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N507 Exam 2 > (15) Anus, Rectum, Prostate > Flashcards

(15) Anus, Rectum, Prostate Flashcards

1
Q

rectum

A
  • lies against the cerum and coccyx then merges w/ the short segment of anal canal
  • extends from rectosigmoid junction, anterior to S3 vertebra, to the anorectal junction at the tip of coccyx
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2
Q

external margin of anal canal

A

poor demarcated

  • moist hairless appearance usually distinguishes it form the surrounding perineal skin
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3
Q

internal anal sphincter

A

an extension of the muscular coat of the rectal wall

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4
Q

what holds the anal canal closed?

A

multiple actions of the voluntary external anal sphincter and the involuntary internal anal sphincter

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5
Q

anal canal

A
  • angle is on a line roughly between anus and umbilicus

- liberally supplied by somatic sensory nerves and a poorly directed finger or instrument wall produce pain

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6
Q

anorectal junction

A
  • serrated line marking the change from skin to mucous membrane (demarcates anal canal from rectum)
  • also called pectinate or dentate line
  • boundary between somatic and visceral nerve supplies
  • easily visible on anoscopic or endoscopic exam but no palpable
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7
Q

prostate gland

A

surrounds urethra and lies next to bladder outlet

-small in childhood, between puberty and 20y/o increases 5x in size; prostate volume further expands as gland becomes hyper plastic

  • right and left lateral lobes lie against anterior rectal wall where they are palpable as a rounded, heart shaped structure approx 2.5cm long
  • separated by s shallow median sulcus or groove: also palpable
  • anterior and central areas of prostate cannot be examined
  • seminal vesicles (shaped like rabbit ears above prostate) are also not normally palpable
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8
Q

in females, the ? is usually palpable through the anterior wall of the rectum

A

uterine cervix

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9
Q

valves of Houston

A

3 inward foldings go the rectal wall
-lowest can be sometimes be felt on pt’s left

-most of rectum that is accessible to digital exam doesn’t
t have peritoneal surface except for anterior rectum which you may be able to reach w/ tip of exam finger

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10
Q

rectal exam: tenderness from peritoneal inflammation or nodularity suggests ?

A

peritoneal masses

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11
Q

rectal/anus/prostate:

common/concerning symptoms and signs

A
  • change in bowel habits
  • blood in stool
  • pain w/ defecation; rectal bleeding or tenderness
  • anal warts or fissures
  • weak urinary stream
  • burning w/ urination
  • blood in urine
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12
Q

change in stool caliber, especially pencil-thin stools, may warn of ?

A

colon cancer

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13
Q

blood in stool may be from ?

A

polyps
carcinoma
GI bleeding
hemorrhoids

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14
Q

mucus in stool may be from ?

A

vilois adenoma
intestinal infections
inflammatory bowel disease
irritable bowel syndrome

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15
Q

anorectal pain, itching, tenesmus, or discharge or bleeding from infection or rectal abscess suggests ?

A

proctitis
(causes include gonorrhea, chlamydia, lymphogranuloma venereum, receptive anal intercourse, ulcerations from herpes simplex, chancres of primary syphilis)

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16
Q

anal intching in younger patients suggests ?

A

pinworms

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17
Q

anal fissures suggests ?

A

proctitis

Crohn disease

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18
Q

genital warts may arise from ?

A

HPV

condylomata lata in secondary syphilis

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19
Q

urinary complaints r/t benign prostatic hyperplasia or prostate cancer (esp. men >70)

A
  • difficulty starting holding back urine stream
  • weak flow
  • frequent pm urination
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20
Q

s/s acute prostatitis

A 
sudden onset of irritative urinary tract symptoms (frequency, urgency, pain w/ urination)
perineal and low back pain
malaise
fever
chills
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21
Q

anal/rectal/prostate:

important topics for health promotion

A
  • prostate cancer prevention and screening
  • colorectal cancer prevention and screening
  • counseling for STIs
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22
Q

risk factors for prostate cancer

A

Age: rare before 40, increase rapidly after 50, median age dx =66

Ethnicity: black

Family history: genetics, 1st degree relative (father/brother), BRCA1/2

Other: agent orange, diet high in animal fat, obesity, smoking

*BPH is not a risk factor

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23
Q

prostate cancer primary prevention

A
  • no evidence that any lifestyle modification works (diet, activity, etc)
  • maybe chemoprevention (5-ARIs)
24
Q

prostate cancer screening

A
  • PSA test
  • digital rectal exam
  • if these abnormal refer for prostate biopsy = gold standard for dx*

-use shared decision making for screenings starting between 40-50y/o until 70y/o or life expectancy <10yrs (annually)

25
Q

PSA

A

glycoprotein produced by prostatic epithelial cells that can be elevated by cancer (also BPH, prostate infections, ejaculation)

26
Q

DRE

A

explores for palpable abnormalities such as nodules, induration, asymmetry in peripheral posterior and lateral areas of prostate gland closest to examining finger
-unable to detect cancers in anterior and central areas of the gland

majority of cancers detected by DRE have already spread beyond prostate

27
Q

for suspicion of colorectal cancer consider ?

A

lower endoscopy

28
Q

rectal exam: male positioning

A

left side lying, buttocks close to edge, hips/knees flexed (esp. upper leg)

  • can have standing and leaning forward w/ hips flexed but less dignified
29
Q

perianal skin compared to skin on buttocks

A

more pigmented and coarser

30
Q

anal and perianal lesions include

A 
hemorrhoids
general warts
herpes
syphilitic chancre
carcinoma
31
Q

anal/perianal linear crack or tear suggests

A

anal fissure from large, hard stool, IBD, to STIs

32
Q

swollen, thickened, fissures perianal skin w/ excoriations suggests

A

pruritus ani

33
Q

anal canal: tender purulent reddened mass w/ fever/chills suggests

A

anal abscess

34
Q

abscesses tunneling to skin surface from anus to rectum may form ?

