshia stoma ne tshilamba tshitoke: stoma muimpe neashale anu umueneka mutoke wa nyama wa rose-mutoke, mutoke, ne wa luya, kadi stoma wa ischemie neikale ne tshilamba tshia violet tshifiike, tshitoke anyi tshifiike anu mu tshimanu tshia mala.

Bua tshinyi mapilu a manga atu imue misangu apatuka onso munda mua tshibombi tshia ileostomy, ne mapilu kayi adi ne njiwu?¶

Bu mudi ileostomie umbusha anyi upitshila mu mala manene onso ne ukepesha dîba dia kupitshila mu mala, manga a extended-release (ER, XR, SR, XL) ne a enteric-coated tablets adi misangu ya bungi apita buludiludi mu tshibombi tshia ostomy kaayi manyanguke, ne adi afila dilekela dia manga anyi dipanga dia luondapu. Kuena ne bua kunua mapilisi a dipatuka mutantshi mule anyi a mu tshifu ne ileostomie to, anu padibu bakuanyishile kudi munganga (lomba mapilu a dipatuka dia lukasa, mâyi anyi bipese), ne kuangatshi kabidi manga a ku mishiku, adi mua kufikisha ku dijimija dia electrolyte didi mua kunyanga muoyo.

Bidi bia pa tshibidilu bua stoma mupiamupia kushintuluka bunene mu ngondo ibidi ya kumpala kunyima kua dipanda anyi?¶

Eyowa. Diakamue kunyima kua dipanda, stoma yonso udi uvula bua dipanda ne udi wenda ukepela ku kakese ku kakese mu diamètre mu mbingu 6 anyi 8 ya kumpala too ne padiye ufika ku bunene buende bua kashidi. Mu ngondo ibidi ya kumpala, udi ne tshia kupima diamètre wa stoma ne tshiamu tshia kupima natshi ku dishintuluka dionso dia wafer bua tshibuelelu katshiyi tshinene bikole (tshidi tshileja dikoba dia peristome kudi enzymes ya digestion idi inyanguka) anyi tshikole menemene (tshidi mua kushipa stoma padiye uvula bua tshitupa tshîpi).

Miaba ne buludiki bua mbulamatadi¶

• Wound, Ostomy, and Continence Nurses Society (WOCN, United States): WOCN Society Clinical Guideline: Management of the Adult Patient With a Fecal or Urinary Ostomy (Triage of stoma ischemia, mucocutaneous separation, prolapse, and peristomal varices).
• Society Americane of Colon and Rectal Surgeons (ASCRS, United States): Clinical Practice Guidelines for Ostomy Surgery (Assessment of superficial vs. sub-fascial stomal necrosis, parastomal hernia strangulation, and stomal obstruction).
• British Society of Gastroenterology (BSG) & St. Mark's Hospital Intestinal Failure Unit (United Kingdom): Guidelines for Management of Patients with a Short Bowel and High-Output Stoma (Nightingale J et al., Gut: jejunal sodium-glucose cotransport physiology, St. dienza dia tshiamu tshia nzembu).
• Société européenne pour la nutrition clinique et le métabolisme (ESPEN, Europe): ESPEN Guideline on Clinical Nutrition in Acute and Chronic Intestinal Failure (High-output ileostomy fluid and magnesium/potassium resuscitation protocols).
• Myers JO & Rothenberger DA / Desai DC (Diseases of the Colon & Rectum / American Journal of Surgery): Osmotic Reduction of Edematous Prolapsed Stomas Using Topical Granulated Sucrose.

Malu adi apetangana¶

• Dikanga dia mala, disama dia tshiadi tshikole, ne bimanyinu bia tshimpitshimpi bia volvulus
• Disama dia tshifu tshikole, disama dia mala, ne disama dia munda dia panyima pa kudia
• Disama dia tshiadi, disama dia mu tshifu, ne dipanga dia mâyi mu mubidi
• Ditapa dia mashi a mu tshifu, dipatuka dia mashi mu tshifu, ne disama dia tshiadi
• Dipatula dia munda ne dilama dia mputa ya mu tshifu