Anus and Rectum

Question 1

Change in bowel pattern, especially stools of thin pencil like shape, may warn of

Answer 1

colon cancer

Question 2

Blood in the stool may be from

Answer 2

polyps,cancer, GI bleeding,local hemorrhoids; mucus may accompany villous adenoma

Question 3

Positive answers to what can indicate increased risk for colorectal cancer and a need for further testing and surveillance?

Answer 3

person or family hx of colonic polyps, colorectal cancer, of IBD

Question 4

What is indicated by itching, anorectal pain, tenesmus, discharge or bleeding from infection or rectal abscess?

Answer 4

Proctitis. Also itching in young patients may be due to pinworms

Question 5

What are some causes of proctitis?

Answer 5

Causes include gonorrhea, chlamydia, lymphogranuloma, venereum, receptive anal intercourse, ulcerations of herpes simplex, chancre, of primary syphilis.

Question 6

What can occur from HPV and condylamata lata in secondary syphilis?

Answer 6

Genital Warts. Anal fissures can be found in proctitis, crohn’s disease

Question 7

Problems with starting or holding back urine in stream, weak flow, frequent urination at night, burning/painful urination all suggest?

Answer 7

urethral obstruction as in benign prostate hyperplasia (BPH) or prostate cancer, especially in men older than 70.

Question 8

feelings of discomfort or heaviness in the prostate area at the base of the penis, which is also associated with malaise, fever, chills suggest?

Answer 8

possible prostatitis

Question 9

True or false: no matter how you position the patient, your examining finger cannot reach the full length of the rectum.

Answer 9

TRUE

Question 10

what are examples of anal and perianal lesions?

Answer 10

hemorrhoids, venereal warts, herpes, syphilitic chancre, and carcinoma

Question 11

a linear crack of tear suggests an anal fissure which can occur from what?

Answer 11

large, hard stools, IBD, or STIs

Question 12

If there is swollen, thickened, fissured perianal skin with excoriations, what should you consider?

Answer 12

pruritus ani

Question 13

tender, purulent, reddened mass with fever or chills accompanies what?

Answer 13

anal abscess

Question 14

abscesses tunneling to the skin surface from the anus or rectum may form a what?

Answer 14

clogged or draining anorectal fistula. Fistulas may ooze blood, pus, or feculent mucus.

Question 15

what should you consider to get a better view of anorectal fistulas?

Answer 15

anoscopy or signmoidoscopy

Question 16

what can cause sphincter tightness?

Answer 16

anxiety, inflammation, or scarring. Laxity occurs in neurologic diseases

Question 17

what causes induration (the quality of being hardened)?

Answer 17

scarring, inflammation, or malignancy

Question 18

What are possible findings in a digital prostate exam?

Answer 18

rectal “shelf” of peritoneal metastases or the tenderness of peritoneal inflammation

Question 19

A single fecal occult blood test is not an adequate screen for which cancer?

Answer 19

colon

Question 20

perirectal area inflamed; no ulcerations, warts, or discharge. Unable to examine external sphincter, rectal, vault, or prostate because of spasm of external sphincter and marked inflammation and tenderness of anal canal. This suggests?

Answer 20

proctitis from infectious cause

Question 21

No perirectal lesions or fissures. External sphincter tone intact. Rectal vault without masses. Left lateral prostate lobe with 1 x 1 cm firm, hard nodule; right lateral lobe smooth; median sulcus obscured. Stool brown and hemoccult negative This raises concern for?

Answer 21

prostate cancer

Question 22

congenital abnormality located in the midline superficial to the coccyz or lower sacrum. Also may have an opening of a sinus tract which may exhibit, a small tuft of hair surrounded by a halo of erythema.

Answer 22

pilonidal cyst. Typically asymptomatic except for perhaps slight drainage, abscess formation and secondary sinus tracts

Question 23

dilated hemorrhoidal veins that originate below the pectinate line and are covered with skin. These seldomly produce symptoms unless thrombosis occurs.

Answer 23

external hemorrhoid (thrombosed)

Question 24

This is a tender, swollen, bluish, ovoid mass that is visible at the anal margin. It causes acute local pain that increases with defecation and sitting.

Answer 24

external hemorrhoid (thrombosed)

Question 25

Enlargements of the normal vascular cushion located above the pectinate line. They are not usually palpable. Sometimes, especially during defecation, these may cause bright-red bleeding.

