Stoma examination – OSCE Guide

Alongside a good abdominal examination it’s important to remember that

many patients you encounter in hospital may already have abdominal pathology.
Stomas are common things to come across and examination can be a skill
frequently assessed in OSCEs. I know that my gut reaction (no pun intended) upon
seeing stomas on examining a patients abdomen was usually to leave it well alone,
but once you know what you’re doing this can be a simple (and actually very
important) examination to have in your arsenal. If you aren’t really sure what a
stoma is, a good place to start is with our summary of the different stoma types.

First of all, stomas are tougher than they look! A gentle examination of a
patients stoma isn’t going to cause the bag to fall off or cause the patient any pain
or discomfort; if these bags have to stay in place and not leak as the patient goes
about their daily routine they are going to be able to withstand some gentle
movement by medical students and in all honestly you won’t have to touch it that
much anyway.

Introduction

Introduce yourself to the patient

Explain procedure and obtain consent

Wash hands

Expose patient adequately

Position patient supine at a 45 degree angle

Ask patient:
“Do you have any pain in your tummy”

“Have you had any problems with your stoma”

‫ جامعي أمحد لطيف اخلاقاني‬. ‫م‬

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Inspection

Site
LIF: Colostomy

RIF: Ileostomy or urostomy

Number of lumens
1 and in RIF: End ileostomy or urostomy

1 and in LIF: End colostomy

2 joined and in RIF: Loop ileostomy

2 joined and in LIF: Loop colostomy

Spout
Spout present:

 Ileostomy (contents toxic to skin)

 Urostomy
No spout: Colostomy

Effluent (what’s coming out)

Hard stool – Colostomy

Soft stool – Ileostomy

Urine – Urostomy

Remember to feel the bag!

Surrounding skin quality

Any inflammation or excoriations? – infection / poor stoma maintenance

‫ جامعي أمحد لطيف اخلاقاني‬. ‫م‬

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Any evidence of complications?
Haemorrhage – Peristomal skin inflammation

Parastomal hernia – Risk of bowel strangulation & necrosis

Prolapse – High output

Retraction – Obstruction

Auscultation

Listen below the umbilicus

Can bowel sounds be heard?

High pitched tinkling indicates obstruction.

To complete the examination…

Wash hands

Thank patient

Summarise findings
“Some Naughty Surgeons Never Stay in the Evenings and Like Porches”

 Site
 Number of lumens
 Spout
 Nature of effluent
 State of surrounding skin
 Evidence of complication
 Likely type of stoma
 Possible pathology/procedure

‫ جامعي أمحد لطيف اخلاقاني‬. ‫م‬

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