Colostomy — Complications

Complications — Colostomy

There are a number of possible problems you may experience after having a colostomy.

Rectal discharge

If you’ve had a colostomy but your rectum and anus are intact, you may have some mucus discharge from your bottom. Mucus is produced by the lining of the bowel to help the passage of stools.

The lining of the bowel continues producing mucus, even though it no longer serves any purpose. The longer the remaining section of your bowel, the more likely you are to have rectal discharge.

The mucus can vary, from a clear «egg white» to a sticky, glue-like consistency. It can either leak out of your bottom or build up into a ball, which can become uncomfortable.

Some people have rectal discharge every few weeks, while others have several episodes a day.

Contact your GP if there’s blood or pus in the discharge – it may be a sign of infection or tissue damage.

Managing the discharge

You may find it helps if you sit on the toilet every day and push down as if passing a stool. This should remove any mucus and stop it building into a ball.

But some people find this difficult because surgery can reduce the sensation in the rectum. Contact your GP if this is the case, as you may need further treatment.

Glycerine suppositories that you insert into your bottom can often help. When the capsules dissolve, they make the mucus more watery, so it’s easier to get rid of.

The mucus can sometimes irritate the skin around your bottom. Using a barrier skin cream should help. You may need to try a few before you find one that works for you. Ask your pharmacist for advice.

Some people find that eating certain foods increases mucus production. While there’s no scientific evidence to support this, you may want to try keeping a food diary for a few weeks to see whether certain foods could be linked to an increase in mucus production.

Parastomal hernia

A parastomal hernia is where the intestines push through the muscles around the stoma, resulting in a noticeable bulge under the skin.

To reduce your risk of getting a parastomal hernia:

  • wear a support garment (belt or underwear)
  • avoid heavy lifting and straining
  • maintain a healthy weight – being overweight can place additional strain on your abdominal muscles

A parastomal hernia isn’t usually painful, but it may be more difficult to hold the colostomy appliance in place and change it.

Most hernias can be managed with the help and support of your stoma nurse. In some cases, surgery may be needed to repair the hernia. But the hernia can come back, even after surgery.

Stoma blockage

Some people develop a blockage in their stoma as the result of a build-up of food.

Signs of a blockage include:

  • not passing many stools, or passing watery stools
  • bloating and swelling in your tummy
  • tummy cramps
  • a swollen stoma
  • nausea or vomiting, or both

If you think your stoma is blocked, you should:

  • avoid eating solid food for the time being
  • drink plenty of fluids
  • massage your tummy and the area around your stoma
  • lie on your back, pull your knees up to your chest, and roll from side to side for a few minutes
  • take a warm bath for 15 to 20 minutes to help relax your tummy muscles

When to get medical help

After trying these steps, if there’s no improvement within two hours, you should contact your GP or stoma nurse immediately as there’s a risk your colon could burst.

Preventing a blockage

To reduce your risk of developing a stoma blockage:

  • chew your food slowly and thoroughly
  • drink plenty of fluids
  • avoid eating large amounts of food at one time

Also, avoid eating foods known to cause blockages, such as corn, celery, popcorn, nuts, coleslaw, coconut macaroons, grapefruit, dried fruit, potato skins, apple skins, orange pith, and Chinese vegetables like bamboo shoots and water chestnuts.

Other complications

Other problems you can have after a colostomy include:

  • skin problems – where the skin around the stoma becomes irritated and sore; your stoma care team will explain how to manage this
  • stomal fistula – where a small channel or hole develops in the skin alongside the stoma; depending on the position of the fistula, appropriate bags and good skin management may be all that’s needed to treat this problem
  • stoma retraction – where the stoma sinks below the level of the skin after the initial swelling goes down, which can lead to leakages because the colostomy bag doesn’t form a good seal; different types of pouches and appliances can help, although further surgery may sometimes be needed
  • stoma prolapse – where the stoma comes out too far above the level of the skin; using a different type of colostomy bag can sometimes help if the prolapse is small, although further surgery may be required
  • stomal stricture – where the stoma becomes scarred and narrowed; further surgery may be needed to correct it if there’s a risk of blockage
  • leakage – where digestive waste leaks from the colon on to the surrounding skin or within the abdomen; trying different bags and appliances may help an external leak, but further surgery may be needed if the leak is internal
  • stomal ischaemia – where the blood supply to the stoma is reduced after surgery; further surgery may be needed

Page last reviewed: 18 September 2017
Next review due: 18 September 2020

www.nhs.uk

The 4 Stages of Cognitive Development

Background and Key Concepts of Piaget’s Theory

Steven Gans, MD is board-certified in psychiatry and is an active supervisor, teacher, and mentor at Massachusetts General Hospital.

