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I can see a stoma at the right lumbar region, but i'm not sure whether it is from ileum or transverse colon. There is midline scar extended from xiphisternum to umbilicus. It may be recent scar because pink color and well healed. [ask patient to cough] There is no incisional hernia noted. There is a covered area by the gauze at the left iliac fossa region. ---------------------------------------------------------------------------
-----------------------------------------------------[open the gauze] examine it depends on what you see under the covered area. -----------------------------------------I have finished my examination -----------------------------------------Q : How do you evaluate functioning of stoma? 1. History : ask patient whether any content come out from stoma 2. PE : look for sign of intestinal obstruction such as distended abdomen 3. Per stoma examination : gangrene, intussusception, mass, external compression, etc.. 4. Contrast study : barium meal, barium enema (depend on site and situation) 5. Endoscopy through stoma : hartmann procedure, etc... Q : Type of stoma? 1. Single Lumen 2. Double lumen 3. Loop colostomy Q : Color of stoma? 1. Pink : Viable 2. Dusky / pale : ischemic 3. Blackish : gangrenous Q : What can coming out from stoma? 1. Affluent : fluid, faeces, blood, gas, pus, mucus, etc.. 2. Consistency : fluid, semisolid, solid Q : How do you determine severity of skin excoriation? 1. Erythema : more eryhthemaous, more severe 2. Amount : single < multiple (multiple : more severe) 3. Size / extension of excoriation : larger size, more severe 4. Distance from stoma : closer to stoma, more severe 5. Associated pus, discharge, blood : if presence, more severe