Familial GI Cancers Unit

IBD Resources

IBD Resources

Orientation for new IBD patients visiting Mount Sinai Hospital

Welcome to the Inflammatory Bowel Disease Centre at Mount Sinai Hospital. Here you will find an online resource tool explaining what to expect on your first visit to Mount Sinai Hospital.  For further inoformation or questions, please contact our Clinical Nurse Specialist, Jane Burns at 416-586-4800 ext 7820.

Potential Problems Following IBD Surgeries

With any type of bowel surgery, there are always risks. The following are potential problems following surgeries.

Bowel Blockage

Bowel blockage or stoppage of the bowel can happen following surgery. The signs of a bowel blockage would include no stool or gas being passed, abdominal distention or fullness, nausea and vomiting. Treatment is most often conservative. Time, nothing by mouth, intravenous fluid and walking are all important measures that can help to alleviate the blockage. Blockage can occur later in the recovery process and treatment would essentially be the same. The important thing to remember following surgery is early and frequent movement.

Infections

Bladder and wound infections may occur. Antibiotics given before and during surgery greatly reduce these risks.

Blood clots

Blood clots are relatively rare. Heparin or blood thinner is given by injection twice a day until discharge to minimize this occurrence. Early movement is the key to avoid clots.

Chest Infection

Chest infection or pneumonia is also considered a potential problem. Deep breathing and coughing exercises are encouraged, as well as early movement to prevent this problem.

Leaks

Leaks at the anastamosis (join) of the pelvic pouch to the anus can occur but are not common. The anastamosis is protected with either a loop ileostomy or rectal tube depending on the surgical scenario. If the loop ileostomy is present, a pouchogram or X-ray of the internal pouch is done prior to the ileostomy closure to ensure that healing has occurred and no leak exists.

Impotency

Impotency or inability to achieve an erection can occur. The small microscopic nerves that surround the rectum can not always be identified when the rectum is removed. This may lead to impotence in an extremely small percentage of patients. In the pelvic pouch operation, the risk is one to two per cent. The risk of impotency is somewhat higher in cancer surgeries involving the rectum. Ejaculation problems can occur in approximately three to four per cent of those males that are operated for ulcerative colitis.

Rectal Stump

When the rectum is left in place, as is the case with a subtotal colectomy, there is always the risk of disease becoming active within the "rectal stump". Signs of disease activity includes: increased bloody drainage, vague low abdominal pain or cramps and a general unwell feeling. Treatment includes steroid suppositories or enemas. This problem is overcome when the rectum is actually removed by either doing a complete protectomy with a permanent ileostomy or a reconstructive procedure in the form of the Pelvic Pouch.

Preparing for Your Surgery

The following provides information about the events leading up to your operation as well as what to expect during your stay at Mount Sinai Hospital.

Pre-Admission Department

Prior to your surgery, your surgeon's secretary will call you with an appointment to attend the Pre-Admission Unit. The pre-admission visit could take up to four hours to complete.

Please make sure you bring your health card (OHIP card), all of your present medications, a list of previous/present illnesses or surgeries, and any other documents that your doctor has given you. If you do not have a Mount Sinai Hospital card, you will need to get one just before your appointment. Please go to the Admitting Department near the Murray Street entrance of the Hospital for your card.

The purpose of the pre-admission visit is to collect all of your medical and nursing information so that we can provide you with the best possible care during your stay with us. You will meet with a registered nurse, a member of your surgical team, and members of the multidisciplinary team that will look after you before, during and after your surgery.

The registered nurse will take a nursing history and provide you with information about your surgery and what to expect before, during and after your operation. The nurse will take a blood sample and arrange for any other tests that your doctor may have requested. The nurse will give you instructions on how to prepare your bowel and the diet you must follow the day before your surgery. You will also receive information about the day of surgery including the time and place.

A member of the surgical team (your surgeon works with a team of doctors - all in various phases of their education) will take a medical history and complete a medical exam. You will be asked information about your past/present medical problems, previous surgeries, medication history, and family medical history.

You will also have an opportunity to meet members of the interdisciplinary team who will look after you before, during and after your hospital stay. The team consists of:

  • Nursing
  • Enterostomal Therapy
  • Social Work
  • Occupational Therapy
  • Physiotherapy
  • Nutrition
  • Pain Service
  • Pharmacy
  • Psychiatry
  • Chaplainc

 

The pre-admission nurse will consult with any of the team members depending upon your needs and requests. If your surgery involves an ostomy, you will be seen by the Enterostomal Therapy Nurse (ET) who will provide you with support and education as well as mark the site for the ostomy. The involvement of the ET nurse will continue both during and following your hospital stay.

Stoma Site Marking

Ideally, an Enterostomal Therapy Nurse should see you prior to surgery so that an appropriate site can be found on your abdomen for the stoma. The following is considered when selecting the site for an ostomy:

  • within the rectus muscle: the rectus muscle runs longitudinally along either side of the abdomen; the stoma should be brought through this muscle in order to provide it with support
  • on a flat surface: the ideal pouching surface is flat, so obvious dips and creases on the skin surface are to be avoided
  • within the visual field: being able to see the stoma is crucial for self-care, so it should be placed where it can be seen easily (e.g. on top of a large abdominal fold rather than underneath)
  • away from belt lines: belts/waist-bands should not be directly on top of a stoma, as these can damage the stoma without your awareness. The stoma should be above or below the belt-line.
  • in women, placement below the belt-line is usually easily achieved as skirts and pants tend to be worn high, along the natural waist-line. In men, placement below the belt-line is often problematic, if not impossible as pants are worn significantly lower. Unless adjustments are made to the height at which pants are worn, placement of the stoma often ends up being above the belt-line in men.

