Rectal Flashcards
The anal canal is normally held in a closed position by the _________external anal sphincter and the __________internal sphincter
voluntary, involuntary
Anal canal is demarcated from the rectum superiorly by a serrated line marking the change from skin to mucous membranes (pectinate or dentate line) which also marks the boundary between ________ and _______nerve supplies. It is ________palpable
somatic and visceral nerve supplies.
NOT
The prostate is small during childhood, but between puberty and age 20, it increases roughly_______
5-fold
Which lobes are palpable on the prostate
two lateral, median sulcus
Median lobe is _____ palpable in prostate
NOT
In females the uterine cervix usually palpable through the _______ wall of the rectum
anterior
GI red flags
Any change in bowel habits?
Blood in the stool?
Pain with defecation?
External anal growths: Anal warts, fissures, hemorrhoids?
GU red flags
- Irritative urinary sx- pain or burning with urination, hesitancy, urgency
- Obstructive urinary sx- trouble starting stream, difficulty keeping stream going, feeling as though the bladder still full despite having urinated
Hematuria- presence of blood in urine
pencil thin stool is a potential sign of
colon CA
Melena
Black tarry
Hematochezia
bloody stool
External hemorrhoids
not painful unless theyre thrombosed
Internal hemorrhoids
originate from vessels and those are painful ones
Proctitis (a type of anal fissure)
acute inflammatory process of the rectum
Weak urinary stream sx such as Difficulty starting or holding back stream, Flow weak, Intermittency, Frequent urination- nocturia, Hematuria are all suggestive of
benign prosthetic Hyperplasia
Painless hematuria is common for _____
bladder cancer
Sudden onnset of irritative sx combined with LBP, pelvic, fever and chills = ____________. Males are NOT prone to UTIs
prostatitis.
Prostate CA risk fx
Leading cancer dx. in men in US and 2nd leading cause of death after lung ca
Risk factors
70% cases in men over 65 years of age
Median age is 66.
AA men have the highest incidence esp. with advanced disease
1st degree relative; risk doubled (take home risk fx)
T/F No evidence of lifestyle modification including dietary changes, increased physical activity can prevent prostate CA
True
What reduces prostate cancer risk to some degree although they are not shown to reduce mortality.
5- alpha reductase inhibitors (finasteride and dutasteride)
Pt is ____ to _____ age range should start screenning for prostate CA
50-55
What is the age to stop screening for prostate ca?
69 vs Life expectancy < 10 years
A positive hem-occult test is indicative of
blood in stool
Common abnormalities:
Hemorrhoids
Perianal abscess
Rashes
Skin tags
Anal fissures
Anal condylomas (warts)
** Pruitius Ani: Swollen, thickened, fissured, perianal skin with excoriation
Pruitius
Swollen, thickened, fissured, perianal skin with excoriation
What may be preventing finger from entering all the way in during the rectal exam?
a mass/lesion preventing finger from entering all the way in
Sphincter tone
Tightness in anxiety, inflammation, or scarring Laxity in some neurologic diseases
Consider testing perianal sensation
Induration
May be caused by inflammation, scarring or malignancy
Normal prostate will feel
rubbery and nontender
A patient who has ______ will not be able to tolerate any palpation
prostitits
When performing the rectal exam, first you want to put your finger clockwise in which you will feel the
Rectal Surface
When performing the rectal exam, you secondary want to put your finger in Counterclockwise in which you will feel
posterior surface of the prostate gland
Sphincter is spastic- exam is painful and may need_____
May need EUA(anasthesia)
What is the most common type of anal fissure?
midline posterior
Anorectal fistula
abnormal connective tract that originates from anal glands to external opening on skin
Result after prior abscess/infection
Look for openings in skin anywhere around anus
Polyp of Rectum
Variable in size
Stalk (pedunculated) vs flat (sessile)
May be soft and difficult to feel
Endoscopy/biopsy needed for dx
Cancer of rectum
Firm, often nodular
Rectal Shelf
Firm to hard nodular rectal “shelf” may be just palpable with fingertip
In women, this can occur behind uterus and cervix
Acute Bacterial prostatitis
presents with fever and UTI sx
Tender, swollen, boggy, warm
Will be extremely tender
BPH
Symptoms occur with smooth muscle contraction in prostate and bladder neck and compression of urethra
Irritative and Obstructive
Normal vs symmetrically enlarged, smooth, firm
Obliteration of median sulcus
Notable protrusion into rectal vault
Severity may not correlate with physical exam findings
Prostate Cancer
Suggestive of area of hardness in gland
Distinct hard nodule or firmness
As it grows may feel irregular and extend beyond gland
Median sulcus may be obscured
genital warts
HPV or condylomata lata (syphilis)
Anal fissures
proctitis, Crohn’s, straining
Who needs rectal/prostate exam
Lower GI bleeding, pain/discomfort in rectum
When doing the rectal exam, if there is pain or tenderness, dont force it. What do you want to do instead?
place fingers on both sides of the anus and gently spread the orifice and bear down. look for a lesion
slide 18
Anal fissure is very painful. The most common is the midline posterior. They may have sentinel ____________ just below it. _________ is spastic which makes the exam painful, may need EUA
skin tag, sphincter
