1196.

الشرح

Core Concept: Ostomy siting and gastrointestinal anatomy. An ileostomy is created from the terminal ileum of the small intestine, which is anatomically located in the right lower quadrant (RLQ) of the abdomen.

Clinical Presentation:

• N/A (Anatomy and Surgical scenario). The effluent is typically liquid to pasty and highly rich in digestive enzymes.

Diagnosis:

• First-line: Preoperative stoma marking by a Wound, Ostomy, and Continence (WOC) nurse, avoiding skin folds and bony prominences.
• Gold Standard: Postoperative clinical evaluation of stoma viability (should be beefy red, moist, and bleed slightly when touched).

Management:

• Acute: Apply a properly fitted, drainable ostomy appliance immediately to protect the peristomal skin from highly corrosive, enzyme-rich effluent.
• Long-term/Definitive: Patient education on pouch changes, strict hydration monitoring (high risk for fluid and electrolyte loss), and dietary modifications to manage output consistency.