NSG 6020 GI REVIEW Questions and Answers (2024/2025)(Verified Answers)

You examine a 59 year old man with a chief complain of new onset rectal pain after a boutof constipation. On examination, you note an ulcerated lesion on the posterior midline of the anus. This presentation is most consistent with: • perianal fistula • anal fissure • external hemorrhoid • Crohn proctitis In anal fissure, there is an ulcer or tear of the margin of the anus. Most fissures occur posteriorly. Risk factors include constipation, diarrhea, recent childbirth, and anal intercourse or other anal insertion practices. The best treatment practices for anal fissures is avoidance of the condition through adequate fiber and fluid intake, avoiding constipation, and minimizing oreliminating activity that triggers or contributes to the condition. Rectal bleeding associated with hemorrhoids is usually described as: • streaks of bright red blood on the stool. • dark brown to black in color and mixed in with normal appearing stool. • a large amount of brisk red bleeding. • significant blood clots and mucous mixed with stool. The superior hemorrhoidal veins form internal hemorrhoids, wheras the inferior hemorrhoidalveins form external hemorrhoids. Both forms are normal anatomical findingsbut cause discomfort when there is an increase in the venous pressure and reulting dilation and inflammation, such as in childbirth, obesity, constipation, and prolonged sitting. Over time, tissue and vessel redundancy develop, resulting in rectal protrusion and increased risk for bleeding. With chronically protruding or prolapsing hemorrhoids, the pt often reports itching, mucous leaking, and staining of undergarments with streaks of stool. Manual reduction of the protruding hemorrhoid after evacuation can be helpful. Therapy for hemorrhoids includes all of the following except: • weight control. • low-fat diet. • topical corticosteroids. • the use of a stool softner. As with anal fissure, prevention of hemorrhoidal engorgement and inflammation is the best treatment. Strategies include weight control, high-fiber diet, regular exercise, and increased fluid intake. Treatment for acute hemorrhoid flare ups includes the use of astringents and topicalcorticosteroids, sitz baths, and analgesics. Surgical intervention is warranted with more conservative therapy fails to yield clinical improvement.These therapies are also used to treat pt's with anal fissure. All of the following are typically noted in a young adult with the diagnosis of acuteappendicitis except: • epigastric pain. • positive obturator sign. • rebound tenderness. • marked febrile response. A 26 year old man presents with acute abdominal pain. As part of the evaluation for acute appendicitis, you order a white blood cell (WBC) count with differential and anticipate thefollowing results: • total WBCs, 4500 mm3; neutrophils, 35%; bands, 2%; lymphocytes, 45% • total WBCs, 14,000 mm3; neutrophils, 55%; bands, 3%; lymphocytes, 38% • total WBCs, 16,500 mm3; neutrophils; 66%; bands, 8%; lymphocytes, 22% • total WBCs, 18,100 mm3; neutrophils, 55%; bands, 3%; lymphocytes, 28% In evaluating a patient with suspected appendicitis, the clinician considers that: • the presentation may differ according to the anatomical location of the appendix. • this is a common reason for acute abdominal pain in elderly patients. • vomiting before the onset of abdominal pain is often seen. • the presentation is markedly different from the presentation of pelvic inflammatory disease. There is no true classic presentation of acute appendicitis. Vague epigastric or periumbilical painoften heralds its beginning.The psoas sign can be best described as abdominal pain elicited by: • passive extension of the hip. • passive flexion and internal rotation of the hip. • deep palpation. • asking the patient to cough. The obturator sign can be best described as abdominal pain elicited by: • passive extension of the hip. • passive flexion and internal rotation of the hip. • deep palpation. • asking the patient to cough.