Ask the Ostomy Experts

Each issue of The Phoenix ostomy magazine features ostomy questions and answers from board-certified nurse Marlene Muchoney, RN, CETN and board-certified colorectal surgeon Dr. Janice Rafferty.


Ask the Ostomy Experts



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Dr. Janice Rafferty

Dr. Rafferty is the chief of colon and rectal surgery division at the University of Cincinnati and specializes in the treatment of inflammatory bowel disease, colon and rectal cancer and benign abnormalities of the pelvic floor and anorectal area.

 Liver Enzymes and an Ileostomy
I am a 60-year-old female. I have had an ileostomy since 1982 due to ulcerative colitis.  I have recently discovered that I have an elevated liver enzyme count, although it appears that my liver is healthy.  I am wondering if the ulcerative colitis disease process or the lack of a colon could have some effect on my liver. 
My 32-year-old son has been diagnosed with Crohn’s and he also has an elevated liver count.  We just find it interesting that we both have the elevated liver counts as well as the gut problems.
P.J.
Dear P.J.,
Liver enzymes can be elevated for a number of reasons; in fact, any substance that is “cleared” by the liver can cause damage. Perhaps medications are the most common culprit, even something as simple as Tylenol can cause these changes. Another common toxin frequently ingested that can cause liver enzymes to change is alcohol. Primary sclerosing cholangitis is a liver abnormality that is frequently associated with inflammatory bowel disease; its effects are not reversed by colectomy. Gallstones in the bile ducts can cause pain and elevation of enzymes associated with the liver and pancreas numbers.
It’s best to have an evaluation by your gastroenterologist, who may have you see a specialist in liver diseases (a hepatologist). Occasionally, special tests are needed, like a liver biopsy, or ERCP, to clarify the reason for the abnormality.

Marlene Muchoney, RN, CETN

With over 28 years of experience, nurse Muchoney is well-qualified to answer ostomy questions from nutrition to skin care to traveling.

 Healing and Ostomy Surgery Incision
My ostomy incision stitches came apart before the wound was healed. Then, I had an infection in the wound. What did I do wrong?
S.M.

Dear S.M.,
Infected wounds often need additional treatment. Wound cultures may be ordered to identify specific organisms to determine antibiotic needs. It is essential to remove any tissue that is not viable in the wound bed. Antibiotics are given as indicated. Dressings that absorb drainage, eliminate any “pockets” (often called dead space), are non-toxic to cells, provide a moist surface to promote wound healing and keep the wound insulated and protected are essential to promote wound healing. 

For wounds other than surgical, evaluation of the factors causing the wound are also evaluated with interventions as needed. Examples include management of pressure ulcers that includes also avoiding pressure, support surfaces, incontinence management, avoiding shearing etc. or adding compression therapy when managing chronic venous stasis ulceration, in addition to nutritional support and topical therapy. 

Home care nurses are extremely important in providing the continuum of care people need when leaving the hospital and going home. They will not only provide continued professional treatment, but will monitor wound healing progress. They will also assess the surrounding skin, provide patient education, cleanse the wound, recommend changes to dressings and plan of care and report any concerns to your physician in a timely fashion. 

Many people with surgical or chronic wounds may also be followed closely in their physician's office or in a specialized center for wound management, as indicated. There are many advanced practice treatment modalities available today. The available dressings and their uses are almost endless and continue to grow.

They include foams, alginates, gauzes, hydrocolloids, transparent dressings impregnated with medications, biologic dressings, gel, synthetics to name a few. Physicians and nurses who specialize and may be certified in wound management and treatment often select treatment and products needed for the plan of care for optimal wound healing.