male gu exam 3 Flashcards
common or concerning symptoms in male gu
-change in bowel habits
-blood in stool
-pain with defecation, rectal bleeding or tenderness
-anal warts of fissures
-weak stream of urine
-burning upon urination
Conduct a comprehensive male genital examination, including evaluation for hernias, rectum, and prostate problems
- Inspect the skin, prepuce, and glans (ulcers, scars, nodules, inflammation).
Inspect the urethral meatus (discharge), and, if indicated, strip or “milk” the penile shaft. - Palpate the shaft of the penis (induration, tenderness).
- Inspect the scrotum including skin, hair, and contour (lesion, swelling, veins, bulging masses, asymmetry).
- Palpate each testis including the epididymis and spermatic cord (presence, size, shape, consistency, symmetry, tenderness, masses, nodules).
- Perform special techniques as indicated:
o Evaluate for groin hernias:
Inspect for a groin bulge.
Palpate for an inguinal hernia (direct or indirect). Palpate for a femoral hernia.
o Evaluate for scrotal mass.
o Peduculosis pubis
lice or crabs
o Phimosis
tight prepuce that cannot be retracted over the penis
o Paraphimosis
= tight prepuce that, once retracted, cannot be returned. Edema ensues
o Balanitis
inflammation of the glans
o Balanoposthitis
inflammation of the glans and prepuce
hypospadias
congenital ventral displacement of the meatus on the penis
- Epispadias
congenital dorsal displacement of the meatus on the penis
common scrotal swellings
o Indirect inguinal swellings, hydroceles, scrotal edemas, testicular carcinoma
cryptorchidism
undescended testicle
. Summarize give patient education for testicular self-examination
- This examination is best performed after a warm bath or shower.This way, the scrotal skin is warm and relaxed. It is best to do the test while standing.
- Standing in front of a mirror, check for any swelling on the skin of the scrotum.
With the penis out of the way, gently feel your scrotal sac to locate a testicle. Examine each testicle separately. - Use one hand to stabilize the testicle. Using the fingers and thumb of your other hand, firmly but gently feel or roll the testicle between your fingers. Feel the entire surface. Find the epididymis. This is a soft, tube-like structure at the back of the testicle that collects and carries sperm and is not an abnormal lump. Check the other testicle and epididymis the same way.
- If you find a hard lump, an absent or enlarged testicle, a painful swollen scrotum, or any other differences that do not seem normal, do not wait. See your health care provider right away.
Recall the classification and presentation of hernias
- Direct hernia
o Bulge near external inguinal ring - Indirect hernia
o Bulge near the internal inguinal ring - Hernia is strangulated
o Blood supply to entrapped contents is compromised - Hernia is incarcerated
o Contents cannot be returned to abdominal cavity
what 3 columns of vascular erectile tissue form the shaft of the penis?
coprus cavernosum, corpus spongiosum (contains urethra)
what forms the bulb of the penis
corpus spongiosum
the testes (length, how they lie, what they produce)
- 4.5 cm long
-left lies lower than the right
-produce spermatozoa and testosterone
functions of the epididymis
provides a reservoir for storage, maturation, and transport of sperm
cowper’s or bulbourethral glands
a pair of pea shaped exocrine glands located posterolateral to the membranous urethra.
The bulbourethral gland or Cowper’s gland, which is homologous to the Bartholin’s gland in females, produces a pre-ejaculate that cleanses and lubricates the urethra prior to the arrival of the semen.
name the basic landmarks of the groin
anterior superior iliac spine, pubic tubercle, and the inguinal ligament
what forms a tunnels for the vas deferens
inguinal canal
femoral hernias (more likely in females)
-occur just below the inguinal ligament
-more likely to present as bowel incarceration or strangulation
how to distinguish direct vs indirect hernias on the physical exam
-direct= bulge is on side of fingers
-indirect=bulge is on tip of fingers
boundaries of hesselbach triangle
laterally- inferior epigastric artery
medially - lateral border of rectus abdominis
inferiorly- inguinal ligament
hiatal hernias
refers to hernias of abdominal cavity via esophageal hiatus of diaphragm
*can be sliding or nonsliding
hypospadias vs epispadias
hypospadias= urethral meatus below
epispadias= urethral meatus above
what do you consider blood in urine
malignancy unless proven otherwise
what can be associated with blood dishcarge?
neoplasms, urethritis, or ulcerations
what can cause purulent discharge?
gonorrhea or prostatitis
possible causes of testicular pain
epidymitis, orchitis, testicular torsion, or reffered pain
what is #1 risk factor for urothelial cancer?
smoking
position of you and pt when checking for hernias
pt should you standing and you should sit on a chair or stool
physical exam: inspection of penis
skin
foreskin
*smegma
*tightness of foreskin
glans
*compress glans gently between your index finger and thumb below to open urethral meatus and allow inspection for discharge
urethral meatus
important topics with paraphimosis
-can cause strangulation of penis
-if cannot fix in office call urology right away
presentation of penile cancer
-penile lesion
-phimosis present in 50% of cases
-palpable lymph nodes in 50% of cases
gonorrhea
-NO LESION
-thick discharge from penis
-painful urination
-collect sampel to test
-treat for gonorrhea and chlamydia at same time
physical exam: palpation of penis
-palpate penis between thumb and first two fingers
-note any tenderness, masses, or induration
-if primary complaint of discharge, squeeze shaft of penis to try and bring discharge
physical exam: inspection palpation of scrotum
inspection
-skin (life scrotum)
-scrotal contours
palpation
-each testes and epididymis
-each spermatic chord
hydrocele
-+transillumination
-increase in size during day or with valsalva
varicocele
-spermatic cord has bag of worms
-may be more palpable with standing or valsalva
-NEG transillumination
spermatocele
-painless, fluid filled cyst on head of epididymis
-+ transillumination
testicular CA
-firm painless mass that does not transilluminate
palpation of hernias
-place tip of finger at anterior inferior margin of the scrotum and move your finger and hand upward toward the external inguinal ring, invaginating the rebdundant scrotal skin
-palpatee teh external inguinal ring
-ask pt to cough or bear down
how can you evaluate for a scrotal hernia?
if a large scrotal mass is found, ask pt to lie down, if mass dissapears it is a hernia
what muscles hold anal canal in closed position?
voluntarily= external anal sphincter
&
involuntarily=internal anal sphincter
describe prostate gland (shape, size, palpable)
-walnut shape
-2.5 cm long
-only lateral lobes and median sulcus are palpable
benign prostatic hyperplasia
the prostate begins to increase in size after age 45, by itself prostate enlargement is not a problem
obstructive urinary symptoms (in men)
due to an enlarge prostate (BPH) blocking the flow of urine
positions that may be used for the anorectal and prostate exam
-pt may stand, leaning forward with his upper body resting across the examining table and hips flexed
-pt may lie on his left side with his buttocks close to the edge of the exam table near you, flex the pt hips and knees
inspection and palpation of anorectal and prostate exam
inspection
-the sacrococcygeal and perineal areas
palpate
-palpate for any abnormalities such as lumps or tenderness
acute prostatitis
-infection of prostate gland
-if pt acutely ill DRE not recomended as it can spread infection into blood stream
-treatment is antibiotics
