Test 4- Privates (women & mens health) Flashcards
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.
Rectovaginal Exam
The purpose of the exam is to:
Appreciate a retroflexed uterus and adnexal masses Look for presence of hemorrhoids, polyps/growths and assess the tone of the rectal sphincter
Technique of Rectovaginal Exam
Place lubricant on index and middle finger of dominant hand then insert index finger into vaginal canal
Insert middle finger into rectum, asking patient to bare down and insert fingers as far possible
Appreciate
Retroflexed uterus
Nodularity along ureteral sacral ligament and cul-de-sac behind uterus – suggesting endometriosis
To find ureteral sacral ligament, pull the cervix anterior with index finger to stretch and palpate for the ligament with finger inserted into rectum
Adnexa – looking for masses and tenderness
Rectal or anal masses/polyps
Special Considerations for Pelvic Exam
Hospitalized patients – Given a proper exam table with leg rests is often not available, if possible delay this exam until patient can be seen in clinic. However if speculum exam is needed immediately, one method is to place an inverted bedpan under the patient’s buttocks to raise pelvis. If yeast vulvovaginitis is suspected, you or patient can obtain a swab and look under microscope or send to lab.
o Patient’s first exam or elderly patients – May require more discussion and education prior to the exam
o Patients with history of trauma – ensure patient knows they have control and can stop the exam at anytime
Prostate Exam
Beginning at about age 45 (age 40 if you are Black or have a strong family history of prostate or other cancers), all men should talk to their doctor about screening for prostate cancer. Routine screening starts with a PSA blood test and may include a rectal exam—both are simple and relatively painless.
PSA Test
Prostate cancer screening starts with a PSA test. This is a blood test, and if your doctor is already drawing blood for other tests, the PSA test order can be added. Results should be back within a few days.
The PSA test measures the level of prostate-specific antigen in your blood. PSA is a protein produced by the prostate, and a small amount is normally released into the bloodstream. When there’s a problem with the prostate, more PSA is released. A rising PSA can be one of the first signs of prostate cancer, though there are other factors that can also cause higher PSA levels. A PSA level above 3 ng/mL may suggest the need for further testing.
Results of PSA Test
your age
Your prostate size
The results of your previous PSA tests
Other medical conditions, such as BPH or prostatitis
Whether you’ve taken any medications that may artificially lower PSA, such as finasteride (Proscar or Propecia) or dutasteride (Avodart)
A history of infections and procedures involving the urinary tract that can elevate the PSA
DRE
Your doctor may determine that a digital rectal exam (DRE) is useful in evaluating your prostate health. The prostate is just in front of the rectum. For this test, your doctor will gently insert a lubricated, gloved finger into your rectum to examine the prostate for irregularities in size, shape, and texture. The test is quite brief, and it might be uncomfortable, but it should not be painful.
Test Results for prostate cancer
Prostate enlargement and mildly increased PSA levels can be a normal part of the aging process, or they could indicate that prostate cancer has begun to develop. Your doctor will take into account your particular situation—including your age, race, and family cancer history—all of which can influence your likelihood of developing prostate cancer.
prostate
If your prostate isn’t enlarged and your PSA level is within normal range, your doctor will likely suggest repeating the tests at regular intervals of 1-2 years as part of your normal checkups. Talk to your doctor about the best course of a personalized prostate cancer screening plan.
prostate
If your prostate shows signs of enlargement or irregularity, or your PSA level comes back a little high, your doctor may suggest repeating the tests after an interval of time to see if your prostate has changed further or your level is on the rise–an indication of a potential problem.
symptoms of prostate cancer
A need to urinate frequently, especially at night, some- times urgently
Difficulty starting or holding back urination
Weak, dribbling, or interrupted flow of urine Painful or burning urination Difficulty in having an erection A decrease in the amount of fluid ejaculated Painful ejaculation Blood in the urine or semen Pressure or pain in the rectum Pain or stiffness in the lower back, hips, pelvis, or thighs
How should the prostate gland feel like?
