Biologic medications and Stomas

When does injectables get used in IBD?

When remission cannot be kept with oral immunosuppressants

What are the 4 biologic injecatable medications used for IBD and answer these questions?

What is a stoma?

Opening on the surface of the body that leads to a hollow organ (gut, bladder, trachea)

• Diverts faeces or urine to an external pouch to allow parts of the bowel to heal after inflammation/infection/treatment

• Can be permanent or reversible

What is ostomy surgery and the 2 types?

Surgically create an opening (stomach) in the abdominal wall for the elimination of dietary waste - maybe permanent or temporary.

• 6,400 each year in the UK

• Colostomy: from a section of the colon

• Ileostomy: from a section of the ileum

What are the reasons someone might needs a stoma following a ileostomy, colostomy or urostomy (ileal conduit)?

Colostomy

• Cancer of colon, rectum or anus

• Diverticulitis

• Crohn’s disease

• Bowel ischaemia

• Bowel incontinence

• Severe trauma

• Rectal prolapse

Ileostomy

• Bowel cancer (benign)

• Familial adenomatous polyposis

• Inflammatory bowel disease (UC and Crohn’s) - fistuli created

• Bowel obstruction

• Severe trauma or injury to colon

Urostomy

• Bladder cancer

What happens during an ileostomy?

• Opening of small intestines (ileum)

• Located RIF (right iliac fossa)

• Watery content (drainage 3-6 times a day)

• Protrudes 50mm (spout to drain faeces) - bag contents are brown

• End-ileostomy (temporary or permanent)

• Loop ileostomy

What happens during a colostomy?

• Opening from the colon

• Located LIF (not always)

• Solid, faecal content (depending on length of colon)

• Protrudes 10mm, more flushed to skin. Firm and well formed

• Descending, transverse or ascending - indicates where it is on the body

• End-colostomy (temporary or permanent)

• Loop colostomy

What happens during an urostomy?

• Also known as ileal conduit

• Bladder removed or bypassed

• Part of small bowel used as bladder

• Collects urine

• Very liquid content

What are the different types of ostomy bags?

Open/drainable - urostomy and illeostomy

• 1 and 2 piece systems available

• Easier to change

• Adhesive tape has to be cut off to fit a persons stoma

Closed - colostomy

What are the advantages of having surgery and getting a stoma?

• Improved quality of life

• Symptom relief

• Predicatability of bowel function

What are the challenges of having surgery and getting a stoma?

• Body image concerns

• Intimacy anxiety

• Leaks

• Skin irritation

• Cost and management

What counselling is done for patients with a stoma?

• Post surgery - swelling reduced, few days before output, liquid/loose at first. Ileostomy aiming <1L

• Good hydration

• Diet

• Ileostomy monitor

• Flatus (beans, peas, onions, fizzy drinks, sweeteners)

• Fibre content (peeling fruit and veg, bran, whole grain/seeds)

• Loose motion (spicy foods, alcohol) or constipation

• Complications around the stoma area (ulcers, dermatitis, bleeding); prolapse; blockages; pancaking

  • If there’s blocks - massage, light exercise

What medications do patients get after a stoma?

• Enteric coated or modified release medicines (ileostomy).

• Formulation (soluble, liquid, capsules) to improve absorption if required.

• Sorbitol content (laxative effect).

• Antacids: Mg, diarrhoea (ileostomy); Al, constipation (colostomy)

• Iron (ileostomy, diarrhoea; colostomy, constipation), sore skin if leaks, stool appear black

• Supplements: Ileostomy, vitamins (especially vitamin B 12)

Ileostomy: high output stoma

• Loperamide (and codeine) to reduce transit time

• St Marks solution

• Diuretics (and monitor electrolytes)

Colostomy: laxatives

• Bulk forming better than simulant. Stool softener can help

• Opioid can be constipating