Ano - Rectal Assessment

Question 1

Related Health History

Answer 1

Diet (fiber)
Bowel habits
Stool characteristics
Melena (blood in stools)
Medications (RX, OTC, herbal)
Hemorrhoids
Incontinence
Tenesmus
Pain in abd/rectal area
Polyps - can be precancerous and run in families
Patient/family HX of GI CA
Colorectal CA (CRC) risk factors

Question 2

Tenesmus

Answer 2

Painful straining at stool without results

Question 3

Melena

Answer 3

Blood in stools

Question 4

Positioning

Answer 4

Sims or left lateral
Knees to chest
Standing bent over a table
Lithotomy (for females)

Question 5

Perirectal Abscess

Answer 5

Pus filled sac from infection around anal opening

Very painful, red, swollen, hard

Question 6

Fissures

Answer 6

Splits in the tissue of anal canal caused by trauma

Very painful, itches/bleeds

Question 7

Fistulas

Answer 7

Small round opening in skin around anal opening. Suggests a tract from the rectum to the skin, drains fluids, Abscess may precede fistulas

Question 8

Hemorrhoids (internal and external)

Answer 8

External - usually painless caused by varicose veins
Can be external or internal (have pt. strain and the internal ones may emerge)
Can contain clotted blood and become very painful, swollen, itch, and bleed

Question 9

Rectal prolapse

Answer 9

Occurs when the mucosa of the rectum telescopes through the anal opening (have the pt. strain). It appears as a red doughnut like mass with folds

Question 10

Pilonidal cysts

Answer 10

Congential disorder
See a small dimple or cyst/sinus that contains hair. Located midline in the sacrococccygeal area, and a palpable sinus tract

Question 11

Pedunculated

Answer 11

Rectal polyp on a stalk

Question 12

Sessile

Answer 12

Rectal polyp flat up against the colon

Question 13

Cancer of the Rectum

Answer 13

Usually asymptomatic
Often found during routine rectal exams
Feels like a firm nodule, an ulcerated nodule with rolled edges, or a large, irregualr shaped, fixed hard nodule

Question 14

Rectal Shelf

Answer 14

Metastatic CA somewhere in the peritoneal cavity that can protrude into the colon
Felt like a hard, nodular shelf like structure

Question 15

Gray-tan feces

Answer 15

No bile pigment

Question 16

Yellow stool

Answer 16

Increase in fat

Question 17

Maroon, black, tarry stool

Answer 17

Indicates presence of blood

Question 18

OCP test

Answer 18

Tests for ova, cysts, and parasites

Question 19

Guaiac (gFOBT)

Answer 19

Yearly from 45-50 y/o
Omit red meat, leafy green veggies, vitamin C, drugs (ASA, steroids, NSAIDS, anticoagulants)
Avoid in pt. has bleeding gums or on menstrual periods

Question 20

FOBT

Answer 20

Regular use of FOBT reduced risk of death fro mCRC by 32% after 30 years of follow up
FOBT shown to decrease the incidence of CRC by 20 % by detecting large precancerous polyps

Question 21

Fecal Immunochemical Test (FIT)

Answer 21

Done every year
Uses antibodies against hemoglobin to detect hidden blood in the stool
Has no dietary restrictions
Requires Less stool samples
Fewer false positive results
Twice as likely to detect advanced adenomas and cancer

Question 22

FIT - DNA (Cologuard)

Answer 22

Done every 3 years
Multi targeted bc it detects blood in stool and also genetic mutation in DNA of cells by large adenomas and CRC
Detected more cancer and precancerous lesions more often than FIT test
Less false positive tests

Question 23

Hermaphrodite

Answer 23

Ambiguous genitalia

Question 24

Pediatric Variations

Answer 24

Frequent UTI in females (bubble baths or molestation)
Diaper rash
constipation
Diarrhea

Question 25

OA Variations

Answer 25

Prone to constipation and diarrhea
CA more common
Increase in frequency of UTI; often cause of sepsis
Prostate enlarged after age 40