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NSG 555 QUIZ 2 MODULE 3 GI/GU EXAM QUESTIONS AND ANSWERS WITH COMPLETE SOLUTIONS VERIFIED
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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 , th...

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  • November 23, 2024
  • 37
  • 2024/2025
  • Exam (elaborations)
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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

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