Ostomy Emergency: Dema kana Purple Ischemic Stoma, Severe Prolapse, uye High-Output Ileostomy Dehydration¶

Intestinal ostomy (colostomy, ileostomy, kana urostomy) inounza chiuno chine hutano kana kupera kwemukati nemumadziro edumbu kuitira kuti tsvina ikwanise kubuda muhomwe yekunze. Nekuti stoma ndiyo yakapfava yemukati mucosal lining yemukati yakachinjika mukati, haina chekunze ganda rekudzivirira uye inotsamira chose pane yakapfuma mesenteric arteries inopinda nemukoto wakaomarara mudumbu redumbu. Kana stoma ikaita dzvuku repepuru, dema dema, kana dema, rikazvimba kusvika radzipwa neplastic wafer ring, matelesikopu kubva mudumbu nekurwadziwa kwakanyanya, kana kudurura anopfuura 1,500 kusvika 2,000 milliliters (1.5 kusvika 2 quarts) emvura yemvura pazuva, fonera munharaunda yako nhamba dze emergency kana kutsvaga rubatsiro rwechimbichimbi chekuvhiya nekukasika. Nezve emergency zvine chekuita nemudumbu uye mvura, ona kuvharika kwebowel, strangulated hernia, uye volvulus, acute mesenteric ischemia uye bowel infarction,uye chepfu yechikafu, acute gastroenteritis, uye kupera mvura mumuviri.

Kuziva kuongorora ruvara uye kudziya kwe stoma, nguva yekukurumidza kucheka ganda rinovharisa ganda, sei kuisa yakaoma granulated tafura shuga kuderedza edematous prolapsed stoma ne osmosis wakarara wakarara, uye nei kunwa mvura yakachena kuchiwedzera-inobuda ileostomy kupera mvura mumuviri kunogona kuponesa zvese muviri wemurwere.

Ita izvi ikozvino¶

1. Ongorora ruvara rwe stoma nekukasira nekubvisa kana kutarisa nemukati mehomwe yakachena. Dutu rine hutano nderokuti inopenya nenyama yenyama yakatsvuka kana yakadzika yepingi, yakanyorova, inopenya, uye inodziya (yakafanana nemukati medama rako). Kana stoma ikaita ** grey, mottled blue, dark plum-yepepuru, brown, kana dema dema**, kana kunzwa kutonhora uye kuoma/kutsvuka kumunwe wegirovhosi, ropa rayo rinobuda rinogurwa (stoma ischemia kana necrosis). Fonera nhamba yako yemunharaunda yechimbichimbi (911 muUS/Canada, 112 muEU, 999 muUK) kuti uongororwe nekukasika.
2. Kana stoma iri kuzvimba kana kuona nekuona kunze (prolapse), bvisa wafer yakasimba kana kuti cheka chinovhara chiya chakafara nekukasika. Usambofa wakasiya wafer yakaomarara yeconvex, plastic locking flange, kana kuti tight precut barrier yeganda pakazvimba kana kubuda stoma. Iyo mhete yepurasitiki yakaoma inoita senge tourniquet yakatenderedza pasi pehura, ichidzvanya tsinga nematsinga mukati memaminitsi. Pera chitete chose kubva padumbu (kana chinja uchienda kuhomwe hombe ine chidimbu chimwe chete inodonhedza mvura ine buri rakachekwa nemamilimita matatu kusvika ku6 [0.12 kusvika 0.25 inches] rakafara kupfuura stoma yakazvimba).
3. Kune stoma isina kuomarara, yepingi, ita kuti murwere arare pasi nemanhede uye apfekedze stoma zvakanyanya neshuga chena yakaoma yepatafura. Kana chikamu chakareba chepingi, ura hunodziya hwakabuda nemudumbu pasina kurwadziwa kwakanyanya kana kushanduka kwemavara matema, radzika murwere pasi nemabvi akakotama zvishoma kuti udzikise chando, putira jira rechando. tauro zvinyoro nyoro pamusoro pehomwe kwemaminitsi gumi, kana kudira ** ½ kusvika 1 kapu yeyakajairika yakaoma chena granulated sucrose (tafura yeshuga)** zvakananga pamusoro pemvura yakanyoroveswa mucosa kwemaminetsi gumi nemashanu kusvika makumi maviri. Shuga yakanyungudutswa inoburitsa mvura mumadziro ebowel yakazvimba neosmosis (Desai osmotic reduction maneuver), ichidzikisa stoma saka inowanzotsvedza ichidzokera mukati pachayo.
4. Kana ileostomy yakabuda ichipfuura 1,500 kusvika 2,000 mL (1.5 kusvika 2 quarts) mumaawa makumi maviri nemana, MIRA kunwa mvura isina kupfava, tii, kana muto wemichero unotapira uye wobva wachinja nekukasika kuhigh-sodium Oral Rehydration Solution (ORS). Mumurwere ane mudumbu mudiki kana ileostomy, kunwa mvura isina kupfava yesoday nesoday yesodium yakawanda kana kuti mvura ine shuga yakawanda. bhegi **, kukurumidza hypovolemic shock uye itsvo kutadza kushanda. Sip World Health Organisation (WHO) yakaderedza-osmolarity ORS kana mushonga wekumusha weSt. Mark's electrolyte (une reshiyo chaiyo yemunyu, soda yekubheka, uye glucose mu1 litre yemvura).
5. Ongorora kuti dumbu rakavharika here pamwe chete nekurwadziwa mudumbu nekurutsa. Kana ileostomy ikaburitsa zero fluid kana gasi kwe4 kusvika maawa matanhatu (kana kuti colostomy haibudisi chinhu kwemaawa 24 kusvika ku48 pamwe chete nemasaisai ekurwadziwa nemudumbu, kuzvimba mudumbu, kurutsa, kurutsa, kurutsa, kurutsa, kurutsa, kusvotwa kugeza kunodziya kana mabvi-chest posture, uye enda kukamuri yekukurumidzira. Usafe wakatora laxatives yekufungidzirwa kuti stoma blockage.
6. Dzora mucosal kubuda ropa nekudzikama kwakananga, kana kuti enda kuchipatara kunopisa stomal variceal hemorrhage. Donhwe reropa dzvuku rakajeka pakupukuta dumbu rakajairika; zvisinei, kana ropa richiputika kana kuzadza chikwama nokukurumidza (kunyanya kune varwere vane chiropa chechiropa uye ** parastomal varices **), shandisa compress inotonhora kana gauze yakanyoroveswa mu oxymetazoline nasal spray zvakasimba pamusoro pekubuda ropa uye kudana mabasa ekukurumidzira.

