Genital Flashcards
Sacrococcygeal inspection for what in particular?
pilonidal dimpling and/or tufts of hair
Inspect anus for what?
- skin characteristics and tags
- lesions, fissures, hemorrhoids, polyps
- fistulae
- prolapse
Palpate posterior surface of prostate for what?
- size
- contour
- consistency
- mobility
Palpation through anterior rectal wall in females for?
cervix and uterus
- size
- shape
- position
- smoothness
- mobility
Anal canal innervation (upper and lower)
- lower half: somatic sensory nn. (sensitive)
- upper half: autonomic control (insensitive)
Spaces between mucosal Columns of Morgagni in anus
crypts - anal glands empty into these
Hemorrhoid Types
- anastomosing veins cross the columns
- Zona hemorrhoidalis
- Internal hemorrhoids
- lower segment of anal canal
- venous plexus that drains into inferior rectal veins
- external hemorrhoids
Rectal storage of flatus and feces
- ampulla- stores flatus and feces
- Houston valves
- 3 semilunar transverse folds - lowest can be palpated
Prostate lobes
3: median sulcus w/ left and right lateral lobes
Infant and Child UG Development
- first stool 24-48h after birth - indicates anal patency
- gastrocolic reflex - stool after each feeding
- toilet training at 2-4 years
- prostate underdeveloped until puberty
Pregnancy Complications
- decreased GI motility - constipation
- pressure in veins below enlarged uterus
- hemorrhoids - aggravated by labor
Older Adult Complications
- degeneration of afferent neurons in rectal wall
- can’t relax anal sphincter
- increase pressure sensation threshold
- stool retention
- loss of sphincter tone - incontinence
- fibromuscular structures of prostate atrophy
- benign hyperplasia of glandular tissue
- loss of function of secretory alveoli
Genital/Rectal HPI
- changes in bowel function
- character, onset/duration, assoc. symptoms, meds: iron, lax.
- anal discomfort (itch, pain, sting, burn)
- related to postion/defecation, straining, blood/mucus, ADL disruption, meds: hemorrhoid creams
- rectal bleeding
- color, related to defication, amount, changes in stool, assoc. symptoms, meds: fiber, iron
- males (change in urinary fx)
- prostate hx, hesitancy/urgency/nocturia/stream/discharge, meds: antihist., anticholinergics, antidepressants, 5-alpha-reductase inhibitors
PMH
- hemorrhoids
- spinal cord injury
- prostate
- epesiotomy
- colorectal CA or related (breast, ovarian, endometrial)
FH
- rectal polyps
- family colon CA
- prostate CA
Personal/Social Hx
- travel history
- diet: fiber and animal fat
- MSM
- HPV vaccination
- alcohol
Infants and Children Personal Hx
- stool characteristics
- BMs with crying, straining, bleeding
- feeding habits
- bowel control and potty training
- associated symptoms
- congenital anomalies
Pregnancy Personal Hx
- gestation and estimated delivery date
- exercise
- fluid intake and diet
- use of complimentary/alternative therapies
- meds: prenatal vitamins, iron
Older Adult Personal Hx
- change in bowel habits or character
- assoc. symptoms
- dietary changes
- males: enlarged prostate and urinary symptoms
Prostate Exam
- size, contour, consistency, mobility, tenderness
- firm, smooth and slightly movable
- about 4cm in diameter
- 1cm protrusion normal
- greater protrusion denotes enlargement
- bogginess indicates BPH
loose hairs penetrating skin in sacrococcygeal area
pilonidal cyst
sign of HPV infection in anus
anal warts
(condyloma acuminata)
infection of soft tissue surrounding anal canal
ususally polymicrobial
perianal/perirectal abscess
tear in anal mucosa
anorectal fissure
inflammatory tract running from anus/rectum
to surface of perianal skin or other tissue
(caused by drainage of abscess)
anal fistula
commonly d/t fungus in adults and parasites in children
pruritus ani
varicose veins below anorectal line covered by skin
or
