Anus and Rectum Flashcards
Change in bowel pattern, especially stools of thin pencil like shape, may warn of
colon cancer
Blood in the stool may be from
polyps,cancer, GI bleeding,local hemorrhoids; mucus may accompany villous adenoma
Positive answers to what can indicate increased risk for colorectal cancer and a need for further testing and surveillance?
person or family hx of colonic polyps, colorectal cancer, of IBD
What is indicated by itching, anorectal pain, tenesmus, discharge or bleeding from infection or rectal abscess?
Proctitis. Also itching in young patients may be due to pinworms
What are some causes of proctitis?
Causes include gonorrhea, chlamydia, lymphogranuloma, venereum, receptive anal intercourse, ulcerations of herpes simplex, chancre, of primary syphilis.
What can occur from HPV and condylamata lata in secondary syphilis?
Genital Warts. Anal fissures can be found in proctitis, crohn’s disease
Problems with starting or holding back urine in stream, weak flow, frequent urination at night, burning/painful urination all suggest?
urethral obstruction as in benign prostate hyperplasia (BPH) or prostate cancer, especially in men older than 70.
feelings of discomfort or heaviness in the prostate area at the base of the penis, which is also associated with malaise, fever, chills suggest?
possible prostatitis
True or false: no matter how you position the patient, your examining finger cannot reach the full length of the rectum.
TRUE
what are examples of anal and perianal lesions?
hemorrhoids, venereal warts, herpes, syphilitic chancre, and carcinoma
a linear crack of tear suggests an anal fissure which can occur from what?
large, hard stools, IBD, or STIs
If there is swollen, thickened, fissured perianal skin with excoriations, what should you consider?
pruritus ani
tender, purulent, reddened mass with fever or chills accompanies what?
anal abscess
abscesses tunneling to the skin surface from the anus or rectum may form a what?
clogged or draining anorectal fistula. Fistulas may ooze blood, pus, or feculent mucus.
what should you consider to get a better view of anorectal fistulas?
anoscopy or signmoidoscopy
what can cause sphincter tightness?
anxiety, inflammation, or scarring. Laxity occurs in neurologic diseases
what causes induration (the quality of being hardened)?
scarring, inflammation, or malignancy
What are possible findings in a digital prostate exam?
rectal “shelf” of peritoneal metastases or the tenderness of peritoneal inflammation
A single fecal occult blood test is not an adequate screen for which cancer?
colon
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?
proctitis from infectious cause
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?
prostate cancer
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.
pilonidal cyst. Typically asymptomatic except for perhaps slight drainage, abscess formation and secondary sinus tracts
dilated hemorrhoidal veins that originate below the pectinate line and are covered with skin. These seldomly produce symptoms unless thrombosis occurs.
external hemorrhoid (thrombosed)
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.
external hemorrhoid (thrombosed)
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.
internal hemorrhoid (prolapsed)
These may prolaspe through the anal canal and appear as reddish, moist, and protruding masses
internal hemorrhoids (prolapsed)
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.
prolapse of the rectum.
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
small; larger
a very painful oval ulceration of the anal canal, found most commonly in the midline posteriorly, less commonly in the midline anteriorly.
anal fissure
This has a long axis that lies longitudinally. There may be a swollen “sentinel” skin tag just below it.
anal fissure. Gentle separation of the anal margins may reveal the lower edge of the fissure.
the anal sphincter is spastic with this condition and the examination is painful when a pt has this.
anal fissure
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.
Anorectal fistula- look for these openings in the skin around the anus.
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.
Polyps of the rectum.
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.
rectal shelf
in women, where does the rectal shelf of metastatic tissue develop?
in the rectounterine pouch, behind the cervix and uterus
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.
normal prostate gland.
only the ________ surface of the prostate is palpable
posterior
True or false: anterior lesions on the prostate, including those that may obstruct the urethra, are detectable by physical examination
FALSE
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.
acute bacterial prostatitis
What organisms are typically the cause of acute bacterial prostatitis
80% come from gram negative aerobes like E.coli, enterococcus, and proteus. In men older than 35, consider Sexual transmission of chlamydia or gonorrhea
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
chronic bacterial prostatitis
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.
chronic pelvic pain syndrome
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.
benign prostatic hyperplasia
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.
benign prostatic hyperplasia
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.
cancer of the prostate. As the cancer enlarges, it feels irregular and may extend beyond the confines of the prostate gland.
hard areas in the prostate are not always malignant. What are some other things that can cause hard areas in the prostate?
prostatic stones, chronic inflammation, and other conditions