Muti wesarudzo: ostomy emergency triage¶

flowchart TD
    A["Ostomy Emergency (Ileostomy, Colostomy, kana Urostomy)"] --> B{"Ongorora ruvara rwe stoma uye chitarisiko"}
    B -->|"Dema, ruvara rwepepuru, slate grey, kutonhora, kana kuoma"| C["ACUTE STOMA ISCHEMIA / NECROSIS: Bvisa wafer yakasimba ipapo"]
    C --> D["Chengetedza murwere NPO (hapana chinhu nemuromo) uye fonera EMS kuti ikurumidze kuongororwa"]
    B -->|"Stoma telescoped kunze 5 kusvika 20 cm (Prolapse)"| E{"Ura hwakaramba huchikwira hupingi/kudziya kana kusviba/kurwadza here?"}
    E -->|"Yakasviba yepepuru / dema, yakaoma, kana kurwadziwa kwakanyanya mudumbu"| C
    E -->|"Beefy tsvuku/pink, yakapfava, uye isingarwadzi"| F["Bvisa wafer yakasimba/flange nekukasika kuitira kuti mhete isakwanise kudzvinya chigadziko"]
    F --> G["Radzika murwere kumusana + dururira shuga yetafura yakachena yakaoma pamusoro pe stoma kwemaminitsi makumi maviri"]
    B -->|"Mvura inobuda> 1,500 kusvika 2,000 mL / zuva + dizzy / weti yakasviba"| H["HIGH-OUTPUT STOMA DEHYDRATION: Misa mvura isina mvura uye zvinwiwa zvine shuga"]
    H --> I["Sip St. Mark's kana WHO Oral Rehydration Solution; enda kuER kana uine dzungu, cramping, kana oliguric"]
    B -->|"Zero kubuda kwe4 kusvika 6 hr (ileostomy) + cramps / kurutsa"| J["ACUTE STOMA OBSTRUCTION: Pfeka wafer wakafara, usanwe chero chinhu kana uchirutsa, HAPANA malaxatives"]
    J --> K["Edza kugeza inodziya uye ibvi-ku-chipfuva chinzvimbo; enda kuER kune zvinyoro nyoro catheter decompression"]

Stoma color guide: kusiyanisa hutano mucosa kubva kune arterial ischemia uye necrosis¶

Nekuti intestinal mucosa haina keratinized yekunze ganda layer (stratum corneum), mubhedha wayo wecapillary unoonekwa zvakananga kune ziso rakashama. Kutarisa stoma ruvara ndiyo inokurumidza nzira yekuongorora mesenteric kubuda kweropa.

Nei stoma ischemia ichiitika¶

Kana chiremba anovhiya achigadzira ileostomy kana colostomy, vanounganidza chiuno kana kupera kweura pamwe neropa rayo rakaita semesenteric uye vanoridhonza kuburikidza nekuvhiya kwakavhurwa kuvhurwa (** trephine **) mu rectus abdominis muscle, fascia, uye ganda. Arterial ropa rekupa kune stoma rinogona kukundikana nekuda kwezvikonzero zvina:

