Test 4- Privates (women & mens health) Flashcards
(93 cards)
Rectal exam
Purpose: part of med exam OR sx’s like!
1. rectal bleeding
2. change in bowel habits
3. discharge or bleeding from the urethra
4. change in urinary flow
Rectal exam: About the rectum
The rectum is a part of your digestive system. The digestive system processes the food your body does not use. The colon is the biggest part of your large intestine. It empties into the rectum, where waste collects as bowel movements. The rectum empties into the anus, where bowel movements leave the body.
How do I get ready for a Rectal Exam
You do not need to do anything special to prepare for a DRE. But there are a few things to keep in mind.
Tell your health care team if you have hemorrhoids or anal fissures. The DRE may make them worse. If you are concerned about the cost of your DRE, find out from your insurance provider what costs they will cover beforehand. Ask how much of the cost you will have to pay out of pocket. You will be asked to sign a consent form before your DRE. The form will state that you understand the benefits and risks of the DRE and agree to have the test. Your doctor or nurse will explain the test before you sign the form, and you can ask questions.
Rectal Exam for Men
The DRE will take place in a private exam room at your doctor’s office. The test only takes a few minutes. You will need to take off any clothes below your waist. You will be given a gown to wear or a cloth to wrap around your body.
For men. The doctor will ask you to stand and bend forward at the waist or they will ask you to lie on your side on an exam table with knees pulled up to your chest. As they start the DRE, the doctor may ask you to relax and take a deep breath. Then they will gently insert a lubricated, gloved finger into your rectum. The doctor will feel the size of your prostate gland. They will also feel for bumps, soft or hard spots, or other abnormal areas. The doctor will also examine the wall of your lower colon and rectum.
Rectal Exam for Women
For women. The doctor will usually ask you to lie on your back on an exam table. Your feet will be in raised stirrups. The doctor may ask you to relax and take a deep breath as they start the DRE. Then they will gently insert a lubricated, gloved finger into your rectum. The goal is to feel your reproductive organs and the bowel. The doctor may also feel for problems in your internal organs. They do this by pressing on your lower abdomen or pelvic area with their other hand.
A DRE usually does not hurt, but you may be uncomfortable. You may also feel the need to urinate. If a man’s prostate is enlarged, there may be some discomfort or mild pain during the exam.
After a rectal exam
After your DRE, you can go back to your normal activities right away. You may bleed slightly from the rectum afterward. This is more likely to happen if you have hemorrhoids or anal fissures.
Tell your health care team if you have a large amount of rectal bleeding.
Questions patients can ask provider rectal exam
Before having a DRE, you may want to ask these questions:
Why do you recommend that I have a DRE? What happens during the DRE? Who will do the DRE? How long will the DRE take? Will it hurt? Can a DRE find cancer? When and how will I get my test results? Who will explain them to me?
Rectal Exam
A rectal exam should be performed on most patients with abdominal pain and any concern for blood loss. Here, we review some important steps of a compete rectal exam.
Rectal Exam Technique
Positions
There are multiple positions that you can ask your patient to stand or lie. These include:
- Standing position: patient standing with toes pointing in, then leans over a table
- Right lateral decubitus (Sims position): patient lies on right side with right hip/leg straight and the left hip/knee is bent
- Knee to chest: patient with lying on table facing down with knees up to chest bent forward
- (Both the standing and knee to chest positions are optimal for the prostate exam)
Rectal Exam- Inspection
Inspection of Anus
Look for external hemorrhoids, fissures (90% of time they are located in midline posteriorly), skin tags, warts or discharge
Palpate Rectum & Prostate
Palpate Rectum and Prostate
1.Use a small amount of lubricant on the index finger and ask the patient to take a deep breath and insert the finger facing down (6 o'clock position) 2. Appreciate the external sphincter tone then ask the patient to bear down and feel for tightening of the sphincter
- Palpate the prostate gland. Note the following:
4. Approximate size of the prostate gland (normally about the size of a walnut, 2-3 cm but wider at the top) 5. Feel for tenderness (prostatitis) Feel for nodules or masses
- Palpate the rectal wall starting from the 6 o’clock position clockwise to the 12 o’clock position. Then return to the 6 o’clock position and palpate the other half of the rectal wall feeling for masses, nodules and tenderness.
Rectal Exam
You can check for blood with a occult guiaciac test
Pelvic Exam
The pelvic exam is a vital part of every woman’s preventative care and is also important towards making a number of diagnoses when presenting with abdominal or pelvic complaints. Here we cover each aspect of the pelvic exam and demonstrate both in text and in our video how this done.
Speculums Pelvic Exam
The main equipment you will use is the speculum so it’s important for you to understand the most commonly used types. These include the:
Pederson’s speculum Graves’ speculum (or Duckbill speculum) - a little wider (often used for procedure) Note: These are cold! Important to keep in warmer temperatures or run under warm water prior to use. Speculums come in various sizes, including smaller, pediatric sizes.
Types of Speculums
a little wider usually used for procedures
Types of Speculums
Most common is the pederson
Before the Pelvic Exam
Before the exam, ensure you have:
- Speculum and lubricant
- Light source
- Needed materials if doing wet mount, pap smear or STD testing
- Have patient empty their bladder
Palpation Pelvic Exam
When palpating, be sure to:
o Feel for abdominal masses
o Appreciate the liver size
o Look for inguinal region for lymphadenopathy–click here for lymph node exam
Vulvular & Pelvic Exam (Speculum Exam)
- Examine the vulvar region looking for erythema or other rashes
- Place lubricant on both index finder of non-dominant hand and warmed speculum
3.Insert index finger into base of vagina - Touch speculum onto patient’s thigh to see if temperature appropriate then insert speculum at slight angle into vagina above finger and rotate to level position as it’s inserted
- Important: Insert speculum all the way BEFORE opening
Insert speculum - Open speculum and adjust until the cervix is in sight and lock open
7.If planned, conduct pap smear and STD testing
Note: a little bleeding (especially if patient nulliparous) after a pap smear is expected. If bleeding profuse of cervix is erythematous and/or purulent discharge present, suspect cervicitis (gonorrhea, chlamydia).
Pelvic Exam Abnormal Findings
Lichen Sclerosis – itching without any discharge, all age groups
Pelvic Exam Abnormal Findings
Vaginal Discharge –> This case shows yeast vulvovaginitis – common cause of vaginal itching and/or discharge, common in hospitalized patients, especially if getting antibiotics.
Also note, bacterial vaginosis is another common cause of discharge and often we need a microscope to differentiate between the two.
Abnormal Pelvic Findings
Trichomonas infection causing a “Strawberry cervix”
Bimanual Exam
Insert index finger and possibly additional finger (with lubricant) in vaginal canal with non-dominant had free to palpate the abdomen.
Bimanual Exam
Look for:
Cervical motion tenderness – could suggest cervicitis or pelvic inflammatory disease Position of uterus (image in folder) – helpful to know if you may not be able to palpate uterus if axial or retroflexed Adnexal size and tenderness – looking for any adnexal masses. Obesity may create a challenge to appreciating the adnexa. The post-menopause ovary can often be too small to palpate.