NURS 5461 GI NEW EXAM QUESTIONS AND
CORRECT ANSWERS 100% VERIFIED
Steps In Managing Chronic Constipation- ANSWER.1 Reduce or stop constipating
medications if possible, consider metabolic causes of constipation, consider structural
evaluation to exclude obstructive lesions
2. Fluid intake ≥1500 mL/day, increase physical activity if possible, increase dietary
fiber to >35 g/day
3. Add a bulking agent—must be taken with at least 8 ounces water
4. Add an osmotic agent
Steps In Managing Chronic Constipation 2 - ANSWER 5. Add a stimulant laxative
6. Add a colonic secretagogue 2 or 3 times per week
7. Refractory cases failing the above steps should consider the following: 1) referral for
anorectal manometry, balloon expulsion test and or defecography with pelvic physical
therapy and or surgical evaluation as indicated based on findings; 2) addition of enema
(water or saline) 2 times a week as needed-follow electrolytes carefully; and/or 3)
surgical evaluation for subtotal colectomy
Downstream Effects—Fecal Impaction - ANSWER common in older adults Treated first
by manual disimpaction, followed by several warm-water enemas After local
disimpaction a polyethylene glycol preparation should be used to cleanse the entire
colon Long-term management= treating the underlying cause usually adding a daily
polyethylene glycol laxative to patient's medication regimen *Weekly cleansing enemas
can be considered in those with recurrent fecal impaction
fecal impaction - ANSWER Affects 2%-7% of adults, mostly older people in poor general
health, women disproportionately affected • Affects quality of life—may lead to social
isolation, delays in treatment • Common cause of nursing home placement
Fecal Incontinence Eavl - ANSWER Consider flexible sigmoidoscopy to exclude
inflammation or tumor • Anorectal manometry measures resting anal sphincter tone,
,squeeze pressure, the rectoanal inhibitory reflex, rectal sensation, and rectal
compliance (requires complete cooperation by patient) • Endorectal ultrasound further
evaluates abnormalities of the anal sphincters, the rectal wall, and the puborectalis
muscle (identified on anorectal manometry)
Fecal bulking agents and antidiarrheal medications • Use diphenoxylate/atropine
cautiously in older adults because of its anticholinergic effects ==> Biofeedback therapy
(anal sphincter strengthening ==>Injectable sphincter bulking agents or surgery ==>
Surgery allows for repair of the sphincter or construction of a new sphincter
⚫ Atonic Constipation - ANSWER Do not use fiber bulk products, use a stimulant q 3
days
Combinations of stimulants with a bulk agent or with a softener could be a reasonable
choice - Perdiem - Peri-Colace
Other Issues: Constipation - ANSWER Implications - Ileus - Megacolon - Hernia -
Hemorrhoids - Fecal impaction - Rectal or uterine prolapse - Laxative dependency
Indications for Referral/Hospitalization - Nausea and vomiting, fever and abdominal pain
suggest ileus and should be treated in the hospital
Osmotic Diarrhea - ANSWER ⚫ Ingestion or malabsorption of a substance that is
osmotically active ⚫ This diarrhea responds to fasting ⚫ CHO malabsorption is the most
common cause—lactose, fructose, sorbitol ⚫ Laxative abuse ⚫ Celiac disease
Secretory Diarrhea - ANSWER Large volume, watery stools that does not respond to
fasting (have whether eating or not Most cases of acute and chronic diarrhea are
secretory Toxins, viruses are common causes Laxative abuse Bile salt malabsorption
Endocrine tumors that stimulate pancreatic secretion
Morphological Change Diarrhea - ANSWER Changes within the mucosa of the intestinal
wall from inflammatory conditions. Chrones, UC
Altered Motility Diarrhea - ANSWER ⚫ Diabetic neuropathy ⚫ Dumping Syndrome ⚫ IBS
⚫ Chronic parasitic infections—Giardia, Entamoeba histolytica, Cyclospora ⚫
, Antibiotics ⚫ Pseudomembranous colitis—C. difficile
Differential Diagnoses - ANSWER Lactose Intolerance, Antibiotic Therapy, Viral
infection, Medications, IBS, Dietary factors, Colon cancer, IBD, Ingestion of Magnesium
containing antacids, AIDS, Laxative abuse
Narrowing it Down. - ANSWER acute vs. Chronic? Sudden onset w/o s/sx of other organs
being involved suggests a viral etiology, drinking water?? [hikers/campers in US
who drink unfiltered water are at high risk of
Giardiasis] ⚫ Medication use—Mg+ containing antacids/supplements; antibiotics,
chemotherapy; immunosuppressives?
