EmDOCs - February 01, 2021 - By Jonathan Bornstein; Jennifer Liao; Marzena Sroczynski; Carlos Rodriguez. Reviewed by: Alex Koyfman; Brit Longnand Caitlyn Costanzo
“Pearls:- Ileostomies tend to be on the right side of the abdomen and have loose liquid stool; colostomies tend to be on the left side of the abdomen and have more formed stool; urostomies tend to be on the right side of the abdomen and produce urine.
- High output failure
- Be aware of this in the dehydrated patient with a new gastrointestinal ostomy who is putting out 1.5-2 L fluid/day.
- IV fluid resuscitation and electrolyte replacement are essential. Pay particular attention to signs of severe hyponatremia, hypokalemia, and hypomagnesemia.
- Consider adv anced imaging to assess for complications such as anastomotic leak, obstruction, or paralytic ileus.
- Stomal necrosis, incarcerated parastomal hernias, and internal reservoir ruptures are surgical emergencies – do not delay in resuscitating your patient and calling your surgical consultants early.
- Not all patients with urostomies and evidence of bacteriuria require antibiotics – it is common for their urine to be colonized with bacteria from the ileal conduit. Reserve antibiotics for patients with systemic signs of infection”