Jean Piaget’s theory of cognitive development suggests that children move through four different stages of mental development. His theory focuses not only on understanding how children acquire knowledge, but also on understanding the nature of intelligence.   Piaget’s stages are:

  • Sensorimotor stage: birth to 2 years
  • Preoperational stage: ages 2 to 7
  • Concrete operational stage: ages 7 to 11
  • Formal operational stage: ages 12 and up

Piaget believed that children take an active role in the learning process, acting much like little scientists as they perform experiments, make observations, and learn about the world. As kids interact with the world around them, they continually add new knowledge, build upon existing knowledge, and adapt previously held ideas to accommodate new information.

How Piaget Developed the Theory

Piaget was born in Switzerland in the late 1800s and was a precocious student, publishing his first scientific paper when he was just 11 years old. His early exposure to the intellectual development of children came when he worked as an assistant to Alfred Binet and Theodore Simon as they worked to standardize their famous IQ test.

Much of Piaget’s interest in the cognitive development of children was inspired by his observations of his own nephew and daughter. These observations reinforced his budding hypothesis that children’s minds were not merely smaller versions of adult minds.

Up until this point in history, children were largely treated simply as smaller versions of adults. Piaget was one of the first to identify that the way that children think is different from the way adults think.

Instead, he proposed, intelligence is something that grows and develops through a series of stages. Older children do not just think more quickly than younger children, he suggested. Instead, there are both qualitative and quantitative differences between the thinking of young children versus older children.

Based on his observations, he concluded that children were not less intelligent than adults, they simply think differently. Albert Einstein called Piaget’s discovery «so simple only a genius could have thought of it.»

Piaget’s stage theory describes the cognitive development of children. Cognitive development involves changes in cognitive process and abilities.   In Piaget’s view, early cognitive development involves processes based upon actions and later progresses to changes in mental operations.

The Stages

Through his observations of his children, Piaget developed a stage theory of intellectual development that included four distinct stages:

The Sensorimotor Stage

Ages: Birth to 2 Years

Major Characteristics and Developmental Changes:

  • The infant knows the world through their movements and sensations
  • Children learn about the world through basic actions such as sucking, grasping, looking, and listening
  • Infants learn that things continue to exist even though they cannot be seen (object permanence)
  • They are separate beings from the people and objects around them
  • They realize that their actions can cause things to happen in the world around them

During this earliest stage of cognitive development, infants and toddlers acquire knowledge through sensory experiences and manipulating objects. A child’s entire experience at the earliest period of this stage occurs through basic reflexes, senses, and motor responses.

It is during the sensorimotor stage that children go through a period of dramatic growth and learning. As kids interact with their environment, they are continually making new discoveries about how the world works.

The cognitive development that occurs during this period takes place over a relatively short period of time and involves a great deal of growth. Children not only learn how to perform physical actions such as crawling and walking; they also learn a great deal about language from the people with whom they interact. Piaget also broke this stage down into a number of different substages. It is during the final part of the sensorimotor stage that early representational thought emerges.

Piaget believed that developing object permanence or object constancy, the understanding that objects continue to exist even when they cannot be seen, was an important element at this point of development.

By learning that objects are separate and distinct entities and that they have an existence of their own outside of individual perception, children are then able to begin to attach names and words to objects.

The Preoperational Stage

Ages: 2 to 7 Years

Major Characteristics and Developmental Changes:

  • Children begin to think symbolically and learn to use words and pictures to represent objects.
  • Children at this stage tend to be egocentric and struggle to see things from the perspective of others.
  • While they are getting better with language and thinking, they still tend to think about things in very concrete terms.

The foundations of language development may have been laid during the previous stage, but it is the emergence of language that is one of the major hallmarks of the preoperational stage of development.  

