Stoma OSCE Examination Quiz

• A A bulge beside the stoma that appears or grows when the patient coughs and settles when they relax ✓
• B Persistent bleeding from the stoma or its skin junction after minor contact
• C A visible gap or wound where the stoma meets the surrounding skin
• D The stoma sinking below the surrounding skin, making it hard to seal the appliance
• E An unusually long segment of bowel protruding through the stoma that worsens on standing

Explanation

Why A is correct

See Inspecting the Output (Effluent). Option A is correct. A parastomal hernia is a hernia (a bulge of abdominal contents through a weak point in the abdominal wall) that forms beside a stoma. The hole made in the abdominal wall to bring the bowel out is a weak point, and over time abdominal contents can push through it. Anything that raises the pressure inside the abdomen makes it more obvious, so ask the patient to cough or lift their head and look and feel beside the stoma for a bulge that appears or enlarges and settles when they relax. Risk factors include obesity and a larger defect in the abdominal wall. Memory aid: a hernia is a bulge that shows when you cough, and for the stoma it sits beside the bag.

• Parastomal hernia: a bulge of abdominal contents through a weak point beside the stoma.
• Bedside test: ask the patient to cough or lift their head and look for a bulge beside the stoma.
• Risk factors: obesity and a larger defect in the abdominal wall.

Why the other options are incorrect

• B. Persistent bleeding from the stoma or its skin junction after minor contact: Persistent bleeding after minor touch describes a bleeding problem at the stoma, not a hernia. It needs its own assessment.
• C. A visible gap or wound where the stoma meets the surrounding skin: This describes mucocutaneous separation, a breakdown at the join of stoma and skin. It is a wound problem, not a hernia.
• D. The stoma sinking below the surrounding skin, making it hard to seal the appliance: This describes stoma retraction, where the stoma is drawn in below skin level. It makes the bag leak but it is not a bulge in the abdominal wall.
• E. An unusually long segment of bowel protruding through the stoma that worsens on standing: This describes stoma prolapse, in which a long length of bowel telescopes out through the stoma. It involves the stoma itself and not a bulge beside it.

Easy

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