1. Early postoperative mesenteric tension kana arterial thrombosis (kutanga maawa 24 kusvika 72 mushure mekuvhiyiwa): Kana mesentery yakatambanudzwa zvakanyanya, yakamonyoroka (volvulus), kana kudzvinyirirwa neshure kwekuvhiya mudumbu madziro kuzvimba, kana kana kuderera kweropa (hypotension) uye mishonga yevasopressor inofa nenzara iyo splanchnic arteries, iyo distal tip ye stoma inorasikirwa neperfusion.
2. Kudzipwa nekapeti kadiki: Dutu rinozvimba mukati memavhiki matanhatu kusvika masere ekutanga mushure mekuvhiyiwa, uye rinozvimba kwenguva pfupi panguva yechirwere chegastroenteritis, prolapse, kana kuvharika kweura. Kana murwere akaramba achiisa ganda rinovharira ganda rekare rave diki pane dhayamita ye stoma, iyo yakaoma hydrocolloid kana plastiki coupling ring inocheka mujinga me stoma sebhande rerabha.
3. Incarcerated parastomal hernia: Chishwe cheura chinosvina padivi pe stoma nepaburi rinopinda mumafuta ari pasi pecutaneous yobva yabatwa nekunyungudutswa.
4. Systemic thromboembolism kana kuti non-occlusive mesenteric ischemia: Gare gare muupenyu, magwara eatrial fibrillation, kutadza kushanda kwemoyo kwakanyanya, kana aortic dissection inogona kuvhara tsinga yepamusoro kana yakaderera mesenteric (ona acute mesenteric ischemia)

Yepamusoro (pamusoro-fascia) vs. yakadzika (pazasi-fascia) stoma necrosis¶

Kana vanachiremba vekukurumidzira vachiongorora stoma yakasviba kana yakasviba, muganhu wakaoma weanatomical ndeye ** anterior rectus fascia ** (yakasimba fibrous muscle sheath inogara 2 kusvika 4 centimita [0.8 kusvika 1.5 inches] pasi peganda redumbu):

• Superficial mucosal ischemia (yakavharirwa pamusoro pefascia): Kunobuda chete kwe stoma kunze kwetsandanyama yedumbu ndiko kunenge kwadoka kana kusviba, ukuwo ura hwakadzika mukati memukoto wetsandanyama unoramba uri pink. Nyaya idzi dzinowanzo slocker iyo yekunze yakafa layer uye inoporesa nekunyatsotarisisa (kunyangwe ichiwanzo nonoka **stomal stenosis ** kana kutetepa).
• ** Deep transmural necrosis (inowedzera pazasi pefascia ichipinda mu peritoneal cavity):** Kana iyo dema, yepepuru, kana grey discoloration ikawedzera kudzika kupfuura fascial level mukati meguvhu redumbu, iyo yakafa madziro emukati mukati medumbu inoputika nekukurumidza uye kudurura chituru chakananga mu peritoneal cavity (**testomy perirotomy) iyo yekukurumidza revision.

Iyo test-tube ("girazi chubhu") yekuvhenekesa cheki inoshandiswa muER¶

Mudhipatimendi rekukurumidzira, varapi vanozora zvinyoro girazi girazi rekuunganidza ropa-chubhu (Vacutainer), jekiseni repurasitiki rakajeka, kana kuti anoscope/otoscope speculum yevana, isa masendimita matatu kusvika ku5 (1.2 kusvika ku2 inches) mu stoma lumen, uye vhenekera chiedza chinopenya padivi pechubhu. Kana iyo yemukati mucosa yakatsvuka pink 1 centimita pasi pasi, iyo ischemia ndeyepamusoro. Kana iyo mucosa ikaramba yakasviba yakasviba, grey, kana yepepuru pazasi pezinga redumbu remadziro fascia, murwere anotorwa nekukurumidza kukamuri yekuvhiya. ** Usambofa wakapinza machubhu egirazi kana zvinhu zvinopinza mustoma kumba **; siya kuongororwa kwemukati kune vanachiremba vekukurumidzira.

Stoma prolapse uye tafura yemhuri shuga (osmotic kuderedza) kufamba¶

stoma prolapse inoitika apo chikamu chehuku chakazara cheura chinopinda (telescopes mukati chaimo) uye chinotsvedzerera kunze nepaburi redumbu, chakarembera kunze kwedumbu sehunde yenzou inoyera chero kubva pa5 kusvika ku25 masendimita (2 kusvika 10 inches) kureba. Prolapse inonyanya kuwanda mu ** loop colostomies ** (kunyanya transverse loop colostomies, apo distal "inactive" nhengo teresikopu kunze) uye kugumisa ileostomies apo abdominal pressure inosimuka kubva pakukosora, kusimudza zvinorema, kuchema mucheche, kana kufutisa.

Nei stoma yakawedzera inobatwa kunze kwemuviri¶

Kana masendimita gumi kusvika gumi nemashanu (masendimita mana kusvika matanhatu) emudumbu abuda nepakamanikana mhete mumadziro emudumbu, mhete yetsandanyama yakamanikana neplastic ostomy wafer inosvina tsinga dzepasi-pressure mesenteric uku tsinga dzine simba guru dzichiramba dzichipomba ropa mudumbu rinobuda. Fluid inokurumidza kudonhedza mucosal tissues (** interstitial edema **). Mukati memaminetsi 30 kusvika ku60, ura hwakanyura hunozvimba kusvika kaviri kana katatu ukobvu hwahwo hwenguva dzose, huchiwedzera kukora uye hunorema zvokusagona kutsvedzeka uchidzokera nomuburi repaguvhu redumbu. Kana ikasadzikiswa, kuzvimba kwacho kunopedzisira kwapwanya tsinga yeropa, kushandura benign pink prolapse kuita gangrenous, strangulated surgical emergency.

