Ch. 25 Anus, Rectum, Prostate

Question 1

By when is the first stool passed in newborn?

Answer 1

Within 24-48 hrs

Question 2

what are characteristics of newborn stool

Answer 2

dark green meconiaum

Question 3

what is gastrocolic reflex?

Answer 3

infant usually having stool after each feeding; response to eating is a wave of peristalsis

Question 4

By what age does voluntary control of external anal sphincter occur?

Answer 4

1 1/2 to 2 y.o.

Question 5

What occurs to the male prostate gland during puberty?

Answer 5

It increases to more double its prepubertal size

Question 6

At what age does the prostate gland start to enlarge?

Answer 6

middle adult years (BPH)

Question 7

What effect does BPH have on urine output and why/

Answer 7

impedes urine output gradually b/c prostate obstructs urethra.

Question 8

Subj. data: usual bowel routine - criteria for constipation

Answer 8

Use Rome III criteria for constipation

* less than or equal to 3 stools/week; straining; lumpy or hard stools; and incomplete evacuation

Question 9

What are the risks for constipation?

Answer 9

1. Older age
2. Women
3. Inactivity
4. Low calorie diet or low fiber diet
5. Low income or low education level

Question 10

what is Dyschezia

Answer 10

pain due to local condition (hemorrhoid, fissure) or constipation

Question 11

what are some causes of diarrhea

Answer 11

gastroenteritis, colitis, irritable colon syndrome

Question 12

what are some epidemiological risks of change in bowel habits/diarrhea?

Answer 12

Visit to daycare center, undercooked meat or eggs, swimming in contaminated water physical contact w/ other sick people, eating raw shellfish. Can consider food poisoning if recent restaurant visit. Consider parasitic or bacterial infection if pt traveled outside of country recently. E. coli is the most frequent cause of traveler’s diarrhea.

Question 13

what is melana

Answer 13

Occult blood in stool

Question 14

what are some common causes of flatulence

Answer 14

can occur with some meds, nutritional supplements, crohn disease, certain foods.

Question 15

Color changes to stool: color and causes

Answer 15

Black stools may be tarry due to occult blood from GI bleeding or non-tarry from ingestion of iron meds.
Red blood in stools occur with GI bleeding or local bleeding around anus and w/ colon and rectal cancer.
Clay color stools indicates absence of bile pigment, as with biliary cirrhosis, gallstones or alcoholic or viral hepatitis.
Frothy stool can indicate steatorrhea which is excessive fat in stool, from malabsorption of fat from celiac disease, cystic fibrosis, chronic pancreatitis, crohn disease.

Question 16

what is steatorrhea

Answer 16

excessive fat in the stool

Question 17

Rectal conditions to ask about

Answer 17

Fecal incontinence (leaking of solid or liquid stool involuntarily)
Mucoid discharge and soiled underwear (occur with prolapsed hemorrhoids)

Question 18

Family hx subj. data to ask re: anus, rectum, prostate

Answer 18

Want to inquire about family hx of polyps or cancer in colon or rectum, IBS or prostate cancer. Want to explore risk factors for colon cancer, rectal cancer, prostate cancer.

Question 19

Pt. centered care: what to ask

Answer 19

what amt of high fiber foods do you eat in daily diet? How many glasses of water do you drink per day?

Question 20

What are some high fiber foods?

Answer 20

Beans, prunes, barley, carrots, broccoli, cabbage.

Question 21

What are some benefits to high fiber foods?

Answer 21

High fiver foods lower cholesterol levels, whereas insoluble fiber foods reduce risk for colon cancer. Fiber foods fight obesity, stabilize blood sugar, help some GI disorders.

Question 22

Add’l hx for infants/children

Answer 22

i. Irritation in child’s anal area: pinworms are common cause of itching and irritated anal skin
ii. Ask about BM – frequency, problems, pain or straining:
1. Assess usual stooling patterns. Encopresis is persistent passing of stools into clothing in a child older then 4, at which age continence would be expected.

Question 23

What are recommendations for digital rectum, stool blood test, colonoscopy, PSA blood test/exams?

Answer 23

Early detection for cancer: DRE performed annually after 50 y.o.; fecal occult blood test annually after age 50 y.o.; sigmoidoscopy q 5 yrs or colonoscopy q 10 years after 50 y.o. or 45 for African Americans. PSA test annually for men older than 50 or 45 for African Americans

Question 24

What are the best positions for examination

Answer 24

left lateral, lithotomy, standing

Question 25

Abnormal findings: perianal inspection

Answer 25

i. Lesions and scars are abnormal findings
ii. Fissure is a linear split
iii. Small round opening in anal area is a fistula (anal area is supposed to be tightly closed, no lesions, hairless with coarse, folded skin that is more pigmented than perineal skin.
iv. Inflammation or tenderness, swelling, tuft of hair or dimple at tip of coccyx may indicate pilonidal cyst.
v. Instruct person to hold breath and bear down by performing Valsalva maneuver. There should be no break in integrity or protrusion through the anal opening. Abnormal finding would be a fissure or hemorrhoids.
vi. Rectal prolapse is a circular red doughnut of tissue.

Question 26

what approach should you avoid to inspect/palpate anus and rectum

Answer 26

do NOT come in at right angle as this is painful and does not promote relaxation of sphincter

Question 27

abnormal findings: anus and rectum

Answer 27

1. Decreased tone is abnormal; as is increased tone that occurs with inflammation and anxiety. Tenderness is also an abnormal finding. (ask person to tighten muscle to assess).
2. swelling or tenderness
3. rectal wall: abnormal findings include:
   a. Internal hemorrhoid above anorectal j’n is not palpable unless thrombosed.
   b. A soft, slightly moveable mass may be a polyp
   c. A firm or hard mass w/ irregular shape or rolled edges may signify carcinoma.

Question 28

Normal prostate findings

Answer 28

2.5 cm long by 4 cm wide; should not protrude more than 1 cm into the rectum
Shape: heart shape, with palpable central groove
Surface: Smooth
Consistency: elastic, rubbery
Mobility: slightly moveable
Sensitivity: nontender to palpation

Question 29

Abnormal prostate findings

Answer 29

Enlarged, firm, smooth gland with central groove obliterated can suggest BPH.
Hard, or boggy, soft, fluctuant is abnormal
Any tone hard, irregular, fixed nodule indicates carcinoma

Question 30

Stool abnormalities

Answer 30

a. Black tarry stool w/ distinct malodor indicates upper GI bleeding w/ blood partially digested (must lose more than 50 mL from upper GI to be considered melena).
b. Black stool: also occurs with ingesting iron or bismuth prep
c. Gray, tan stool – absent bile pigment (e.g. obstructive jaundice)
d. Pale, yellow, greasy stool – increased fat content as occurs with malabsorption syndrome
e. Occult bleeding usually indicates cancer of colon.
f. jellylike mucus shreads mixed in stool can indicate inflammation

Question 31

Developmental comp. aging adult

Answer 31

you may note relaxation of perianal musculature and decreased sphincter control

Question 32

what is the valsalva maneuver

Answer 32

the action of attempting to exhale with the nostrils and mouth, or the glottis, closed. This increases pressure in the middle ear and the chest, as when bracing to lift heavy objects, and is used as a means of equalizing pressure in the ears.

Question 33

What is encopresis

Answer 33

persistent passing of stools into clothing in a child older than 4 y.o., at which age continence is expected.

Question 34

In infants how do you check anal reflex?

Answer 34

check anal reflex by stroking anal area, sphincter should contract quickly.