Exam #4: Anus & Rectum

Question 1

What diseases is melena a sign of?

Answer 1

Upper source: GERD, peptic ulcer, gastritis

*Note that melena is “sticky”

Question 2

What are the diseases the are associated with hematochezia?

Answer 2

Lower source: colon rectum or anus

• Colon cancer, polyps, diverticula, hemorrhoids, anal fissure, inflammatory conditions of the colon and rectum

Question 3

List some epidemiologist statistics related to prostate cancer.

Answer 3

• Leading male cancer diagnosis
• Second leading cause of death in men (to heart disease)
• Risk increases after 50
• Risk is higher in African American males

If you biopsy a male’s prostate after 50, their age in years is the equal to the probability that you find abnormal cells

Question 4

What are the three requirements for effective screening?

Answer 4

1) Patient need to be at some RISK
2) Asymptomatic
3) Effective interventions must exist

Question 5

Is it recommended to generally screen for prostate disease?

Answer 5

NO–screening is grade “D” i.e. DO NOT screen

Question 6

When is screening for prostate disease indicated? What method is recommended?

Answer 6

Starting at age 45 for risk based i.e:

• African American
• Father or brother with prostate cancer before 65

*PSA (antigen testing) is not recommended–>DRE

Question 7

What tumors does DRE detect well?

Answer 7

Tumors on the posterior & lateral aspects of the prostate; these are the tumors that can be reached

*There is a LOW SENSITIVITY to testing–>you’ll miss 40% of tumors

Question 8

When is colorectal screening recommended?

Answer 8

Starting at 50 years in both sexes

- Colonoscopy Q10 years

Question 9

What are the signs of acute bacterial prostatitis?

Answer 9

Dysuria 
Frequency 
Nocturia (new) 
Hesitancy 
Subrapubic pain
Painful ejaculation 
Flu-like symptoms

*with increased WBC count

Question 10

What are the signs and symptoms of BPH?

Answer 10

Same as acute bacterial prostatitis but WITHOUT inflammation

Question 11

Is PSA useful after you have done DRE?

Answer 11

NO

Question 12

What is the differentiating factor between BPH & prostate cancer?

Answer 12

Prostate cancer is associated with asymmetric enlargement of the prostate vs. BPH that is symmetrical

Question 13

What is an anal fissure?

Answer 13

Tear in the skin of the anus

• acute
• small blood

Caused by straining & constipation

Question 14

What is an anal fistula?

Answer 14

Infected anal gland above the dentate line that becomes a chronic draining abscess
- Bypasses the external sphincter and can lead to stool leakage

Question 15

What is the difference between internal & external hemorrhoids?

Answer 15

External hurt (below dentate line)

Question 16

What is a rectal prolapse?

Answer 16

A protruding mass from the anus that can initially be reduced

Question 17

What are polyps?

Answer 17

Intestinal growths