The Day of Surgery

At the scheduled time and day of your operation, please go to the Admitting Department (near the Murray Street entrance of the Hospital). The clerk in the department will prepare the information for your chart, provide you with a hospital bracelet and assign you your unit and bed. From the Admitting Department you will go to your assigned unit.

Once on the unit, a registered nurse will greet you and settle you into your room. You will change into a hospital gown making sure all makeup, and nail polish is removed. Please leave all jewelry at home. Your nurse will take your vital signs, start an intravenous and administer any medication that your surgeon may have ordered. Shortly after, a hospital assistant will take you down to the operating room area on the 5th floor on a stretcher.

The Operating Room

You will have a short stay in the waiting area of the operating room where you will meet with your surgical nurse, surgeon and anaesthetist. They may ask you routine questions to clarify the information in your chart.

Once they move you into the operating room, you are settled on the operating table. The operating room is similar to how it is portrayed on any television medical show. The room is bright, somewhat cold and everyone with you in the room is gowned, gloved and masked. Once you are settled, the anaesthetist will quickly put you to sleep with medication in the intravenous.

The Recovery Room or Post Anaesthetic Care Unit (PACU)

Following your operation you will be moved to the PACU, which is on the same floor as the operating room. Your stay in this unit is generally half of the operating time. There will be a nurse at your side checking your vital signs and encouraging you to take deep breaths and move your arms and legs. The intent is to wake you up from the anaesthetic, encourage deep breathing to expand your lungs and promote arm and leg movement to facilitate blood circulation to prevent potential postoperative problems. You may or may not have memories of this stay. Once you are awake, you will be moved to the surgical unit.

The Surgical Unit
Recovery on the surgical unit will vary depending on the type of surgery you had and your rate of recovery. Generally speaking, bowel surgery involves a seven to 10 day hospital stay. The ultimate goal of your post-operative stay is to start the recovery process and regain your strength and energy to enable you to return home.

As much as possible, we try to have one nurse assigned to your care. It is important that you set goals with your nurse and health care team, and share any concerns or questions you may have so that we can provide you with the best possible care. Closer to discharge, the team will discuss plans for your return home and organize home care if is needed.

We encourage all of our patients to leave the hospital by 8:30 a.m. on the day of discharge. This allows us to prepare the room for the next patient. The surgical team will tell you in advance of the date that you will be sent home.

The health care team is happy to respond to questions or concerns from both you and your family. Your comments about your care are always encouraged and welcomed.

Helpful Hints

  • do not bring valuables to the Hospital
  • do bring a Walkman, reading material
  • do bring slippers, housecoat and toiletries
  • do encourage family/friends to visit - visiting hours
  • allow for four to six weeks for recovery following surgery
  • do not lift or do any strenuous activity for six weeks
  • a surgical waiting area (near the Murray Street entrance) is available for family/friends to wait during your surgery

 

Questions?

If you have any questions about this information or your surgery, please contact your surgeon's secretary.

Medical Management for IBD Patients

A comprehensive source for information on Inflammatory Bowel Disease for those living with the disease and their family and friends.

On this site you'll find information on the following topics:


Here is a look at experiences given by patients, nurses and physicians dealing with Ulcerative Colitis

Patient and Clinical Nurse Specialist living with Ulcerative Colitis   Dr. Mark Silverberg discusses living with Ulcerative Colitis

 

 


 

Crohn's and Colitis Diet Guide: Second Edition
crohnscolitisbook2nded

The Head of Mount Sinai's Division of  Gastroenterology, Dr. A. Hillary Steinhart together with Registered Dietitian Julie Cepo have published a second edition of this companion to Crohn's and Colitis.  This updated second edition, in a very informative and easy-to-understand manner, provides all the necessary guidelines regarding the specific foods that might cause problems, as well as delicious and nutritious recipes that can be enjoyed without compromising this difficult condition. Buy from Indigo now!

Crohn's and Colitis Diet Guide: Includes 150 Recipes
Crohn's and Colitis Diet Guide: Includes 150 Recipes
The Head of Mount Sinai's Division of  Gastroenterology, Dr. A. Hillary Steinhart together with Registered Dietitian Julie Cepo have published this companion to Crohn's and Colitis, offering reliable dietary advice and strategies to aid suffers of  inflammatory bowel disease combined with 150 appropriate recipes. Good nutrition is an important tool in symptom control. Buy from Indigo now!
Crohn's and Colitis: Understanding and Managing IBD (2012, 2nd ed.)
crohns undandmanbook2 The Head of Mount Sinai's Division of Gastroenterology, Dr. A. Hillary Steinhart, has published the second edition of this book to help patients better understand inflammatory bowel disease. It is available in book stores across Canada, including Indigospirit in the lobby of Mount Sinai Hospital. Buy from Indigo now!
Crohn's and Colitis: Understanding and Managing IBD (2006)
Crohn's and Colitis: Understanding and Managing IBD The Head of Mount Sinai's Division of Gastroenterology, Dr. A. Hillary  Steinhart, has published this book to help patients better understand inflammatory bowel disease. It is  available in book stores across Canada, including Indigo spirit in the lobby of Mount Sinai Hospital.
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