Nhanho-ne-nhanho yekudzikisa kumba uchishandisa iyo Desai granulated tafura yeshuga nzira¶

Kana iyo stoma yakawedzera iri ** pink kana tsvuku, inodziya, yakapfava, uye isingakonzere kurwadziwa kwakanyanya mudumbu **, unogona kushandisa yakajairwa chipatara osmotic therapy kumba uchironga kuongororwa kwekurapa:

1. Bvisa chipfuko chinopinza kana kuvhura homwe yezvimedu zviviri nekukasika. Kana buri repurasitiki kana gomba rehydrocolloid ririkuchera muzasi meuura hwabuda, bvisa zvinyoronyoro kubva paganda kuitira kuti pasi pe stoma pasabatike.
2. ** Radzikai murwere kumusana kwavo (supine).** Isa piro pasi pemabvi avo kuti tsandanyama dzemudumbu dzisununguke uye simba rinokwevera zvinhu pasi rimire kudhonzera ura pasi.
3. Dururira chena yakaoma granulated tafura shuga (sucrose) nerupo pamusoro pe stoma yese yakafumurwa.
4. Dururira ** ½ kusvika 1 kapu (100 kusvika 200 magiramu) yeshuga yakaomeswa chena yakaomeswa** zvakananga pamvura yakanyorova, yakazvimba mucosal pamusoro pehuura hwakarembera kuti hunyatsoputirwa. (Usa ** usa ** kushandisa shuga yehupfu, ine cornstarch, uye usanyunguse shuga mumvura kutanga; inofanira kuva makristasi akaoma.)
5. Mashandiro anoita osmosis physics: The swollen intestinal mucosa is a semipermeable membrane yakazadzwa ne hypotonic edema fluid. Dry sucrose crystals inogadzira yakanyanya hypertonic osmotic gradient kuyambuka mucosal pamusoro, nekukasira kudhonza mvura yakavharirwa kubva mumadziro emukati akazvimba kupinda mune shuga coating.
6. Mira maminitsi 15 kusvika ku20 uchichengeta murwere akati sandarara. Shuga chena yakaoma inonyunguduka kuita muto wakajeka sezvo mvura ichibuda mumadziro estoma. Kupfuura maminitsi gumi nemashanu kusvika ku20, ura hwakasimba, hwakazvimba hunooneka uye hunoderera ne30 kusvika ku50 muzana muhupamhi.
7. Bvumira kudzikisira kwega kana kutungamira kwakapfava-chanza.
8. Muzviitiko zvakawanda, panongodzikira uye murwere anofema akarara akati sandara, ura hwakarembera hunotsvedza zvakanaka uchidzokera mukati medumbu rega.
9. Kana wakarairwa kare nachiremba wako kana mukoti ostomy, unogona kuisa girovhosi, mvura-inonyungudika-rubricant-yakavharidzirwa flat palm zvinyoro nyoro padivi pemuromo weiyo deflated stoma uye shandisa chiedza mukati kutungamira apo murwere anofema. Usafe wakasunda nesimba, usambopinza chigunwe mumadziro emuura, uye mira nekukasika kana ukanzwa kuramba kana kurwadziwa.
10. Dzora homwe hombe, inopfakanyika yechidimbu chimwe chete inodonhera shure. Geza sirapu yeshuga nemvura yepombi inodziya, pukuta ganda rakapoterera, wozora homwe yakapfava yechidimbu chimwe chete yakachekwa kuti ikwane stoma nemamilimita maviri kusvika matatu (0.1 inchi) ekusununguka. Bata chiremba wako wekuvhiya kana Ronda, Ostomy, uye Continence (WOC) mukoti.

High-output ileostomy dehydration: nei mvura yakachena ichiita kuti iwedzere¶

Nekuti ura hombe (coloni) ine basa rekutorazve 1,000 kusvika 1,500 milliliters (1 kusvika 1.5 quarts) yemvura uye sodium zuva rega rega, murwere ane ** colostomy ** anowanzo gadzira semi-yakaumbwa kana yakaumbwa stool ine yakaderera dehydration ngozi. Kusiyana neizvi, murwere ane **ileostomy ** (kana jejunostomy / short bowel syndrome) akadarika kana kubvisa colon yose.

Normal vs. ngozi ileostomy goho mavhoriyamu¶

• Normal mature ileostomy output: 500 kusvika 1,200 milliliters (0.5 kusvika 1.2 quarts) pamaawa makumi maviri nemana e oatmeal-gobvu kana mazino-kusachinja-chinja kubuda (kudurura homwe yakajairika 4 kusvika 6 kanomwe pazuva).
• High-Output Stoma (HOS) pachikumbaridzo: Kubuda kunopfuura 1,500 milliliters (1.5 quarts) mumaawa makumi maviri nemana kwemazuva maviri, kana kudarika 2,000 millilitres (2 quarts) munguva imwe chete ye24-houch (kudurura maawa 1, 1 kusvika ku2 kaviri pamvura. zuva).

