Rectal examination

Question 1

What to look for in DRE?

Answer 1

1. external haemorrhoid (perianal haematoma)
2. skin tag
3. rectal prolapse
4. anal fissures (fissure-in-ano)
5. fistula
6. anal warts

Question 2

Anal fissure (Fissure-in-ano)

Answer 2

• usually posterior and midline
• tag of skin at base (sentinel pile) -> chronic fissure
• multiple fissures/ broad based = IBD, malignancy, STI

Question 3

Fistula-in-ano

Answer 3

entrance of tract maybe visible

red pouting appearance caused by granulation tissue

may occurs with Crohn’s disease or perianal abscess

Question 4

Skin tag

Answer 4

occurs with Crohn’s disease or haemorrhoid

Question 5

Rectal prolapse

Answer 5

• may be apparent only when pt strain
• dark red mass
• gaping anus suggests loss of internal and external sphincter tone (may coexist with prolapse)

Question 6

Anal wart (Condylomata acuminata)

Answer 6

(don’t confuse with skin tags)

Pedunculated papilloma with white surface & red base

may srround anus