Colostomy in Newborns Self-Administered Readiness Test

This quiz is separated into three parts: Pre-Operative Preparation, Intra-Operative Preparation, & Post-Operative Protocol.

Pre-Operative Preparation

1 Which of these is not a necessary resuscitative measure in a neonate requiring emergency colostomy:

	Low pressure suctioning of the mouth and oropharynx
	Respiratory support with supplemental oxygen
	Placement of gauze soaked with glucose water in the mouth to prevent hypoglycaemia
	Monitoring of vital signs

2 Late markers of shock in a neonate include;

	Tachycardia
	Hypotension
	Poor urine output
	Reduced cry

3 In fluid resuscitation, for a neonate with intestinal obstruction, urine output should be at least:

	0.5ml/kg/hr
	1ml/kg/hr
	2ml/kg/hr
	4ml/kg/hr

4 For a neonate with intestinal obstruction, adequate nasogastric decompression can be attained with the following size of nasogastric tube:

	4F
	5F
	8F
	14F

5 During resuscitation of a neonate with intestinal obstruction, the following electrolyte values represent appropriate daily maintenance values:

	3-5mmol/kg sodium
	2-5 mmol/kg potassium
	2-3 mmol/kg calcium
	0.5-1mmol/kg chloride

6 Intravenous fluids should be carefully delivered to the surgical neonate using a 1 litre drip bag to ensure adequate hydration.

	True
	False

7 In a neonate with intestinal obstruction, nasogastric decompression is necessary to improve respiration and reduce the risk of aspiration.

	True
	False

8 Intraosseous access can be placed on the distal 1/3of the tibia or proximal 1/3 of the femur.

	True
	False

9 Hypoglycaemia in the surgical neonate can be quickly corrected using 4ml/kg of 50% dextrose water.

	True
	False

10 Pre-operative preparation of a neonate requiring emergency colostomy is best completed within 48 hours of presentation.

	True
	False

Intra-Operative Preparation

1 Appropriate anaesthesia for a neonate requiring a colostomy is:

	Regional anaesthesia.
	Local anaesthesia to reduce the systemic exposure of a neonate to anaesthetic agents.
	Spinal anaesthesia with airway management and close monitoring.
	General anaesthesia with endotracheal intubation.

2 Which is most suitable for a divided sigmoid colostomy in a neonate:

	Transverse 8cm incision in the right upper quadrant.
	Transverse 4cm incision on the left lower quadrant.
	Oblique 8cm incision on the right upper quadrant.
	Oblique 4cm incision on the left lower quadrant.

3 During colostomy, the peritoneum should be:

	Nicked with McIndoe scissors before extending the incision to ensure no bowel has been picked.
	Should be picked with forceps and squeezed between the fingers.
	It is impossible to pick the peritoneum of a new-born as it is too flimsy
	Access into the peritoneal cavity should be rapid with a single deep incision to minimise blood loss.

4 The sigmoid colon is best identified by:

	Presence of omentum on the anti-mesenteric border of a freely attached bowel in the pelvis.
	Its attachment to the descending colon.
	Presence of taenia and marginal artery with absence of omentum.
	Distended bowel loop located within the pelvis.

5 Which of these is true?

	A sigmoid colostomy is best sited proximally close to its junction with the descending colon.
	Siting a sigmoid colostomy proximally makes mobilization difficult and may result in stoma retraction.
	Bowel decompression should be done through a stab incision on the anti-mesenteric border of the sigmoid colon through which faeces is milked.
	Once the marginal artery is identified in the mesentery, it should be ligated for adequate vascular control.

6 Keeping bowel moist is unadvisable as it increases the risk of hypothermia.

	True
	False

7 Division of the bowel loop is best be done after closure of the fascia.

	True
	False

8 Only small sized non-absorbable suture on round-body needles such as Vicryl 4/0 should be used for colostomy in newborns.

	True
	False

9 Fascial anchorage of both the proximal and distal limbs of the bowel reduces the risk of bowel ischemia.

	True
	False

10 Anchorage of bowel to the fascia should be done by placing full-thickness stitches at several points along the circumference of the bowel.

	True
	False

Post-Operative Protocol

1 Which of these is not a complication of colostomy in neonates?

	Para-stoma hernia
	Sepsis
	Retraction
	Necrosis

2 Nasogastric decompression in the post-operative period does not serve one of the following functions:

	Prevent vomiting.
	Assess bowel function.
	Timing for commencement of feeding.
	Determine fluid and caloric needs.

3 Adequate post-operative analgesia:

	IV paracetamol 10mg/kg /dose.
	IV ketorolac 2mg /kg/dose.
	IV paracetamol and oral ketorolac.
	Topical analgesia is safe and adequate considering the age.

4 Post-operative IVF:

	120% maintenance to recover intra-op losses.
	Maintenance only with replacement of daily deficits.
	Reviewed once vomiting occurs.
	Prepared every 48 hours.

5 Post-operative hematologic and biochemical parameters:

	Reviewed 48 hours post-op and deficits corrected.
	Moderate anaemia can be corrected with oral haematinics.
	Hypokalaemia may result in ileus and delay oral feeding.
	Sepsis may cause hypercalcemia.

6 Frequent inspection of stoma for bleeding, and prolapse in the immediate post-op period.

	True
	False

7 Soft absorbent cotton napkins may suffix in place of stoma bags for colostomy dressing.

	True
	False

8 Dressing over the stoma should be initially moist, non-adherent and loose for ease of stoma inspection.

	True
	False

9 Using an antibiotic cream for Peristomal skin barrier reduces the risk of SSI as well as skin excoriation.

	True
	False

10 Postoperative antibiotics should be continued for five days as risk of wound infection is high.

	True
	False