Iyo jejuno-ileal sodium-glucose cotransport trap (Nei mvura yakachena ichibudisa munyu)¶

Lita rega rega remvura yeileostomy effluent ine inosvika ** 90 kusvika 120 millimoles (2,000 kusvika 2,700 milligrams) yesodium **, pamwe ne potassium, magnesium, uye bicarbonate.

Kusiyana necolon, iyo yekumusoro dumbu diki (jejunum) ine "leky" intercellular tight junctions isingagoni kunwisa mvura kunze kwekunge sodium neglucose zvichishingaira kutakurwa pamwe chete nepakati pebrashi-border membrane kuburikidza ne SGLT1 (Sodium-Glucose Linked Transporter 1) protein, inoda kuiswa kwe sodium inosvika 60 kusvika 90 mmol/L mukati megut lumen.

• Chii chinoitika kana murwere weileostomy akanwa mvura yakachena, tii isina simba, kofi, soda yekudya, kana zvinwiwa zvemitambo yekutengesa: Mvura isina mvura ine 0 mmol/L yesodium, uye zvinwiwa zvemitambo (seGatorade kana Powerade) zvinongova ne18 kusvika 20 mmol/L yesodium pamwe chete neshuga yakawanda. Kana iyi mvura yakaderera-sodium ichipinda mujejunum, sodium inokurumidza kupararira kubva muropa remurwere ichipinda mugut lumen kuti ienzane neosmotic gradient, uye huwandu hwemvura pamwe chete nesodium yemuviri yakanyunguduka inodururwa yakananga mubhegi reileostomy maminitsi makumi maviri gare gare. Nyota iyo murwere anowana uye iyo yakawanda yakajeka mvura yavanochera, iyo inokurumidza kupera mvura (**secretory net net fluid kurasikirwa **).
• Chii chinoitika kana vakanwa muto wemichero unotapira, soda yenguva dzose, kana mvura inodzungudza zvinovaka muviri: Hyperosmolar shuga inodhonza mavhoriyamu makuru emvura kubva muropa kupinda mubowel lumen ne osmosis (osmotic diarrhea), yakapetwa kaviri kubuda kwe stoma mukati meawa.

Masanganisirwo eSt. Mark's Solution kana WHO Oral Rehydration Solution kumba¶

Kudzoreredza yakakwira-yakabuda ileostomy fluid kurasikirwa kumba, nhungamiro kubva kuBritish Society of Gastroenterology (BSG), ESPEN, uye St. Mark's Hospital Intestinal Failure Unit inotsanangura kurambidza plain hypotonic fluids (plain water, tea, coffee) kusvika pasi pe500 kusvika 1,000 mL/zuva uye kutsiva rehydrrolyte Ossolution. (75 kusvika 90 mmol/L sodium)**:

1. Commercial WHO Reduced-Osmolarity Oral Rehydration Salts: Sanganisa imwe chiyero WHO ORS packet (kana masaga maviri eDioralyte double-simba sekurairwa nechikwata che stoma, kana CeraLyte 70/90, DripDrop, kana Pedialyte Sport) muhuwandu chaihwo hwakatarwa hwemvura yakachena 1 litre 3.
2. St. Mark's Electrolyte Mix (Chipatara Chepamutemo Formula ye1 Lita [4.2 US Mikombe] yeMvura):
3. Maspuni matanhatu emazinga (20 magiramu) ehupfu hweglucose (kana 6 nhanho yeshuga yepatafura kana shuga yakachena/dextrose poda isingawanikwe, kunyangwe hupfu hweglucose hunodiwa kuti uwedzere osmolarity)
4. 1 level teaspoon (3.5 gramu) yetable salt (sodium chloride)
5. ** ½ level teaspoon (2.5 gramu) yesoda yekubikira (sodium bicarbonate) ** (kana trisodium citrate)
6. Nyura zvachose mu **1 litre (1,000 mL) yemvura inotonhora **. Sip zvishoma nezvishoma mukati mezuva rose (kuipisa kana kuwedzera diki diki-isina shuga lemon / lime inonhuhwirira inoita kuti munyu uwedzere kuve nyore kushivirira).
7. Kuparadzana kwakasimba uye zvinwiwa pakudya: Usanwa zvinwiwa maminitsi makumi matatu zvisati zvaitika, panguva, kana maminitsi makumi matatu mushure mekudya chikafu chakaomarara, saka chikafu chakasimba chinofamba zvishoma nezvishoma nemudumbu mudiki. Idya chikafu chine starch chinosunga chinokora ichoostomy kubuda: mupunga chena, pasta isina munyu, mbatatisi yakabikwa, chingwa chichena, mabhanana, bhotoro renzungu rakatsetseka, applesauce, uye marshmallows.

Acute stoma blockage (chikafu bolus kana mechanical obstruction)¶

Nekuti iyo ileostomy inopfuura nepaburi rakamanikana mudumbu mhasuru yemadziro, fibrous, chikafu chisina kutsengwa (popcorn, howa, celery tambo, kokonati, michero yakaomeswa, nzungu, kana citrus pith) inogona kusangana pamwechete kuita plug yakasimba kuseri kwe abdominal fascia (** chikafu bolus obstruction**). Adhesions, kumonyoroka (volvulus), kana parastomal hernia inogonawo kutsenga ura mukati.