above the anorectal junction covered by rectal mucosa
external / internal hemorrhoids
Anus Skin Lesions
- polyps (malignant or benign)
- anal cancer
- most squamous cell assoc. w/ HPV
- adenocarinomas originate in glands near anus
- basal cell carcinoma and malignant melanoma
- colorectal cancer
- most adenocarcinomas
Prostate Disorders
- prostatitis
- benign prostatic hypertrophy (BPH)
- prostatic cancer
- 99% adenocarcinomas from gland cells in prostate
Disorders in Children
- imperforate anus
- blind ending, stenosed, or fistulous connection to perineum, urinary tract, vagina
- enterobiasis (roudworm, pinworm)
- adult lives in rectum/colon and emerges at night to lay eggs in perianal skin
Male Infant/Child Development
- 12 weeks gestation: sexual differentiation
- 3rd trimester: testicals descend from retroperitoneal space through inguinal canal
- 3-4 years: prepuce separates from glans in uncircumcised
HPV Immunization in Males
- quadrivalent vaccine age 11-12
- HPV4 for ages 13-21 not vaccinated or not completed 30-dose series
- can recieve vaccine through age 26
- MSM
- immune compromised (HIV)
Benefis of Circumcision
- decreased UTIs
- decreased transmission of some STIs
- decreased acquisition of HIV
- decreased penile cancer risk
protrusion of peritoneal-lined sac through abdominal wall
hernia
- indirect- soft swelling in area of internal ring
- direct- swelling bulges anteriorly
- femoral - occurs in fossa ovalis where femoral artery exits abdomen
- strangulation - blood supply compromised
inability to replace foreskin after retraction
paraphimosis
urethral meatus on ventral surface of penis
hypospadias
skin lesion associated with primary syphilis
syphilitic chancre
lesion caused by HSV-2
genital herpes
lesions caused by HPV
genital warts (condyloma acuminata)
STI of lymphatics caused by Chlamydia trachomatis
lymphogranuloma venereum
benign skin infection caused by pox virus
molluscum cantagiosum
fluid accumulation in scrotum
hydrocele
benign cystic accumulation of sperm in epididymis
spermatocele
tortuosity and dilation of veins of
pampiniform plexus in spermatic cord
varicocele
acute inflammation of testis secondary to infection
orchitis
inflammation of epididymis often associated with UTI
epididymitis
twisting of testis on spermatic cord
testicular torsion
seminomas and nonseminomas arising from germ cells
testicular carcinoma
congenital anomaly associated with XXY chromosomes
Klinefelter syndrome
newborn genitalia not clearly male or female
ambiguous genetalia
d/t presence or absence of male hormone controls during development of sex organs
Steps to Perform Male Urethral Swab
- insert swab 1-2cm
- rotate in one direction 10 seconds
- withdraw swab, place into container, break at line
- seal and label vial
Breast Exam - Palpation
- chest wall sweep
- bimanual digital palpation
- lymph node palpation (incl. axillae and infraclavicular areas)
- all breast area in supine position
- tail of Spence
- nipples
benign fluid-filled cysts cuased by duct enlargment
fibrocystic changes
benign tumors of stromal and epithelial elements that represent a hyperplastic or proliferative process in a single termial duct
fibroadenoma
ductal carcinoma from epithelial lining of ducts /
lobular carcinoma from glandular tissue of lobules
malignant breast tumors
benign breast lump occurring as inflammatory response to injury
fat necrosis
benign tumor of subareolar ducts
produce nipple discharge
intraductal papillomas and papillomatosis
benign condition of subareolar ducts that produce discharge
duct ectasia
lactation not associated with childbearing
galactorrhea
surface manifestation of underlying ductal carcinoma
Paget disease
inflammation and infection of breast tissue
mastitis
breast enlargement in men
gynecomastia
breast enlargement in girls before puberty
premature thelarche