A normal prostate has a rubbery, soft feel and is symmetric with a smooth groove down the middle, separating the right side from the left.
A firm or hard region in the prostate called a nodule can indicate that prostate cancer is present. If the urologist feels a prostate nodule, other diagnostic tests are recommended.
Old penis
testicular atrophy (shrinkage of the testicles) is also a normal part of aging. Combined with the loss of skin elasticity throughout the body and the effects of gravity, the scrotum and penis can both sag and look more wrinkled with age. A reduction in blood flow may also lighten the color of the penis later in life.
Hemorrhoids
Hemorrhoids are swollen veins in your lower rectum. Hemorrhoids inside the rectum are usually painless but tend to bleed. Hemorrhoids outside the rectum may cause pain. Hemorrhoids (HEM-uh-roids), also called piles, are swollen veins in the anus and lower rectum. Hemorrhoids are similar to varicose veins.
Naegeles rule
Naegeles rule
Tanner male stages
Tanner male stages
Growth
Tanner female
Testicular self exam
palpation of scrotum
hydrocele
varicole
An enlargement of the veins within the scrotum.
A varicocele may develop as a result of poorly functioning valves that are normally found in veins. In other cases, it may occur from compression of a vein by a nearby structure.
Varicoceles often produce no symptoms but can cause low sperm production and decreased sperm quality, leading to infertility.
Varicoceles that cause no symptoms typically require no treatment. Cases in which symptoms occur can be repaired surgically.
strangulated hernia
A strangulated hernia occurs when the hernia contents are ischemic due to a compromised blood supply. This phenomenon occurs most commonly when there is a small opening in the musculature and a significant quantity of contents within the hernia itself.
incarcerated hernia treatment
Approximately 70% of incarcerated hernia can be reduced manually. Manual reduction may result in serious complications, such as intestinal rupture, peritonitis and even testicular necrosis. Therefore, in the case of failure, surgery should be immediately performed for incarcerated hernia.
testicular torsion
Testicular torsion is an emergency condition. It happens when the spermatic cord, which provides blood flow to the testicle, rotates and becomes twisted. The twisting cuts off the testicle’s blood supply and causes sudden pain and swelling. Testicular torsion requires surgery right away to save the testicle.
symptoms of testicular torsion?
sudden, severe pain in the scrotum.
swelling of the scrotum, redness, tenderness or hardening of the scrotum.
nausea and vomiting.
abdominal pain on the same side as the torsion.
the testicle being in a strange position, such as higher than normal or on an unusual angle.
what is the most common type of hernia in males?
Inguinal hernias are the most common type, accounting for 75% of all hernias. They mostly affect men or people assigned male at birth (AMAB). They happen when part of your bowel protrudes into your inguinal canal, a passageway that runs down your inner thigh. Femoral hernia.
nabothian cyst
A nabothian cyst is a lump filled with mucus on the surface of the cervix or cervical canal. The cervix is located at the lower end of the womb (uterus) at the top of the vagina. It is about 1 inch (2.5 centimeters) long.
hegers & chadwicks sign know!
What is the Hegar sign? Hegar sign is a non-specific indication of pregnancy that is characterized by the compressibility and softening of the cervical isthmus (i.e., the portion of the cervix between the uterus and the vaginal portion of the cervix).
menstrual disorders
menstrual disorders
leopolds manuevers
The Leopold maneuvers are used to palpate the gravid uterus systematically. This method of abdominal palpation is of low cost, easy to perform, and non-invasive. It is used to determine the position, presentation, and engagement of the fetus in utero.
leopolds manuevers
The Leopold maneuvers are used to palpate the gravid uterus systematically. This method of abdominal palpation is of low cost, easy to perform, and non-invasive. It is used to determine the position, presentation, and engagement of the fetus in utero.