Kuziva chikamu vs. kuvharika kwe stoma¶

• Partial stoma blockage: Dumbu rinomira kupfuura rakakora gobvu robuda rinonhuwa, mvura ine mvura pasi pekumanikidzwa pamwe chete neruzha rukuru, kugwamba kwedumbu, uye kuzvimba, edematous stoma dome.
• ** Yakazara stoma blockage: ** ** Zero stool uye zero gasi ** pinda muhomwe kwe ** 4 kusvika 6 maawa mu ileostomy ** (kana 24 kusvika 48 maawa nekurwadziwa mucolostomy). Dumbu rinorembera, masaisai ekurwadziwa kukuru kwechikosoro anorova maminetsi mashoma ega ega, stoma inozvimba, uye murwere anotanga kurutsa mvura yegirini ine nyuchi kana yakasvibira.

Matanho epamba akachengeteka echikafu-bolus plug (kana murwere ASIRI kurutsa)¶

1. **Bvisa wafer yazvino woisa homwe ine kuvhura hombe ** kuti igadzikane kuzvimba kwe stoma.
2. Rega kudya chikafu chakaoma chese nekukasika. Kana murwereasiri kurutsa, anogona kusveta oral rehydration solution. Kana uchisvotwa kana kurutsa, zvichengete pasina nemuromo (NPO).
3. Nyora mubhavhu rinodziya kwemaminetsi gumi nemashanu kusvika makumi maviri kana isa pedhi inodziya nepakati pedumbu kuti umbodzikamisa tsandanyama dzemudumbu.
4. Ita mabvi kusvika kuchipfuva uye zvinyoro nyoro peristomal massage: Rara nedivi wakadhonzwa mabvi akananga kuchipfuva, kana dombo zvinyoro nyoro pamaoko nemabvi uku uchipuruzira dumbu uchitenderedza stoma kuti ubudise plug yechikafu kuseri kwefascia.
5. Usambotora mushonga wemukanwa pakuvharika kweileostomy. Malaxative anoita kuti pave nechisimba peristalsis paplug yakavharwa, zvichiita kuti ura hubude uye kupera simba kwemvura.
6. Enda kudhipatimendi rinoona nezvechimbichimbi kana zvabuda zvikasazotangazve mukati memaawa mana kusvika matanhatu kana kurutsa kukatanga. Vanachiremba vachaongorora zvinyoro-nyoro zvedigital stoma voisa yakazorwa 14-French kana 16-French red-rabha catheter masendimita mashoma mu stoma kudiridza bolus yechikafu nesaline inodziya yakajairika.

Parastomal hernia strangulation, kubuda ropa kwakasiyana, uye mucocutaneous separation¶

Parastomal hernia incarceration vs. reducible bulge¶

Kusvika 30 kusvika 50 muzana yevarwere vane ostomy vanopedzisira vaita **parastomal hernia **, bulge pasi peganda pedyo ne stoma apo imwe loop yeura inosunda padivi pe stoma kuburikidza nekuvhurwa kwemhasuru.

• Bamba risingabude rinodzikisika: Bulge racho rinobuda kana wakamira kana kukosora, rinonzwa rakapfava uye risingarwadzi, rinoita flat kana wakarara, uye stoma inoramba iri pink ine zvinobuda zvakajairika.
• Kudzipwa/kuvharirwa parastomal hernia (Kuvhiyiwa Emergency): Buru riri padivi pe stoma rinova dombo-rakaoma, rakaomarara, rakapfava, uye harigone kutsetseka kana wakarara; ganda pamusoro pebulge rinoshanduka tsvuku kana purplish; iyo stoma inoshandura dusky yepepuru kana kumira kuburitsa zvinobuda; uye murwere anotanga kurwadziwa kwakanyanya mudumbu uye kurutsa. Bvisa wafer nekukasika, rara pasi, usasundire bundu rinorwadza mukati, uye fonera emergency emergency.

Kubuda ropa mudumbu: mucosal friction vs. portal-hypertension parastomal varices¶

• Minor mucosal inoyerera: Kupukuta zvine simba panguva yekuchinja bhegi kana kuti twuma wafer mupendero uchikwesha stoma kunowanzokonzera ropa rakatsvuka rakajeka pa gauze. Kudzvanya inotonhorera, yakanyorova gauze pad zvinyoro nyoro pakatarisana nenzvimbo kwemaminetsi maviri kusvika matatu kunomisa zvachose.
• Parastomal variceal hemorrhage (Hupenyu-Kutyisidzira): Muvarwere vane chiropa cirrhosis kana portal hypertension, high-pressure portal veins inoumba mhete yevaricose tsinga dzakapinda ipapo apo stoma inosangana neganda remudumbu (**caput medusae **, rinowanzo onekwa sebluish purush pa- ganda). Misiyano iyi inogona kubvaruka yega uye kupomba **mazana emamililita eropa rakasviba kana rakajeka rakatsvuka muhomwe ye ostomy mukati memaminitsi **, zvichitungamira kuhemorrhagic shock.
• Kurumidza rubatsiro rwekutanga: Bvuura homwe, tsvaga panokwirira pamuganhu weganda-stoma, wodzvanya kamwe chete yakapetwa sterile gauze pad (kana gauze yakanyoroveswa ne over-the-counter oxymetazoline 0.05% nasal spray) zvakananga uye zvakasimba painobuda ropa nemunwe mumwe 19/19/19 Chengetedza murwere akafuratira nemakumbo akasimudzwa (ona esophageal varices uye cirrhosis kubuda ropa)