Children become much more skilled at pretend play during this stage of development, yet continue to think very concretely about the world around them.

At this stage, kids learn through pretend play but still struggle with logic and taking the point of view of other people. They also often struggle with understanding the idea of constancy.
For example, a researcher might take a lump of clay, divide it into two equal pieces, and then give a child the choice between two pieces of clay to play with. One piece of clay is rolled into a compact ball while the other is smashed into a flat pancake shape. Since the flat shape looks larger, the preoperational child will likely choose that piece even though the two pieces are exactly the same size.

The Concrete Operational Stage

Ages: 7 to 11 Years

Major Characteristics and Developmental Changes

  • During this stage, children begin to thinking logically about concrete events
  • They begin to understand the concept of conservation; that the amount of liquid in a short, wide cup is equal to that in a tall, skinny glass, for example
  • Their thinking becomes more logical and organized, but still very concrete
  • Children begin using inductive logic, or reasoning from specific information to a general principle

While children are still very concrete and literal in their thinking at this point in development, they become much more adept at using logic.   The egocentrism of the previous stage begins to disappear as kids become better at thinking about how other people might view a situation.

While thinking becomes much more logical during the concrete operational state, it can also be very rigid. Kids at this point in development tend to struggle with abstract and hypothetical concepts.

During this stage, children also become less egocentric and begin to think about how other people might think and feel. Kids in the concrete operational stage also begin to understand that their thoughts are unique to them and that not everyone else necessarily shares their thoughts, feelings, and opinions.

The Formal Operational Stage

Ages: 12 and Up

Major Characteristics and Developmental Changes:

  • At this stage, the adolescent or young adult begins to think abstractly and reason about hypothetical problems
  • Abstract thought emerges
  • Teens begin to think more about moral, philosophical, ethical, social, and political issues that require theoretical and abstract reasoning
  • Begin to use deductive logic, or reasoning from a general principle to specific information

The final stage of Piaget’s theory involves an increase in logic, the ability to use deductive reasoning, and an understanding of abstract ideas.   At this point, people become capable of seeing multiple potential solutions to problems and think more scientifically about the world around them.

The ability to thinking about abstract ideas and situations is the key hallmark of the formal operational stage of cognitive development. The ability to systematically plan for the future and reason about hypothetical situations are also critical abilities that emerge during this stage.

It is important to note that Piaget did not view children’s intellectual development as a quantitative process; that is, kids do not just add more information and knowledge to their existing knowledge as they get older. Instead, Piaget suggested that there is a qualitative change in how children think as they gradually process through these four stages.   A child at age 7 doesn’t just have more information about the world than he did at age 2; there is a fundamental change in how he thinks about the world.

Important Concepts

To better understand some of the things that happen during cognitive development, it is important first to examine a few of the important ideas and concepts introduced by Piaget.

The following are some of the factors that influence how children learn and grow:

A schema describes both the mental and physical actions involved in understanding and knowing. Schemas are categories of knowledge that help us to interpret and understand the world.

In Piaget’s view, a schema includes both a category of knowledge and the process of obtaining that knowledge.   As experiences happen, this new information is used to modify, add to, or change previously existing schemas.

For example, a child may have a schema about a type of animal, such as a dog. If the child’s sole experience has been with small dogs, a child might believe that all dogs are small, furry, and have four legs. Suppose then that the child encounters an enormous dog. The child will take in this new information, modifying the previously existing schema to include these new observations.

Assimilation

The process of taking in new information into our already existing schemas is known as assimilation. The process is somewhat subjective because we tend to modify experiences and information slightly to fit in with our preexisting beliefs. In the example above, seeing a dog and labeling it «dog» is a case of assimilating the animal into the child’s dog schema.

Accommodation

Another part of adaptation involves changing or altering our existing schemas in light of new information, a process known as accommodation. Accommodation involves modifying existing schemas, or ideas, as a result of new information or new experiences.   New schemas may also be developed during this process.

Equilibration

Piaget believed that all children try to strike a balance between assimilation and accommodation, which is achieved through a mechanism Piaget called equilibration. As children progress through the stages of cognitive development, it is important to maintain a balance between applying previous knowledge (assimilation) and changing behavior to account for new knowledge (accommodation). Equilibration helps explain how children can move from one stage of thought to the next.  