A

clogged or draining anorectal fistula (may ooze blood, pus, feculent mucus)
-consider anoscopy or sigmoidoscopy for better visualization

35
Q

anal sphincter tightness may occur w/

A

anxiety
inflammation
scarring

36
Q

anal sphincter laxity occurs in

A

neurologic diseases such as S2-S4 cord lesions
signals possible changes in urinary sphincter and detrusor muscle

-consider testing perianal sensation

37
Q

anal induration may be caused by

A

inflammation
scarring
malignancy

38
Q

rectal mass w. irregular borders suggests

A

rectal cancer

39
Q

prostate exam may cause the patient to feel ?

A

urge to pee

40
Q

normal prostate on palpation

A

rubbery
nontender
no evidence of fixity to surrounding tissues

41
Q

7 parts of BPH symptoms score

A
  1. incomplete emptying
  2. frequency
  3. intermittency
  4. urgency
  5. weak stream
  6. straining
  7. nocturia
42
Q

Pilondial Cyst

A
  • fairly common, congenital, abnormality located in midline superficial to the coccyx or lower sacrum
  • opening of a sinus tract sometimes w/ tuft of hair surrounded by a halo of erythema
  • generally asymptomatic except for slight drainage but abscess formation and secondary sinus tacts may occur
43
Q

external hemorrhoids

A

dilated hemorrhoidal veins that originated below the pectinate line that are covered by skin

  • seldom produce symptoms unless thrombosis occurs which causes actor local pain that increases w/ defectation and sitting
  • a tender, swollen, bluish, ovoid mass is visible at anal margin
44
Q

internal (prolapsed) hemorrhoids

A

enlargements of the normal vascular cushions located above the pectinate line, usually not palpable

  • may cause bright-red bleeding, especially during defectation
  • may also prolapse through the anal canal and appear as reddish, moist, protruding masses, typically located in one or more of the positions illustrated
45
Q

prolapse of rectum

A

on straining for a bowel movement, rectal mucosa, w/ or w/o muscular wall. may prolapse through anus appearing as a doughnut to rosette of red tissue

  • prolapse involving only mucosa is relatively small and sows radiating folds
  • when entire bowel wall is involved, the prolapse is larger and covered by concentrically circular folds
46
Q

anal fissure

A

very painful oval ulceration of the anal canal

  • most commonly found in midline posteriorly, less commonly in midline anteriorly
  • its long axis lies longitudinally
  • may be swollen “sentinel” skin tag just below it
  • gentle separation of anal margins may reveal the lower edge of fissure
  • sphincter is spastic, exam is painful (local anesthesia may be required)
47
Q

anorectal fissure

A

inflammatory tract or tube that opens at one end into the anus or rectum and at the other end onto the skin surface or into another viscus

  • an abscess usually antedates such a fistula
  • look for fistulous opening or openings anywhere in the skin around the anus
48
Q

polyps of rectum

A
  • fairly common
  • variable in size and number
  • can develop a stalk (pedunculate) or lie on the mucosal surface (sessile)
  • soft and may be difficult or impossible to feel even when in reach of the examining finger
  • endoscopy and biopsy are needed for differentiation of benign from malignant lesions
49
Q

cancer of rectum

A

-firm, nodular, rolled edge of an ulcerated cancer

50
Q

rectal shelf

A
  • widespread peritoneal metastases from any source may develop in the area of the peritoneal reflection anterior to the rectum
  • a firm to hard nodular rectal “shelf” may be just palpable w/ the tip of the examining finger
  • in women, this shelf of metazoic tissue develops in the rectouterine such, behind cervix and the uterus
51
Q

normal prostate gland

A

(palpated through anterior rectal wall)

  • rounded, heart-shaped structure approx 2.5cm long
  • median sulcus can be palpated between 2 lateral lobes
  • only posterior surface of prostate is palpable
  • anterior and central lesions, including those that obstruct the urethra, are not detectable by physical exam
52
Q

Acute bacterial prostatitis

A

presents w/ fever and urinary tract symptoms scubas frequency, urgency, dysuria, incomplete voiding, Lowe back pain

  • gland feels tender, swollen, boggy, warm
  • usually caused by gram- bacteria (E. coli, enterococcus, proteus) or STI (GC/Chlamydia)
53
Q

chronic bacterial prostatitis

A

associated w/ recurrent UTIs usually from same organism

  • may be asymptomatic or have dysuria or mild pelvic pain
  • gland may feel normal w/o tenderness/swelling
  • cultures usually show E. coli

-may be hard to distinguish from chronic pelvic pain syndrome

54
Q

BPH

A

nonmalignant enlargement of prostate gland that increases w/ age (>50y/o)

  • symptoms arise from smooth muscle contraction in prostate and bladder neck and from compression of urethra
  • may be irritative (urgency, frequency, nocturia) or obstructive (decreased stream, incomplete emptying, straining) or both
  • gland may be normal in size, feel enlarged, smooth, firm, slightly elastic, may be obliteration of median sulcus and more notable protrusion into rectal lumen
55
Q

Prostate cancer

A

suggested by an area of hardness in the gland - a distinct hard nodule that alters the contour of the gland may or may not be palpable

  • as the cancer enlarges it feels irregular and may extend beyond the confines of the gland
  • median sulcus may be obscured
  • hard areas of prostate aren’t always malignant: may be stones, chronic inflammation

N507 Exam 2 (6 decks)

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