Mucocutaneous separation uye stoma retraction¶

Mumavhiki maviri kusvika mana ekutanga mushure mekuvhiyiwa, mitsara inobata mupendero we stoma kune ganda redumbu rinogona kukwevera kure (** mucocutaneous separation ), kana stoma inogona kunyura pasi peganda ( retraction **).

• Musiyano wengozi: Kuparadzana kusina kudzika kubva pamusoro peganda kunotungamirirwa nana mukoti weWOC achishandisa absorptive calcium alginate kana hydrofiber powder. Zvisinei, kana stoma ** ikadzikama zvakapoteredza 360 madhigirii uye inodonha pasi pasi pemuscular fascia mu peritoneal cavity , chituru chinodururira zvakananga mudumbu ( peritonitis **). Kana ukaona gomba rakadzika risina chinhu rine marwadzo akanyanya emudumbu uye fivha, fonera amburenzi nekukurumidza.

Nhamba dzenharaunda dzechimbichimbi uye zvirongwa zveagency¶

• United States neCanada: Fonera 911 kune dema/pepuru stoma ischemia, musungwa parastomal hernia, kubuda ropa kukuru, kana kupera simba zvakanyanya mumuviri nesyncope. The Wound, Ostomy, and Continence Nurses Society (WOCN) uye American Society of Colon uye Rectal Surgeons (ASCRS) inotsigira kubviswa nekukurumidza kwezvimedu zvinomanikidza, supine osmotic kuderedzwa negranulated sucrose yezvinogona kuputika stomas, uye oral rehydration therapy kune yakakwira-output ileostomi.
• United Kingdom: Fonera 999 kuti uwane acute peritonitis, necrotic stoma, kana kuvhunduka kwakanyanya, kana kufonera 111 / wako NHS Stoma Care Nurse Nyanzvi yekukurumidzira kuchipatara kwezuva rimwe chete kubhejera kana kubuda kwakanyanya. British Society of Gastroenterology (BSG) uye St. Mark's Hospital nhungamiro inogadzirisa St. Mark's electrolyte solution uye hypotonic fluid restriction ye-high-output stomas.
• ** European Union: ** Fonera ** 112 **. European Society for Clinical Nutrition and Metabolism (ESPEN) uye European Crohn's and Colitis Organisation (ECCO) nhungamiro inotungamira yekutanga isotonic/high-sodium ORS (90 mmol/L sodium), loperamide/antisecretory titration iri pasi pekutariswa nachiremba, uye nekukasika kuvhiya ongororo yeischemic kana yakavharika stomas.
• Australia neNew Zealand: Fonera 000 muAustralia kana 111 muNew Zealand. Mapuroteni eAustralian Association of Stomal Therapy Nurses (AASTN) anosimbisa kukurumidza kuwedzera kwemudziyo kune edematous/prolapsed stomas uye nekukasira intravenous rehydration kune yakakwira-output ileostomy ine oliguria.
• India neAsia-Pacific: Fonera 112 muIndia, 995 muSingapore, 119 muJapan neSouth Korea, kana 999 muMalaysia neHong Kong. Ona yedu yakazara runyorwa rwe nhamba dzepasi rose dze emergency.

Mibvunzo inowanzo bvunzwa¶

Sei kudira yakajairika tafura chena shuga pane inoputika stoma inoita kuti iderere?¶

Iyo inobuda pamusoro pe stoma ndiyo yemukati mucous membrane yeura, iyo inoita semipermeable barriers. Kana stoma ichibuda kubva mudumbu, kudhumhana kwetsinga kunoteya mvura yakawandisa mukati mematishu, zvichiita kuti zvinyanye kuzvimba kuti zvitsvedzeke nekuvhura tsandanyama. Kupfekedza mucosa yakanyorova neyakaoma granulated sucrose crystals inogadzira ine simba hypertonic osmotic gradient inokurumidza kukwevera mvura yakavharirwa kunze kwemukati memukati yakazvimba ichipinda mushuga, ichibvisa matishu mukati me15 kusvika 20 maminetsi kuitira kuti ikwanise kutsvedza zvakanaka ichidzokera mukati yakarara yakati sandara.

Sei mumwe munhu ane ileostomy asingakwanisi kunwa mvura yakawanda yakajeka apo bhegi ravo riri kuzadza nemvura inobuda?¶

Kusiyana nekoroni ine utano, ura hudiki hwepamusoro haugoni kusveta mvura iri yoga; masero ayo anoda huwandu hwe sodium (60 kusvika 90 millimoles per litre) pamwe chete nehuwandu hweglucose kukwevera mvura pamadziro emukati muropa. Kana murwere we ileostomy akanwa mvura yakachena, tii, kana zvinwiwa zvemitambo yakaderera-sodium, sodium inodonha kubva muropa ravo ichipinda mudumbu kuti ienzanise munyu, ichinyungudusa mvura yavanenge vangonwa uye munyu wemuviri wavo wakananga muhomwe ye ostomy uye kuwedzera kupera simba.

