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Patient Assessment > anus, rectum, prostate > Flashcards

anus, rectum, prostate Flashcards

1
Q

Concerning symptoms of the anus and rectum

A
  • change in bowel habits
  • melena/hematochezia
  • pain with defecations
  • rectal bleeding
  • tenderness
  • history of anal warts/fissures
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2
Q

anal pain, itching, tenesmus or discharge, bleeding is

A

proctitis

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3
Q

what are the causes of proctitis

A
  • IBD
  • STI
  • Radiation induced
  • bacterial infection
  • trauma
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4
Q

what is the main cause of rectal itching in younger patients?

A

pinworms

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5
Q

how do kids get pinworms?

A

through ingestion (they are in soil and can transfer through the hands)

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6
Q

when is the scotch tape test conducted?

A

for pinworms
* put scotch tape on the anus

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7
Q

what causes accumulate, cauliflower like warts? what causes it?

A

Condyloma acuminata
HPV

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8
Q

what is a flat top wart seen secondary in syphilis?

A

Condyloma lata

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9
Q

where are anal fissure found?

A

midline is most common

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10
Q

what can cause anal fissures?

A
  • constipation
  • straining
  • crohn’s
  • trauma (anal sex)
  • infection
  • STI/STD
  • anal cancer
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11
Q

what are some obstructive symptoms

A
  • difficulty starting stream
  • weak stream
  • incomplete bladder emptying
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12
Q

what are some irritative symptoms?

A
  • dysuria
  • urinary frequency
  • urgency
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13
Q

what position do you have th pt in for a DRE

A

on the side or standing over a table

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14
Q

what 2 things are you assessing for during a DRE

A
  1. anal sphincter tone
  2. anal canal and rectal surgace for abnromalities
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15
Q

what do you palpate the prostate for?

A

the lateral lobes and median sulcus

note the size, shape, texture, mobility, nodules

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16
Q

what does the prostate normally feel like?

A
  • rubbery and nontender
  • round, heart shaped
  • only the posterior side
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17
Q

how long is the normal prostate

A

2.5cm

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18
Q

what are some indications for a DRE

A
  1. abdominal or pelvic pain
  2. prostate exam
  3. change in bowel habits
  4. rectral bleeding, pain, itching
  5. melena/hematochezia
  6. urinary or fecal incontinence
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19
Q

where is a pilonidal cyst found

A

midline natal cleft superficial to the coccyx

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20
Q

what pathology may you possibly see the opening of a sinu tract with a small tuft of hair surrounded by erythema

A

pilonidal cyst

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21
Q

pilonidal cysts are normally _________ until an abscess forms

A

asymptomatic

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22
Q

what hemorrhoid causes pain

A

external hemorrhoids that are thrombosed

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23
Q

what hemorrhoid originates below the denate line and are covered with skin?

A

external hemorrhoids

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24
Q

what does thormbosis of an external hemorrhoid cause?

A

acute pain with a tender, swollen, bluish mass at the anal margin

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25
Q

where are internal hemorrhoids found?

A

above the denate line that can cause bleeding with defecation

26
Q

which hemorrhoid causes bleeding with defecation?

A

internal hemorrhoids

27
Q

what can happen to internal hemorrhoids?

A

they can prolapse

28
Q

what pathology appears as a rosette from the anus with radiating folds?

A

Partial thickness rectal prolapse
(rectal mucosa only)

29
Q

what pathology appears as larger mass from the anus and is covered by circular folds?

A

full thickness rectal prolapse (entire bowel wall prolapse)

29
Q

what is a very painful tear of the anoderm?

A

anal fissure

30
Q

where do anal fissures most commonly occur ?

A

the midline posteriorly

31
Q

what is associated with a sentinel skin tag

A

anal fissure

32
Q

what does the anus sphincter feel like for a DRE with anal fissures

A

anal sphincter is spastic

exam is painful

33
Q

what is a fissure that gos from the anal glands to an external opening of the skin

A

anorectal fissure

34
Q

what is anorectal fistulas a result of

A

previous anorectal abscess/infection

35
Q

what are the two types of polyps of the rectum

A
  1. peduncalated (stalk)
  2. sessile (flat)
36
Q

are polyps easy to feel?

A

No they are soft and difficult to feel

37
Q

how do you differentiate polyps from malignancy

A

sigmoidoscopy or colonoscopy and biopsy

38
Q

what is a rectal shelf from?

A

peritoneal metastases

usually on the anterior

39
Q

pts have a “boggy” or swollen prostate

A

acute bacterial prostatitis

40
Q

what do pts present with for acute bacterial prostatitis

A
  • fever
  • uti symptoms
  • perineal/suprapubic/rectal pain
41
Q

in males <35 experiencing acute bacterial prostatitis, consider

A
  • n. gonorrhea
  • C. trachomatis
42
Q

in males >35 experiencing acute bacterial prostatitis, consider

A

e. coli
enterococcus proteus

43
Q

how does chronic bacterial prostatitis prostate feel?

A
  • normal
  • without swelling or tenderness
44
Q

what is associated with recurrent UTIs and the same organism

A

chronic bacterial prostatitis

45
Q

what symptoms are associated with chronic bacterial prostatitis

A
  • asymptomatic
  • dysuria
  • mild pelvic pain
46
Q

what does the prostate feel like for BPH pts

A
  • symmetrically enlarged
  • smooth
  • firm
  • +/- median sulcus palpable
47
Q

what symptoms are associated with BPH

A

irritative or obstructive or both

48
Q

what is suggested by an area of hardness in the gland?

A

prostate cancer

49
Q

what is the normal “finger print” of a prostate

A

2 fingerprints
20g weight

50
Q

what is the most frequently diagnosed non-skin cancer in the US?

A

Prostate cancer

51
Q

what age is at higher risk for prostate cancer

A

> 50 yo

52
Q

what ethnicity is associated with higher risk of prostate cancer

A

African american

higher chance before 50yo and advance stage

53
Q

what family history is associated with increased risk of prostate cancer?

A
  • first degree relative (2x the risk)
  • 2+ relatives with prostate cancer (5-11x risk)
  • BRCA mutations
54
Q

smoking, agent orange, high fat diety, and obesity are assoicated with higher risk of

A

prostate cancer

54
Q

what can elevate PSA

A
  1. prostate cancer
    also:
    * BPH
    * prostatitis
    * perianal trauma
    * prostate infection
    * ejaculation
    * dre
55
Q

what does PSA stand for

A

prostate specific antigen

55
Q

what is considered a normal level of PSA

A

<4ng/ml

56
Q
A
57
Q

what % of men will have a PSA elevated and what % will have cancer

A

12% of men with elvated PSA
30% with prostate cancer

58
Q

what percent of men with abnormal DRE will have prostate cancer on biopsy

A

28% of men

59
Q

what types of cancer metastasize to the bone?

A
  • breast
  • lung
  • tomato
  • kidney
  • prostate

Patient Assessment (20 decks)

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