Chronic Diarrhea - ANSWER Definition: decrease in fecal consistency lasting >4 weeks
Medications: SSRIs, PPIs, some oral hypoglycemic and chemotherapeutic agents,
Vitamin C, Mg++ containing antacids ➢ Artificial sweetener in diet drinks, food,
chewable medications containing sorbitol or other artificial sweeteners
malodorous feces?fat malabsorption, blood suggest IBD
Diverticular Disease - ANSWER Prevalence is age-dependent:60%by 60y 20% develop
diverticulitis • 10% develop diverticular bleeding
Uncommon [< 20 percent] in those younger than 40
⚫ Diverticulitis most commonly presents in the sigmoid colon [left colon]; if there is
rupture and bleed-it is more likely to arise from a non-inflamed diverticula in the right
colon
- 10-25% will develop diverticulitis w/5% eventually developing a massive bleed
Can present in 3 different clinical patterns - ANSWER - Diverticulosis ⚫ Asymptomatic
or symptomatic presence of noninflamed multiple colonic diverticula - Diverticulitis ⚫
Inflammation of 1 or more of the diverticula with possible resultant perforation leading
to fistula or abscess - Diverticular Bleeding ⚫ Associated with right sided diverticula
Diverticula are 1-2 mm to "giant" in size - Most commonly in sigmoid
CORRECT ANSWERS 100% VERIFIED
Steps In Managing Chronic Constipation- ANSWER.1 Reduce or stop constipating
medications if possible, consider metabolic causes of constipation, consider structural
evaluation to exclude obstructive lesions
2. Fluid intake ≥1500 mL/day, increase physical activity if possible, increase dietary
fiber to >35 g/day
3. Add a bulking agent—must be taken with at least 8 ounces water
4. Add an osmotic agent
Steps In Managing Chronic Constipation 2 - ANSWER 5. Add a stimulant laxative
6. Add a colonic secretagogue 2 or 3 times per week
7. Refractory cases failing the above steps should consider the following: 1) referral for
anorectal manometry, balloon expulsion test and or defecography with pelvic physical
therapy and or surgical evaluation as indicated based on findings; 2) addition of enema
(water or saline) 2 times a week as needed-follow electrolytes carefully; and/or 3)
surgical evaluation for subtotal colectomy
Downstream Effects—Fecal Impaction - ANSWER common in older adults Treated first
by manual disimpaction, followed by several warm-water enemas After local
disimpaction a polyethylene glycol preparation should be used to cleanse the entire
colon Long-term management= treating the underlying cause usually adding a daily
polyethylene glycol laxative to patient's medication regimen *Weekly cleansing enemas
can be considered in those with recurrent fecal impaction
fecal impaction - ANSWER Affects 2%-7% of adults, mostly older people in poor general
health, women disproportionately affected • Affects quality of life—may lead to social
isolation, delays in treatment • Common cause of nursing home placement
Fecal Incontinence Eavl - ANSWER Consider flexible sigmoidoscopy to exclude
inflammation or tumor • Anorectal manometry measures resting anal sphincter tone,
,squeeze pressure, the rectoanal inhibitory reflex, rectal sensation, and rectal
compliance (requires complete cooperation by patient) • Endorectal ultrasound further
evaluates abnormalities of the anal sphincters, the rectal wall, and the puborectalis
muscle (identified on anorectal manometry)
Fecal bulking agents and antidiarrheal medications • Use diphenoxylate/atropine
