PR Exam Flashcards
Skin excoriations are suggestive of what?
Skin excoriation: secondary to anal pruritis which can be caused by haemorrhoids, faecal incontinence or constipation.
Skin tags are suggestive of what?
Skin tags: minor projections of skin at the anal verge that are usually benign. Perianal skin tags can, in some cases, be associated with inflammatory bowel disease.
External haemorrhoids are suggestive of what?
External haemorrhoids: located below the dentate line and innervated by somatic nerves. On examination, they typically appear as a lump located just inside or outside the anal verge.
Anal fissures are suggestive of what?
Anal fissure: a tear in the tissue of the anal canal, typically located posteriorly in the midline. Anal fissures most commonly develop secondary to constipation and are very painful (often making rectal examination impossible).
External bleeding are suggestive of what?
External bleeding: may be caused by external haemorrhoids, anal cancer or brisk gastrointestinal bleeding.
Anal fistulas are suggestive of what?
Anal fistula: a chronic abnormal communication between the internal anal canal and the perianal skin. Fistulae may discharge pus and have surrounding inflammation. Causes of anal fistulae include perianal Crohn’s disease, chronic anal abscess and diverticulitis.
Rectal prolapse are suggestive of what?
Rectal prolapse: on inspection, a mass with concentric rings of mucosa will be visible protruding through the anus.
Internal haemorrhoids are suggestive of what?
Internal haemorrhoids: located above the dentate line and innervated by visceral nerves. On examination, bluish, bulging vessels covered by mucosa may become visible when the patient coughs. Internal haemorrhoids are typically asymptomatic due to their visceral innervation.
Breifly describe IBD
Inflammatory bowel disease
Inflammatory bowel disease (IBD) is a general term that is used to describe disorders that involve chronic inflammation of the gastrointestinal tract. Ulcerative colitis and Crohn’s disease are subtypes of IBD and differ in their clinical presentation.
Ulcerative colitis is the most common form of IBD and affects the colon and rectum. Typical findings on rectal examination include loose bloody stool and excess mucous.
Crohn’s disease is another subtype of IBD which can affect any part of the gastrointestinal tract from the mouth to the anus. Typical findings on rectal examination may include rectal bleeding, perianal fistulas, abscesses and multiple skin tags.
When examining the prostate, what should you assess?
Describe a normal finding
In males, palpate the prostate gland anteriorly and assess the size, symmetry and texture of the gland:
A normal prostate is approximately walnut-sized with a palpable midline sulcus.
It should be symmetrical and its consistency should be similar to that of the tip of the nose.
When examining the anal canal, what are you feeling for?
Rectal lumps e.g. tumour, polyp, internal haemorrhoid) - Note the size, location (e.g. 9 o’clock) and texture (e.g. smooth, irregular)
Feel for any hard stool present in the rectum, which may indicate constipation.
Note the location of any tenderness, which may indicate an anal fissure or thrombosed internal haemorrhoids.
Anal tone- Measured by asking the patient to bear down on your finger. Causes of reduced anal tone include spinal cord pathology (e.g. cauda equina syndrome), inflammatory bowel disease and previous rectal surgery.
Upon removing your finger, what should you make a note of?
What do they indicate?
Inspect for blood or mucous:
Dark sticky blood is known as melaena and is associated with upper gastrointestinal bleeding (e.g. stomach ulcer).
Fresh red blood is associated with lower gastrointestinal bleeding (e.g. rectal malignancy, fissure).
Excess mucous can be associated with inflammatory bowel disease (e.g. ulcerative colitis).
What further investigations/ assessments will you perfrom?
Abdominal examination: if there were concerns about intraabdominal pathology (e.g. appendicitis).
Blood tests: including FBC, haematinics and U&Es if there were concerns about gastrointestinal bleeding.
Faecal occult blood testing: if there were concerns about lower gastrointestinal malignancy.
Flexible sigmoidoscopy/colonoscopy: if there were concerns about lower gastrointestinal bleeding or malignancy.
CT abdomen and pelvis: if there were concerns about lower gastrointestinal malignancy.
