NSG 555 QUIZ 2 MODULE 3 GI/GU EXAM QUESTIONS
AND ANSWERS WITH COMPLETE SOLUTIONS VERIFIED
cranial nerve function
Reflects brainstem function
Pupil response, eye movement, cough/gag/corneal reflexes
external vs internal hemorrhoids s/s
external: usually asymptomatic unless a small thrombus , then acutely painful and itchy
and edema
internal: painless bright red blood with BMs and occ. a reducible prolapse.
hemorrhoids definition
increased pressure-->vascular engorgement-->trauma to vessels-->pain and prolaps of
tissue
4 degrees of internal hemorrhoids
1. painless bleeding, bulge but no prolapse
2. prolapse during defacation, reduce spontaniously, bleeding/itching
3. prolapse with defacation+manual reduction needed. pain
4th degree: permanently prolapsed and not reducible.
diagnostics of hemorrhoids
clinical one. further testing not needed but if pt over 50 or concern re cancer should get
colonoscopy.
management of hemorrhoids
,high fiber diet, increased fluid. fiber 20-30 g/day
sitz baths
stool softeners (not laxatives, can make it worse because of variable consistency)
topical analgescis reduce inflammation.
vasoconstrictive preps cnan help too
can do rubber band ligation if still symptomatic after dietary/lifestyle change
complications of hemorrhoids
4th degree can be at risk for strangulation and can become gangrenous and need
surgery. use rubber band ligation.
s/s perianal sepsis: urinary retention and fever after rubber band ligation
anal fissure
painful linear cracks common in kids and middle age adults.
if present <6 weeks it's acut if >6 weeks it's chronic
caused by trauma from constipationor diarrhea which causes a chemical burn or anal
stenosis
anal fissure that is NOT posterior midline
suspect STI, TB, HIV, infection, UC, crohns, malignant neoplasm, etc REFER THESE
PTS
s/s and PE of anal fissure
tearing with passing stool, pain, small amounts of blood on TP.
,differential dx anal fissure
anal cancer, perianal abscess, thrombosed hemorrhoid
RED FLAG s/s: anal carcinoma hx, persistent anorectal pain/bleeding, bloody diarrhea,
wt loss
management of anal fissures
usually resolve without tx.
Inc fiber, stool softeners, sitz baths, supps or foam antiinflammatory agents
lidocaine gel before BMs
topical nitrates or oral CCBs (diltiazem) helps healing of fissures
Gold standard treatment of CHRONIC anal fissure
lateral internal sphincerotomy: reduces internal sphincter tone allowing fissure to heal
Pruritis ani
RED FLAG IF wieght loss or refractory s/s to rule on cancer
Itching. very common. caused by hundreds of things.
dx: ITCH: infection, topical irritan, cutaneous/cancer, hypersensitivite. rule out STI, may
need biopsy if no relief, assess if food alergy or detergent allergy, pin worms, yest, etc.
management of pruritis ani
hygien. increase fiber if there are loos stools. Use a hair dryer on cool setting to dry
anus. avoid perfumes.
1% hydrocortisone cream (d/c after 2 weeks to avoid skin atrophy)
antihistamine with antipruritic (Atarax/hydroxyzine)
, Witch hazel
relief in 4-6 weeks
anorectal abscess or fistula
common in crohns patients. pus from internal opening of fistual tract, purulent drainage
or a sinus.
dx: CT or MRI both good. small bowel exam to assess crohns, colonoscopy
Mgt: incision and drainage is first line treatment
pharm mgt: abx usually not needed unless infection. if infection with cellullitis or
immunosuppression cipro or metronidazole
cirrhosis
end stage consequence of hepatic fibrosis.
