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Hnp > Rectal Exam and Pathologies > Flashcards

Rectal Exam and Pathologies Flashcards

1
Q

The GI tract terminates in a short segment called the?

A

anal canal

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2
Q

Normally, the anal canal is held in a closed position by two muscles, the _________ external anal sphincter and ___________ internal anal sphincter

A

voluntary; involuntary

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3
Q

The angle of the anal canal lies on a line roughly between the anus and umbilicus, true or false?

A

true

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4
Q

The anal canal is liberally supplied by somatic sensory nerves, true or false?

A

true

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5
Q

A ________ line demarcates the anal canal from the rectum

A

serrated

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6
Q

The ______________ (often called the pectinate or dentate line) is the boundary between somatic and visceral nerve supplies

A

anorectal junction

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7
Q

In the male, the ___________ lies against the anterior rectal wall

A

prostate gland

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8
Q

What is the prostate shaped like and how long is it?

A

rounded, heart shaped, and normally 2.5 cm long

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9
Q

Which parts of the prostate are palpable?

A

Only the lateral lobes and median sulcus

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10
Q

In the female, the ___________ usually is palpable through the anterior wall of the rectum

A

uterine cervix

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11
Q

What is the leading type of cancer in men?

A

Prostate cancer is the leading cancer diagnosed in men in the United States, and the third leading cause of death

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12
Q

What are the primary risk factors for prostate cancer?

A

The primary risk factors are age, ethnicity, and family history (although a series of studies have suggested an association between intake of dietary fat and risk of prostate cancer)

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13
Q

What should you include in your health promotion and counseling?

A

Screen for prostate cancer, polyps, colorectal cancer, and counseling about STD’s.

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14
Q

What should you inspect and what are you looking for during a rectal exam?

A

Inspect the sacrococcygeal and perianal areas. Assess for lumps, ulcers, inflammation, rashes, or excoriations. Palpate any abnormal areas, noting lumps or tenderness.

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15
Q

What should you do if severe tenderness prevents you from being able to do a rectal exam?

A

Instead, place your fingers on both sides of the anus, gently spread the orifice, and ask the patient to bear down. Look for a lesion, such as an anal fissure, that might explain the tenderness.

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16
Q

What do you identify on the prostate? What does a normal prostate feel like?

A

Examine the posterior surface of the prostate gland. Identify lateral lobes and median sulcus.
Note size, shape, and consistency of the prostate; identify any nodules or tenderness. Normal prostate is rubbery and nontender.
If possible, extend your finger above the prostate to the region of the seminal vesicles and the peritoneal cavity; note any nodules or tenderness.
Note the color of any fecal matter on the glove, and test it for occult blood.

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17
Q

Documentation for a normal rectal exam

A

No perirectal lesions or fissures. External sphincter tone intact. Rectal vault without masses. Prostate smooth and nontender with palpable median sulcus. (or in a female, uterine cervix nontender.) Stool brown and Hemoccult negative.

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18
Q 
A 65-year-old male presents to clinic for a routine examination. The following is the documentation of his prostate examination. Which statement would be of concern?
A.) Firm
B.) Heart-shaped 
C.) 2.5 cm long
D.) Median sulcus palpable
A

A.) Firm, the normal prostate is rubbery

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19
Q

The rectum is usually examined after the female genitalia, while the woman is in the ___________position

A

lithotomy

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20
Q

What other reasons is the lithotomy position good for a rectal exam on a female?

A

this position is also ideal for conducting the bimanual examination and is suitable for testing the integrity of the rectovaginal wall and may also help to palpate a cancer high in the rectum

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21
Q

If the rectum only needs to be examined, how should a woman position herself?

A

The side-lying position affords a much better view to the perianal and sacrococcygeal areas.
Use the same techniques for examination that are used for men.

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22
Q 
The female patient may remain in a lateral position for examination of which of the following: 
Adnexal mass
Perianal fissure
Integrity of the rectovaginal wall
Pelvic mass
A

Perianal fissure!
The rectum is usually examined while the woman is in the lithotomy position, which is also ideal for conducting the bimanual examination and is suitable for testing the integrity of the rectovaginal wall; it may also help to palpate a cancer high in the rectum
If the rectum only requires examination, the side-lying position affords a much better view to the perianal and sacrococcygeal areas

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23
Q

How common is a pilonidal cyst? How does it start?

A

fairly common, it is probably congenital

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24
Q

Where do you find a pilonidal cyst, specifically?

A

Midline superficial to the coccyx or the lower sacrum. Look for the opening of a sinus tract. This opening may exhibit a small tuft or hair surrounded by a halo of erythema.

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25
Q

What are the symptoms of a pilonidal cyst?

A

Generally asymptomatic, except perhaps for slight drainage, abscess formation and secondary sinus tracts may complicate the picture.

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26
Q

dilated veins that originate below the pectinate line and are covered with skin

A

external hemorrhoids

27
Q

What are the symptoms of external hemorrhoids?

A

They seldom produce symptoms unless thrombosis occurs. This causes acute, local pain that increases with defecation and sitting. A tender, swollen, bluish, ovoid mass is visible at the anal margin.

28
Q

enlargements of the normal vascular cushions located above the pectinate line

A

internal hemorrhoids-they are not usually palpable

29
Q

What are the symptoms of internal hemorrhoids?

A

Sometimes during defecation, internal hemorrhoids may cause bright red bleeding. They may also prolapse through the anal canal and appear as reddish/pinkish, moist, protruding masses.

30
Q

How does a prolapsed rectum occur?

A

On straining for a bowel movement, the rectal mucosa, with or without its muscular wall, may prolapse through the anus, appearing as a doughnut or rosette of red tissue.