Answer 25

internal hemorrhoid (prolapsed)

Question 26

These may prolaspe through the anal canal and appear as reddish, moist, and protruding masses

Answer 26

internal hemorrhoids (prolapsed)

Question 27

on straining for a bowel movement, the rectal mucosa, with or without its muscular wall, may prolapse through the anus, appearing as a doughnut or rosette of red tissue.

Answer 27

prolapse of the rectum.

Question 28

a prolapse involving only mucosa is relatively (small or large?) and shows radiating folds. When the entire bowel wall is involved, the prolapse is (larger or smaller?) and covered by concentrically circular folds

Answer 28

small; larger

Question 29

a very painful oval ulceration of the anal canal, found most commonly in the midline posteriorly, less commonly in the midline anteriorly.

Answer 29

anal fissure

Question 30

This has a long axis that lies longitudinally. There may be a swollen “sentinel” skin tag just below it.

Answer 30

anal fissure. Gentle separation of the anal margins may reveal the lower edge of the fissure.

Question 31

the anal sphincter is spastic with this condition and the examination is painful when a pt has this.

Answer 31

anal fissure

Question 32

an 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 typically antedates this condition.

Answer 32

Anorectal fistula- look for these openings in the skin around the anus.

Question 33

These are fairly common. They are variable in size and number, they can develop on a stalk (pedunculated) or lie on the mucosal surface (sessile). They are soft and may be difficult or impossible to feel even when in reach of the examining finger. Protoscopy and biopsy are needed for differentiation of benign from malignant lesions.

Answer 33

Polyps of the rectum.

Question 34

widespread peritoneal metastases from any source may develop in the area of the peritoneal reflection anterior to the rectum. This is a firm to hard nodule that may be just palpable with the tip of the examining finger.

Answer 34

rectal shelf

Question 35

in women, where does the rectal shelf of metastatic tissue develop?

Answer 35

in the rectounterine pouch, behind the cervix and uterus

Question 36

this can be palpated through the anterior rectal wall, and is rounded, heart0shaped structure approximately 2.5 cm long. The median sulcus can be felt between the two lateral lobes.

Answer 36

normal prostate gland.

Question 37

only the ________ surface of the prostate is palpable

Answer 37

posterior

Question 38

True or false: anterior lesions on the prostate, including those that may obstruct the urethra, are detectable by physical examination

Answer 38

FALSE

Question 39

this condition presents with fever and urinary tract symptoms such as frequency, urgency, dysuria, incomplete voiding, and sometimes low back pain. The prostate gland feels tender, swollen, “boggy” and warm.

Answer 39

acute bacterial prostatitis

Question 40

What organisms are typically the cause of acute bacterial prostatitis

Answer 40

80% come from gram negative aerobes like E.coli, enterococcus, and proteus. In men older than 35, consider Sexual transmission of chlamydia or gonorrhea

Question 41

what condition is associated with recurrent urinary tract infections, usually from the same organism. Men who have this may be asymptomatic or have symptoms of dysuria or mild pelvic pain. Prostate gland may feel normal, without tenderness or swelling. Cultures of prostatic fluid usually show infection with E. coli

Answer 41

chronic bacterial prostatitis

Question 42

This is seen in up to 80% of symptomatic men who report obstructive or irritative symptoms on voiding but show no evidence of prostate or urinary tract infection.

Answer 42

chronic pelvic pain syndrome

Question 43

nonmalignant enlargement of the prostate gland that increases with age, presents in more than 50% of men by 50 years of age. Symptoms arise both from smooth-muscle contraction in the prostate and bladder neck and from compression of the urethra.

Answer 43

benign prostatic hyperplasia

Question 44

Symptoms of this may be irritative (urgency, frequency, nocturia), obstructive (decreased stream, incomplete emptying, straining), or both, and are seen in more than 1/3 of men by 65 years of age. The affected prostate gland may be normal in size or may feel symmetrically enlarged, smooth, and firm, though slightly elastic; There may be obliteration of the median sulcus and more notable protrusion into the rectal lumen.

Answer 44

benign prostatic hyperplasia

Question 45

an are of hardness in the prostate gland suggests this. A distinct hard nodule that alters the contour of the gland may or may not be palpable. The median sulcus of the prostate may be obscured.

Answer 45

cancer of the prostate. As the cancer enlarges, it feels irregular and may extend beyond the confines of the prostate gland.

Question 46

hard areas in the prostate are not always malignant. What are some other things that can cause hard areas in the prostate?

Answer 46

prostatic stones, chronic inflammation, and other conditions