cautiously in older adults because of its anticholinergic effects ==> Biofeedback therapy
(anal sphincter strengthening ==>Injectable sphincter bulking agents or surgery ==>
Surgery allows for repair of the sphincter or construction of a new sphincter
⚫ Atonic Constipation - ANSWER Do not use fiber bulk products, use a stimulant q 3
days
Combinations of stimulants with a bulk agent or with a softener could be a reasonable
choice - Perdiem - Peri-Colace
Other Issues: Constipation - ANSWER Implications - Ileus - Megacolon - Hernia -
Hemorrhoids - Fecal impaction - Rectal or uterine prolapse - Laxative dependency
Indications for Referral/Hospitalization - Nausea and vomiting, fever and abdominal pain
suggest ileus and should be treated in the hospital
Osmotic Diarrhea - ANSWER ⚫ Ingestion or malabsorption of a substance that is
osmotically active ⚫ This diarrhea responds to fasting ⚫ CHO malabsorption is the most
common cause—lactose, fructose, sorbitol ⚫ Laxative abuse ⚫ Celiac disease
Secretory Diarrhea - ANSWER Large volume, watery stools that does not respond to
fasting (have whether eating or not Most cases of acute and chronic diarrhea are
secretory Toxins, viruses are common causes Laxative abuse Bile salt malabsorption
Endocrine tumors that stimulate pancreatic secretion
Morphological Change Diarrhea - ANSWER Changes within the mucosa of the intestinal
wall from inflammatory conditions. Chrones, UC
Altered Motility Diarrhea - ANSWER ⚫ Diabetic neuropathy ⚫ Dumping Syndrome ⚫ IBS
⚫ Chronic parasitic infections—Giardia, Entamoeba histolytica, Cyclospora ⚫
, Antibiotics ⚫ Pseudomembranous colitis—C. difficile
Differential Diagnoses - ANSWER Lactose Intolerance, Antibiotic Therapy, Viral
infection, Medications, IBS, Dietary factors, Colon cancer, IBD, Ingestion of Magnesium
containing antacids, AIDS, Laxative abuse
Narrowing it Down. - ANSWER acute vs. Chronic? Sudden onset w/o s/sx of other organs
being involved suggests a viral etiology, drinking water?? [hikers/campers in US
who drink unfiltered water are at high risk of
Giardiasis] ⚫ Medication use—Mg+ containing antacids/supplements; antibiotics,
chemotherapy; immunosuppressives?
Chronic Diarrhea - ANSWER Definition: decrease in fecal consistency lasting >4 weeks
Medications: SSRIs, PPIs, some oral hypoglycemic and chemotherapeutic agents,
Vitamin C, Mg++ containing antacids ➢ Artificial sweetener in diet drinks, food,
chewable medications containing sorbitol or other artificial sweeteners
malodorous feces?fat malabsorption, blood suggest IBD
Diverticular Disease - ANSWER Prevalence is age-dependent:60%by 60y 20% develop
diverticulitis • 10% develop diverticular bleeding
Uncommon [< 20 percent] in those younger than 40
⚫ Diverticulitis most commonly presents in the sigmoid colon [left colon]; if there is
rupture and bleed-it is more likely to arise from a non-inflamed diverticula in the right
colon
- 10-25% will develop diverticulitis w/5% eventually developing a massive bleed
Can present in 3 different clinical patterns - ANSWER - Diverticulosis ⚫ Asymptomatic
or symptomatic presence of noninflamed multiple colonic diverticula - Diverticulitis ⚫
Inflammation of 1 or more of the diverticula with possible resultant perforation leading
to fistula or abscess - Diverticular Bleeding ⚫ Associated with right sided diverticula
Diverticula are 1-2 mm to "giant" in size - Most commonly in sigmoid
