anus, rectum, prostate Flashcards
Concerning symptoms of the anus and rectum
- change in bowel habits
- melena/hematochezia
- pain with defecations
- rectal bleeding
- tenderness
- history of anal warts/fissures
anal pain, itching, tenesmus or discharge, bleeding is
proctitis
what are the causes of proctitis
- IBD
- STI
- Radiation induced
- bacterial infection
- trauma
what is the main cause of rectal itching in younger patients?
pinworms
how do kids get pinworms?
through ingestion (they are in soil and can transfer through the hands)
when is the scotch tape test conducted?
for pinworms
* put scotch tape on the anus
what causes accumulate, cauliflower like warts? what causes it?
Condyloma acuminata
HPV
what is a flat top wart seen secondary in syphilis?
Condyloma lata
where are anal fissure found?
midline is most common
what can cause anal fissures?
- constipation
- straining
- crohn’s
- trauma (anal sex)
- infection
- STI/STD
- anal cancer
what are some obstructive symptoms
- difficulty starting stream
- weak stream
- incomplete bladder emptying
what are some irritative symptoms?
- dysuria
- urinary frequency
- urgency
what position do you have th pt in for a DRE
on the side or standing over a table
what 2 things are you assessing for during a DRE
- anal sphincter tone
- anal canal and rectal surgace for abnromalities
what do you palpate the prostate for?
the lateral lobes and median sulcus
note the size, shape, texture, mobility, nodules
what does the prostate normally feel like?
- rubbery and nontender
- round, heart shaped
- only the posterior side
how long is the normal prostate
2.5cm
what are some indications for a DRE
- abdominal or pelvic pain
- prostate exam
- change in bowel habits
- rectral bleeding, pain, itching
- melena/hematochezia
- urinary or fecal incontinence
where is a pilonidal cyst found
midline natal cleft superficial to the coccyx
what pathology may you possibly see the opening of a sinu tract with a small tuft of hair surrounded by erythema
pilonidal cyst
pilonidal cysts are normally _________ until an abscess forms
asymptomatic
what hemorrhoid causes pain
external hemorrhoids that are thrombosed
what hemorrhoid originates below the denate line and are covered with skin?
external hemorrhoids
what does thormbosis of an external hemorrhoid cause?
acute pain with a tender, swollen, bluish mass at the anal margin
where are internal hemorrhoids found?
above the denate line that can cause bleeding with defecation
which hemorrhoid causes bleeding with defecation?
internal hemorrhoids
what can happen to internal hemorrhoids?
they can prolapse
what pathology appears as a rosette from the anus with radiating folds?
Partial thickness rectal prolapse
(rectal mucosa only)
what pathology appears as larger mass from the anus and is covered by circular folds?
full thickness rectal prolapse (entire bowel wall prolapse)
what is a very painful tear of the anoderm?
anal fissure
where do anal fissures most commonly occur ?
the midline posteriorly
what is associated with a sentinel skin tag
anal fissure
what does the anus sphincter feel like for a DRE with anal fissures
anal sphincter is spastic
exam is painful
what is a fissure that gos from the anal glands to an external opening of the skin
anorectal fissure
what is anorectal fistulas a result of
previous anorectal abscess/infection
what are the two types of polyps of the rectum
- peduncalated (stalk)
- sessile (flat)
are polyps easy to feel?
No they are soft and difficult to feel
how do you differentiate polyps from malignancy
sigmoidoscopy or colonoscopy and biopsy
what is a rectal shelf from?
peritoneal metastases
usually on the anterior
pts have a “boggy” or swollen prostate
acute bacterial prostatitis
what do pts present with for acute bacterial prostatitis
- fever
- uti symptoms
- perineal/suprapubic/rectal pain
in males <35 experiencing acute bacterial prostatitis, consider
- n. gonorrhea
- C. trachomatis
in males >35 experiencing acute bacterial prostatitis, consider
e. coli
enterococcus proteus
how does chronic bacterial prostatitis prostate feel?
- normal
- without swelling or tenderness
what is associated with recurrent UTIs and the same organism
chronic bacterial prostatitis
what symptoms are associated with chronic bacterial prostatitis
- asymptomatic
- dysuria
- mild pelvic pain
what does the prostate feel like for BPH pts
- symmetrically enlarged
- smooth
- firm
- +/- median sulcus palpable
what symptoms are associated with BPH
irritative or obstructive or both
what is suggested by an area of hardness in the gland?
prostate cancer
what is the normal “finger print” of a prostate
2 fingerprints
20g weight
what is the most frequently diagnosed non-skin cancer in the US?
Prostate cancer
what age is at higher risk for prostate cancer
> 50 yo
what ethnicity is associated with higher risk of prostate cancer
African american
higher chance before 50yo and advance stage
what family history is associated with increased risk of prostate cancer?
- first degree relative (2x the risk)
- 2+ relatives with prostate cancer (5-11x risk)
- BRCA mutations
smoking, agent orange, high fat diety, and obesity are assoicated with higher risk of
prostate cancer
what can elevate PSA
- prostate cancer
also:
* BPH
* prostatitis
* perianal trauma
* prostate infection
* ejaculation
* dre
what does PSA stand for
prostate specific antigen
what is considered a normal level of PSA
<4ng/ml
what % of men will have a PSA elevated and what % will have cancer
12% of men with elvated PSA
30% with prostate cancer
what percent of men with abnormal DRE will have prostate cancer on biopsy
28% of men
what types of cancer metastasize to the bone?
- breast
- lung
- tomato
- kidney
- prostate