31
Q

A rectal prolapse involving only mucosa looks like?

A

relatively small and shows radiating folds

32
Q

A rectal prolapse involving an entire bowel wall?

A

the prolapse is larger and covered by concentrically circular folds

33
Q

What are the symptoms of an anal fissure and how does it present?

A

It is a very painful oval ulceration of the anal canal, found most commonly in the midline posteriorly, less commonly in the midline anteriorly. Its long axis lies longitudinally. There may be a swollen “sentinel” skin tag just below it.

34
Q

What is a rectal exam like for someone with an anal fissure?

A

Gentle separation of the anal margins may reveal the lower edge of the fissure. The sphincter is spastic; the examination is painful. Local anesthesia may be required.

35
Q

Inflammatory tract or tube that opens at one end into the anus or rectum and at the other end onto the skin surface or into another viscus is called?

A

anorectal fistula

36
Q

What usually antedates an anorectal fistula?

A

An abscess usually antedates an anorectal fistula. Look for the fistulous opening or openings anywhere in the skin around the anus.

37
Q

Polyps of the rectum are how common? What do they look like?

A

Fairly common. Variable in size and number. They can develop on a stalk (predunculated) or lie on the mucosal surface (sessile). They are soft and may be difficult to or impossible to feel even when in reach of the examining finger.

38
Q

How do you differentiate from malignant and benign polyps of the rectum?

A

proctoscopy and biopsy are needed for differentiation

39
Q

How does cancer of the rectum present?

A

asymptomatic carcinoma of the rectum makes routine rectal examination important for adults. They can be firm, nodular, and have a rolled edge of an ulcerated cancer.

40
Q

Widespread peritoneal metastases from any source may develop in the area of the peritoneal reflection anterior to the rectum. This is called what?

A

rectal shelf

41
Q

What does a rectal shelf feel like?

A

A firm to hard nodular rectal shelf may be just palpable with the tip of the examining finger. In a woman, this shelf of metastatic tissue develops in the rectouterine pouch, behind the cervix and the uterus.

42
Q

Where is the median sulcus on the prostate?

A

It is between the two lateral lobes on the prostate. Only the posterior part of the prostate is palpable. Anterior lesions, even ones that may obstruct the urethra, are not detectable by physical exam.

43
Q

Acute bacterial prostatitis symptoms?

A

fever, urinary tract symptoms such as frequency, urgency, dysuria, incomplete voiding, and sometimes low back pain.

44
Q

What does the prostate feel like with acute bacterial prostatitis?

A

Tender, swollen, “boggy” and warm. Examine it gently.

45
Q

More than 80% of infections for acute bacterial prostatitis are caused by gram-negative aerobes such as?

A

E. coli, enterococcus, and proteus. In men younger than 35, consider sexual transmission of gonorrhea or chlamydia.

46
Q

What is chronic bacterial prostatitis associated with?

A

Recurrent urinary tract infections, usually from the same organism.

47
Q

What are the symptoms of chronic bacterial prostatitis?

A

Men may be asymptomatic, or have symptoms of dysuria, or mild pelvic pain. The prostate gland may feel normal, without tenderness or swelling. Cultures of prostatic fluid usually show infection of e. coli.

48
Q

What condition is difficult to distinguish from acute or chronic bacterial prostatitis?

A

chronic pelvic pain syndrome- seen in up to 80% of symptomatic men who report obstructive or irritative symptoms on voiding but show no evidence of prostate or urinary tract infection. Physical exam findings are not predictable, but exam is needed to assess any prostate induration or asymmetry suggestive of carcinoma.

49
Q

nonmalignant enlargement of the prostate gland that increases with age, present in more than 50% of men by 50 years of age

A

Benign prostatic hyperplasia

50
Q

What are the symptoms of BPH?

A

Symptoms arise from both smooth muscle contraction in the prostate and bladder neck and from compression of the urethra. They may be irritative (urgency, frequency, nocturia), obstructive (decreased stream, incomplete emptying, straining), or both, and are seen in more than 1/3 of men by 65 years old.

51
Q

What does the prostate look like in BPH?

A

The gland may be normal in size, or may feel symmetrically enlarged, smooth and firm, though slightly elastic; there may be obliteration of the median sulcus and more notable protrusion into the rectal lumen.

52
Q

How does cancer of the prostate present?

A

Area of hardness in the gland. A distinct hard nodule that alters the contour of the gland may or may not be palpable. As he cancer enlarges, it feels irregular and may extend beyond the confines of the gland. The median sulcus may be obscured. Hard areas in the prostate are not always malignant. They may also result from prostatic stones, chronic inflammation, and other conditions.

53
Q

How do you treat bph?

A

Alpha blockers

54
Q

What lab will be elevated in bph?

A

PSA (prostate-specific antigen), which should rise with age, but if it doubles in one year refer them to urology

55
Q

Nocturia with weak flow could mean?

A

BPH

56
Q

Nocturia with normal flow could mean?

A

Sleep apnea

57
Q

Prostatitis can lead to….

A

Sepsis

58
Q

Guiaic test positive and negative will show what?

A

Blue=positive for blood in stool, not blue= negative

59
Q

What can give a false positive guiaic test?

A

Iron or eating meat

60
Q

Back pain, lower extremity weakness, loss of sphincter tone could mean?

A

Cauda equina syndrome

61
Q

Treatment for hemmorhoids?

A

Steroids and anusol, fiber, fluids

62
Q

When do you see a rectal shelf?

A

Uterine cancer

63
Q

How do you treat prostatitis?

A

Cipro for 3 weeks

Hnp (9 decks)

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