Irreversible
commonly from BV or HCV, ETOH liver disease, NAFLD, and NASH
apap, amiodarone, methotrexate, isoniazid, abx, arbon tetrachloride can also cause.
portal hypertension
the elevation of blood pressure within the portal venous system due to shunting of
portal/arterial blood supplies
fibrosis in the liver causes
portal HTN, obstructive biliary channels, destruction of liver cells, liver cancer, liver
failure
AND ANSWERS WITH COMPLETE SOLUTIONS VERIFIED
cranial nerve function
Reflects brainstem function
Pupil response, eye movement, cough/gag/corneal reflexes
external vs internal hemorrhoids s/s
external: usually asymptomatic unless a small thrombus , then acutely painful and itchy
and edema
internal: painless bright red blood with BMs and occ. a reducible prolapse.
hemorrhoids definition
increased pressure-->vascular engorgement-->trauma to vessels-->pain and prolaps of
tissue
4 degrees of internal hemorrhoids
1. painless bleeding, bulge but no prolapse
2. prolapse during defacation, reduce spontaniously, bleeding/itching
3. prolapse with defacation+manual reduction needed. pain
4th degree: permanently prolapsed and not reducible.
diagnostics of hemorrhoids
clinical one. further testing not needed but if pt over 50 or concern re cancer should get
colonoscopy.
management of hemorrhoids
,high fiber diet, increased fluid. fiber 20-30 g/day
sitz baths
stool softeners (not laxatives, can make it worse because of variable consistency)
topical analgescis reduce inflammation.
vasoconstrictive preps cnan help too
can do rubber band ligation if still symptomatic after dietary/lifestyle change
complications of hemorrhoids
4th degree can be at risk for strangulation and can become gangrenous and need
surgery. use rubber band ligation.
s/s perianal sepsis: urinary retention and fever after rubber band ligation
anal fissure
painful linear cracks common in kids and middle age adults.
if present <6 weeks it's acut if >6 weeks it's chronic
caused by trauma from constipationor diarrhea which causes a chemical burn or anal
stenosis
anal fissure that is NOT posterior midline
suspect STI, TB, HIV, infection, UC, crohns, malignant neoplasm, etc REFER THESE
PTS
s/s and PE of anal fissure
tearing with passing stool, pain, small amounts of blood on TP.
,differential dx anal fissure
anal cancer, perianal abscess, thrombosed hemorrhoid
RED FLAG s/s: anal carcinoma hx, persistent anorectal pain/bleeding, bloody diarrhea,
wt loss
management of anal fissures
usually resolve without tx.
Inc fiber, stool softeners, sitz baths, supps or foam antiinflammatory agents
lidocaine gel before BMs
topical nitrates or oral CCBs (diltiazem) helps healing of fissures
Gold standard treatment of CHRONIC anal fissure
lateral internal sphincerotomy: reduces internal sphincter tone allowing fissure to heal
Pruritis ani
RED FLAG IF wieght loss or refractory s/s to rule on cancer
Itching. very common. caused by hundreds of things.
dx: ITCH: infection, topical irritan, cutaneous/cancer, hypersensitivite. rule out STI, may
need biopsy if no relief, assess if food alergy or detergent allergy, pin worms, yest, etc.
management of pruritis ani
hygien. increase fiber if there are loos stools. Use a hair dryer on cool setting to dry
anus. avoid perfumes.
1% hydrocortisone cream (d/c after 2 weeks to avoid skin atrophy)
antihistamine with antipruritic (Atarax/hydroxyzine)
, Witch hazel
relief in 4-6 weeks
anorectal abscess or fistula
common in crohns patients. pus from internal opening of fistual tract, purulent drainage
or a sinus.
dx: CT or MRI both good. small bowel exam to assess crohns, colonoscopy
Mgt: incision and drainage is first line treatment
pharm mgt: abx usually not needed unless infection. if infection with cellullitis or
immunosuppression cipro or metronidazole
cirrhosis
end stage consequence of hepatic fibrosis.
Irreversible
commonly from BV or HCV, ETOH liver disease, NAFLD, and NASH
apap, amiodarone, methotrexate, isoniazid, abx, arbon tetrachloride can also cause.
portal hypertension
the elevation of blood pressure within the portal venous system due to shunting of
portal/arterial blood supplies
fibrosis in the liver causes
portal HTN, obstructive biliary channels, destruction of liver cells, liver cancer, liver
failure