Ndingaziva sei mutsauko pakati pebeetroot yakajairwa / tsvina yechikafu neropa chairo kana stoma iri kufa?¶

Kudya bhiti tsvuku, gelatin tsvuku, dhayi tsvuku yechikafu, licorice, kana mahwendefa esimbi anowanzo shandura chituru kana mvura mukati mehomwe ye ostomy inopenya mutsvuku kana dema, izvo zvinogona kutaridzika zvinotyisa. Zvisinei, zvokudya nesimbi zvinongopenda zvinobuda mukati mehomwe; havambochinji ruvara rwenyama ye stoma mhenyu pachayo. Zvinyoro pukuta pamusoro pe stoma bud nematishu akanyorova: stoma ine hutano icharamba ichiratidzika kupenya kwepingi-tsvuku, kunyorova, uye kudziya, nepo ischemic stoma ichange iine rima repepuru, shava, kana matishu matema mukati memadziro emukati chaimo.

Sei mapiritsi emishonga dzimwe nguva achibuda akazara mukati mehomwe ileostomy, uye mapiritsi api ane ngozi?¶

Nokuti ileostomy inobvisa kana kudarika ura hwose uye inopfupisa nguva yekufamba-famba, kuwedzera-kusunungurwa (ER, XR, SR, XL) uye mahwendefa ane enteric-akavharidzirwa anowanzopfuura akananga muhomwe ye ostomy isina kunyungudika zvachose, zvichiita kuti mishonga ine ngozi irege kubvisa kana kukundikana kurapwa. Usambotora mapiritsi akareba-akabudiswa kana enteric-akavharidzirwa ne ileostomy kunze kwekunge akanyatsocheneswa nemushonga wemishonga (kumbira mahwendefa, zvinwiwa, kana zvigamba zvinokurumidza kuburitswa), uye usambotora mishonga yemuromo, iyo inogona kukonzeresa kuparara kwe electrolyte.

Zvakajairika here kuti stoma itsva ichinje saizi mukati memwedzi miviri yekutanga mushure mekuvhiyiwa?¶

Ehe. Pakarepo mushure mekuvhiyiwa, stoma yega yega inozvimba kubva pakuvhiyiwa uye zvishoma nezvishoma inoderera muhupamhi pamusoro pemavhiki matanhatu kusvika masere ekutanga kusvika yasvika pakukura kwayo kwekusingaperi. Mumwedzi miviri yekutanga iyoyo, unofanira kuyera dhayamita ye stoma negwara rekuyeresa pakuchinja kwega kwega kwechifukidziro kuitira kuti kuvhurika kusava kwakakura zvakanyanya (izvo zvinofumura ganda re peristomal kune corrosive digestive enzymes) kana kuomesa zvakanyanya (izvo zvinogona kudzipa stoma kana ikazvimba kwenguva pfupi).

Nzvimbo uye nhungamiro yepamutemo¶

• ** Maronda, Ostomy, uye Continence Nurses Society (WOCN, United States):** WOCN Society Clinical Guideline: Kutungamirirwa Kwemurwere Mukuru NeFecal kana Urinary Ostomy (Triage ye stoma ischemia, mucocutaneous separation, prolapse, uye peristomal varices).
• American Society of Colon and Rectal Surgeons (ASCRS, United States): Clinical Practice Guidelines for Ostomy Surgery (Kuongorora kwepamusoro-soro vs. sub-fascial stomal necrosis, parastomal hernia strangulation, uye stomal obstruction).
• British Society of Gastroenterology (BSG) & St. Mark's Hospital Intestinal Failure Unit (United Kingdom): Nhungamiro Yekutungamirira Varwere vane Ura Hupfupi uye High-Output Stoma (Nightingale J et al., Gut: jejunal sodium-glucose cotransport physiology, hypotonic solution uye Stronic solution Marks).
• **European Society for Clinical Nutrition uye Metabolism (ESPEN, Europe): ** *ESPEN Nhungamiro pamusoro peClinical Nutrition muAcute uye Chronic Intestinal Failure * (High-output ileostomy fluid uye magnesium / potassium resuscitation protocols).
• Myers JO & Rothenberger DA / Desai DC ( Zvirwere zveColon & Rectum / American Journal of Surgery):** Osmotic Kuderedzwa kweEdematous Prolapsed Stomas Kushandisa Topical Granulated Sucrose.

Mazano anoenderana¶

• Kuvharika kwemaura, kudzipwa hernia, uye volvulus zviratidzo zvechimbichimbi
• Acute mesenteric ischemia, bowel infarction, uye postprandial abdominal njodzi.
• Chikafu chepfu, acute gastroenteritis, uye kupera mvura mumuviri
• Esophageal varices kuputika, cirrhosis kubuda ropa, uye hepatic encephalopathy
• Kubviswa kwedumbu uye maronda emudumbu akavhurika