NSG 555 - Nurse Practitioners in Primary Care II
Exam 2
Question:
anal fissure
Answer:
painful linear cracks common in kids and middle age adults.if present <6 weeks it's acute if >6 weeks it's chronic
caused by trauma from constipation or diarrhea which causes a chemical burn or anal stenosis
Question:
anal fissure that is NOT posterior midline
Answer:
suspect STI, TB, HIV, infection, UC, crohn’s, malignant neoplasm, etc.
REFER THESE PTS
- / 4
Question:
s/s and PE of anal fissure
Answer:
tearing with passing stool, pain, small amounts of blood on TP.
Question:
differential dx anal fissure
Answer:
anal cancer, perianal abscess, thrombosed hemorrhoid
RED FLAG s/s: anal carcinoma hx, persistent anorectal pain/bleeding, bloody
diarrhea, wt loss
Question:
management of anal fissures
Answer:
usually resolve without tx.Inc fiber, stool softeners, sitz baths, supps or foam anti-inflammatory agents lidocaine gel before BMs topical nitrates or oral CCBs (diltiazem) helps healing of fissures
- / 4
Question:
Gold standard treatment of CHRONIC anal fissure
Answer:
lateral internal sphincerotomy: reduces internal sphincter tone allowing
fissure to heal
Question:
Pruritis ani
Answer:
RED FLAG IF weight loss or refractory s/s to rule on cancer Itching. very common. caused by hundreds of things.
dx: ITCH: infection, topical irritan, cutaneous/cancer, hypersensitivity. rule out STI, may need biopsy if no relief, assess if food allergy or detergent allergy, pin worms, yest, etc.
Question:
management of pruritis ani
Answer:
hygiene. increase fiber if there are loose 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 3 / 4
relief in 4-6 weeks
Question:
anorectal abscess or fistula
Answer:
common in crohn’s 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
Question:
cirrhosis
Answer:
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.
- / 4