A Word From Verywell

One of the most important elements to remember of Piaget’s theory is that it takes the view that creating knowledge and intelligence is an inherently active process.

«I find myself opposed to the view of knowledge as a passive copy of reality,» Piaget explained. «I believe that knowing an object means acting upon it, constructing systems of transformations that can be carried out on or with this object. Knowing reality means constructing systems of transformations that correspond, more or less adequately, to reality.»

Piaget’s theory of cognitive development helped add to our understanding of children’s intellectual growth. It also stressed that children were not merely passive recipients of knowledge. Instead, kids are constantly investigating and experimenting as they build their understanding of how the world works.

www.verywellmind.com

Kidney Failure in Cats

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Your cat’s kidneys do many important things. They help manage blood pressure, make hormones, stimulate the bone marrow to make more red blood cells, and remove waste from the blood.

Cats’ kidneys can begin to fail with age. Untreated, kidney disease can lead to a series of health problems. When it’s chronic, there’s no cure. But with early diagnosis and good care, you can help boost both the quality and length of your pet’s life.

Older cats aren’t the only ones at risk. Kittens can be born with kidney diseases. Trauma, toxins, and infection are also causes.

Types of Kidney Disease

There are two types of kidney failure in cats. Each has different causes, treatments, and outlooks.

Acute renal failure develops suddenly, over a matter of days or weeks. It happens in cats of all ages and is usually the result of:

  • Poisons, which are the most common cause of acute renal failure. Antifreeze, toxic plants like lilies, pesticides, cleaning fluids, and certain human medications are highly poisonous to your cat’s kidneys. Even a single tablet of ibuprofen can lead to her kidneys shutting down. Check around your house and garage for these substances and make sure your cat can’t get into them.
  • Trauma, especially involving a broken pelvis or burst bladder
  • Shock from losing a lot of blood quickly or rapid dehydration; overheating in hot weather, a significant rise in activity, vomiting, and diarrhea can all cause a big dip in fluids.
  • Infection in the kidneys
  • Blockages that change the flow of blood into the kidney and the flow of urine out of it (such as in a male cat that can’t pee because of aВ urethral blockage)
  • Heart failure with low blood pressure, which reduces blood flow to the kidneys

If diagnosed in time, acute renal failure can often be reversed. But chronickidney problems can be harder to treat. Found mostly in middle-aged and older cats, they develop over months and even years. If your cat is 7 years or older, pay special attention to her health.

While the exact causes of chronic kidney disease aren’t always clear, even to vets, they include:

  • Kidney infections and blockages, which may not result in acute renal failure, but wear down kidney function at a low level for months or years
  • Other conditions, from advanced dental disease and high blood pressure to thyroid problems and cancer

Continued

11 Signs Your Cat’s Kidneys May Be Failing

  • Frequent urinating. While you might think this is a sign your cat’s kidneys are working well, it actually means she’s no longer able to hold water. Urinating outside her litter box is another signal.
  • Drinking a lot of water. This means your cat is trying to replace the fluid she’s lost through urinating.
  • Bacterial infections of the bladder and kidney. These develop more easily in the dilute urine produced by failing kidneys.
  • Weight loss and decreased appetite.
  • Vomiting, diarrhea, and bloody or cloudy urine.
  • Mouth ulcers, especially on the gums and tongue.
  • Bad breath with an ammonia-like odor.
  • A brownish-colored tongue.
  • A dry coat.
  • Constipation.
  • Weakness and indifference.

Diagnosis and Treatment

Your vet will do blood and urine tests. X-rays, an ultrasound (an image of your cat’s insides), or biopsy (tissue sample) might also be needed to make a diagnosis. If kidney disease is found, treatments can range from surgery to remove blockages to IV fluids to a special diet and medications. You may also be able to inject fluids under your cat’s skin at home. Talk to your vet about the best options.

A kidney diet is low in both phosphorus and protein, and is enriched with vitamin D and omega-3 fatty acids. Remember that it’s important to introduce your cat to new foods gradually. Your vet can advise you how to make this transition an easy one.

