Rectum, Prostate Flashcards
What PMH do you want?
- Hemorrhoids
- Spinal cord injury
- Bowel habits and characteristics: timing, frequency, number, consistency, shape, color, odor
- Males: prostatic hypertrophy or carcinoma
- Females: episiotomy or fourth-degree laceration during delivery
- Colorectal cancer or related cancers: breast, ovarian, endometrial
What FH do you want?
- Rectal polyps
- Colon cancer or familial cancer syndromes (Risk Factors below)
- Prostate cancer
What are the risk factors for colon cancer?
>50 yo FH of colorectal CA PMH colon CA, polyp, IBD PMH ovarian or endometrial CA AA race Jewish Low fiber diet obese smoking lack of exercise heavy ETOH DM type II
What are risk factors for anal CA?
HPV infection multiple sex partners Receptive anal smoking immunosuppressed Black
What are the risks for prostate CA?
>50 yo AA race north americans and NW europe FH prostate BRCA 1 or BRCA 2 Diet - high fat, dairy, calcium Hrmones - high androgens Inactive
When do you screen for prostate CA?
> 50 for non risk
45 for high risk - AA
40 for super high - FH CA
What is the prostate screen?
PSA and DRE
When do men with 2.5 PSA need to be tested for prostate CA?
every 2 years
When do men with >2.5 PSA need screening for prostate CA?
annually
Who does not benefit from prostate screen?
men that are not expected to live for another 10 years
MSM screen
Human immunodeficiency virus (HIV) serology, if HIV-negative or not tested within the previous year
Syphilis serology
HBsAg to detect hepatitis B virus HBV infection
Test for the following infections in men who have had receptive oral intercourse during the preceding year regardless of history of condom use during exposure:
Urethral infection and rectal infection with N. gonorrhoeae and C. trachomatis
Pharyngeal infection with N. gonorrhoeae
Consider evaluation for herpes simplex virus (HSV)-2 infection with type-specific serologic tests if infection status is unknown. Routine testing for anal cytologic abnormalities or anal HPV infection can be considered but evidence is limited concerning the natural history of anal intraepithelial neoplasias, the reliability of screening methods, the safety and response to treatments, and the programmatic support needed for such a screening activity.
More frequent STI screening (e.g., at 3- to 6-month intervals) is indicated for MSM who have multiple or anonymous partners, have sex in conjunction with illicit drug use, who use methamphetamine, or whose sex partners participate in these activities.
What are the three positions for DRE?
(1) the standing position with the hips flexed and the upper body supported by the exam table.
(2) the left lateral position with the hips and knees flexed
(3) the knee–chest position
What do you look for when inspecting the sarcococcygeal and perianal area?
- Skin characteristics – should appear smooth, note color, scars
- Lesions – also lumps, rashes
- Pilonidal dimpling and/or tufts of hair
- Inflammation
- Excoriation
How do you inspect for rectal prolapse, fistuals, fissures, polyp, hemorrhoids?
have pt bear down
How should the anal muscular ring feel?
- Feel smooth
- Exert even pressure
- Have no nodules or irregularities
