Makindo Medical Notes"One small step for man, one large step for Makindo" |
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| Feature | Ileostomy | Colostomy |
|---|---|---|
| Typical site | Right lower quadrant | Left lower quadrant (sigmoid/descending) |
| Stoma appearance | Spouted, protrudes 2–3 cm to protect skin | Flush or slightly protruding |
| Effluent character | Liquid to paste; enzyme-rich; corrosive | Formed to semi-formed; less irritating |
| Volume / frequency | High output (600–1200 mL/day typical; may be >1.5 L) | Lower output (200–600 mL/day), 1–3 empties/day |
| Fluid & electrolyte risk | ↑ Dehydration, hyponatraemia, hypomagnesaemia | Lower risk; near-normal fluid balance |
| Odour | Milder odour | More noticeable odour |
| Diet advice (general) | Extra salt/ORS; chew well; caution with high-fibre/“stringy” foods initially | Balanced diet; fewer restrictions once settled |
| Appliance | Drainable pouch (emptied multiple times/day) | Closed or drainable pouch; often single-use changes |
| Irrigation suitability | ❌ Not suitable | ✅ Possible with left-sided (sigmoid) colostomies |
| Medication issues | ⚠️ Poor absorption of MR/EC formulations; prefer immediate-release / liquids (avoid sorbitol if high output) | Near-normal absorption; still review MR/EC if stool transit is rapid |
| Skin complications | Peristomal dermatitis common (enzyme irritation) | Less common; leakage still causes dermatitis |
| Common indications | IBD, familial polyposis, subtotal colectomy, diversion | Cancer, diverticular disease, obstruction, trauma |
| Loop vs end | Loop often temporary (defunctioning); end after colectomy | Loop (temporary diversion) or end (Hartmann’s) |
| Long-term risks | High-output stoma, renal stones, gallstones, B12 deficiency if ileal resection | Parastomal hernia, constipation, prolapse |
🧠Teaching tip: ileostomies lose sodium-rich fluid; advise ORS (e.g., St Mark’s solution) over plain water in high-output states, and review MR/EC medications to avoid “ghost tablets”.