With a carefully managed diet.В plenty of clean freshВ water,В a serene environment,В and regular check-ups, you can help your cat live her best life possible.

Sources

ASPCA: “Kidney Disease.”

Cornell University College of Veterinary Medicine: “Diagnosis: Kidney Disease.»

Misericordia University: “Renal Failure in Cats.»

Washington State University College of Veterinary Medicine: “Chronic Kidney Disease and Failure (CKD, CRF, CRD).”

pets.webmd.com

Congestive Heart Failure in Dogs

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Congenital Heart Disease in Dogs

Your beloved pet can have heart problems just like you. Know the symptoms so you can get your companion the help she needs.

Heart disease may lead to congestive heart failure. That’s when your dog’s heart has trouble pumping blood to the rest of its body.

Heart disease can affect one side of the heart or sometimes both sides. It can progress slowly and may take years to spot.

Causes

Congenital means that the dog was born with a heart defect. But old age, injury, and infection can exacerbate it. Diet and exercise play roles too.

Symptoms

Take notice of these early symptoms of heart problems:

  • Coughing more than usual (during or after exercise or a few hours before bedtime)
  • Having a hard time breathing or exercising
  • Tiring easily
  • Pacing before bedtime and having a hard time settling down
  • Increased respiratory rate — how many breaths per minute

More symptoms may develop, as the disease gets worse, including:

  • A swollen belly from fluid buildup in (called ascites)
  • Fainting because of blocked blood flow to the brain
  • Change in tongue or gum color to bluish gray because of poor oxygen flow
  • Weight loss as your dog loses her ability to store healthy fat

Getting a Diagnosis

Your vet will want to know any symptoms you’ve noticed. He or she will want to know what she eats, what medications and supplements she may be taking, and if she is current on heartworm protection.

The vet will listen to your dog’s chest and may want to run some tests, including:

  • A blood and urine test to check for any other problems that could be affecting your dog’s heart.
  • Chest X-rays. These use radiation in low doses to make images of your dog’s internal organs.
  • An EKG. This test measures electrical signals from your dog’s heart and tells how fast it’s beating and if that rhythm is healthy.
  • An ultrasound. Ultrasound uses sound waves to look at the size, shape, and movement of the heart.
  • Heartworm antigen test. Your vet will take blood from your dog to test it for heartworms.
  • Holter monitor. This is taped to your dog’s chest and worn for 24-48 hours to capture heart rhythms and rate.

Continued

Treatment

Your dog’s treatment depends on what specific heart problem she has and what may be causing it.

Your vet may recommend one or more of the following:

  • Medications to help the heart work and correct irregular heartbeats
  • Medications to slow fluid build-up in the lungs
  • Surgery to correct a torn valve or to insert a pacemaker to correct the heart beat
  • A commercial or prescription low-salt diet to help decrease fluid build-up in your dog’s body
  • Limited activity or exercise to manage weight without putting too much strain on your dog’s heart

Your vet may also recommend supplements. Dogs with congestive heart failure may benefit from vitamin B supplements, taurine (an amino acid that supports brain development), or carnitine (an amino acid that helps turn fat into energy). Antioxidants like Coenzyme Q and vitamin E may also help.

Medication can also clear heartworms or bacterial infections if they’re caught early enough.

What to Expect

Make sure to bring your dog for regular visits with your vet and stick with your treatment plan. Unchecked heart problems can make things harder on your dog and even shorten her life. With the right treatments, care, and monitoring, your dog can live a long, comfortable life.

Sources

American Heart Association: «Pets May Help Reduce Your Risk of Heart Disease.»

AKC Canine Health Foundation: «Aortic Stenosis.»

VCA Animal Hospitals: «Congestive Heart Failure in Dogs.»

Christina Fan, DVM, Pasadena Pets Veterinary Hospital

Cornell University College of Veterinary Medicine: «Leaky Valve Disease in Older Dogs.»

Tufts University: «Treatments for Pets with Heart Disease: Congestive Heart Failure.»

American Veterinary Medical Association: «The Facts on AVMA’s Proposed Policy on Raw Pet Food Diets.»

The Humane Society of the United States.

Doctors, Fosters & Smith: «Heart Failure in the Dog.»

pets.webmd.com

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