Week 6_Male GU_Anus, Rectum, Prostate Flashcards
COMMON CC MALE GU, PROSTATE, ANORECTAL & FEMALE GU EXAM
Urinary complaints- dysuria, frequency, hesitancy (depending on age- decreased stream, hesitancy, nocturia) Penile discharge/lesions or pain Scrotal pain/swelling or lesions or mass Groin pain Pubic area rash, itching Reproductive health or sexual concerns STI screening and concerns E.D. or low libido
Urinary Questions
Urinary Questions Difficulty urinating/urinary retention Dysuria (Painful urination) Polyuria or Nocturia Urine characteristics, such as? Incontinence
Genitalia questions
Penis: discharge, lesions, rash?
Testicular: swelling, mass, pain?
Sexual contacts: 5 P’s
Practices: Men, women or both? Anal, oral or vaginal? Other sex practices?
Protection: STI prevention
Past STI history: any positives? Treatments? Last testing?
Pregnancy: What are you doing to prevent pregnancy?
Plus: Feel safe? Forced sex? (Under the influence)? Need support?
LGBTQ PATIENTS
Be sensitive and non-judgemental
Be aware of your non-verbal communication
Ask questions such as:
How would you prefer to be addressed? What would you like me to call you?
Are there any concerns or questions you have currently?
Tell me your story . . .
Ask a thorough sexual history- including STI hx & prevention, PEP & PreP
Ask about surgical hx
Ask about hormone therapy
MALE GU INSPECTION OF LYMPH NODES, PENIS
Palpate the Femoral and Inguinal Lymph nodes
Inspect the penis
Foreskin- pull back gently or may ask pt to pull back for you
Urethra- position, inflammation, discharge, lesions (p682)
Glans- erythema, lesions
Shaft- underside as well
Base and groin- skin under pubic hair
Inspect for: smegma, chancres, cacrcinomas
Lesion, scar, uretra meatus,
EPISPADIS & HYPOSPADIS
Congenital conditions
Epispadis- urethral meatus located on dorsal side of penis
(on top)
Hypospadis- meatus located on ventral side of penis
(below)
HPV (CONDYLOMATA ACUMINATA)
Can be located on Penis, scrotum, groin, thighs, anus- usually asymptomatic
Many types of HPV don’t cause symptoms at all and are UNDETECTABLE in men
No “test” or routine screening for men
Vaccine recommended age 11 and up
SYPHILIS
Primary syphilist: Ulceration know as Chancre- painless
Heals w/in 3-8 weeks
Treponema pallidum: incubates 9-90 days after exposure
Often goes undetected
RPR blood test
Difficult to distinguish between chancroid, HSV
HSV (HERPES SIMPLEX VIRUS 1 OR 2)
Grouped or scattered vesicles 1-3mm
If on a mucous membrane, appears as an erosion
Incubation 2-7 days after exposure
May have fever, body aches, and lymphadenopathy
TESTICULAR QUESTIONS
Severe/acute testicular pain is considered an emergency
Trauma
Pain or other symptoms- oldcarts (onset, location, duration, characteristics, aggravating/alleviating, radiating, treatments tried/timing, severity)
Erythema, edema, warmth
Penile discharge? Difficulty urinating?
Fever, chills, body aches
Medical hx?
Inspect and Palpate the Scrotum & Testes
Edema, redness, lesions Masses, swelling, tenderness Gentle, do not squeeze hard Transillumination: to view scrotal sac May ask him to hold his penis out of the way
TESTICULAR TORSION
Testicular Pain Hx of trauma Lack of Cremaster Reflex Stroke inside of thigh- the ipsilateral cremaster muscle should contract- causing the testis to raise up Ultrasound needed to confirm diagnosis
PALPATION OF INGUINAL CANAL
Easiest to do w/male standing, clinician seated
Use a gloved index finger to gently push up and into the canal (skin is loose)
Ask him to hold his penis out of the way (if necessary)
To check for Hernia- ask him to cough and/or bear down (feel a bulge @ tip of finger?)
SCROTAL EDEMA
Warmth? Tenderness? Symmetrical? Mass? Erythema? Associated Symptoms? Trauma? STI?
ANORECTAL ANATOMY in male vs female
In the male
The prostate gland lies against the anterior rectal wall
It is rounded, heart-shaped, and normally 2.5 cm long
Only the lateral lobes and median sulcus are palpable, rubbery
In the female
The cervix may be palpable through the anterior wall of the rectum
If female has a tampon inserted, may be palpable
ANORECTAL QUESTIONS
Change in bowel pattern?
Any pain on defecation?
Any itching?
Any extreme tenderness in the anus or rectum?
Any purulent discharge or bleeding?
How much? Drops on toilet paper, fills the bowl? Bright red? Mixed w/feces
Weak urinary stream or nocturia: implies enlarged prostate
Any history of anal warts, ulcerations, hemorrhoids, or fissures?
Anal intercourse or use of “sex toys”?
Health Promotion:
Prostate exam (age 50 or older)
Colonoscopy? (age 50 /45nor older-females & males, unless 1st degree relative w/hx 40 or ten year prior to had it)
ANORECTAL PALPATION
DRE: digital rectal exam
A properly performed examination should not be painful
Successful examination requires a calm demeanor, explanation to the patient of what he or she may feel, gentleness, and slow movement of your finger
In asymptomatic adolescents, it is appropriate to defer the rectal exam
ANORECTAL/PROSTATE
One of several patient positions may be used for examination
The patient may stand, leaning forward with his upper body resting across the examining table and hips flexed
Preferred position for Male Anorectal/Prostate: The patient may lie on his left side with his buttocks close to the edge of the exam table near you; flex the patients hips and knees, especially the top leg
ANORECTAL INSPECTION
Masses- hemorrhoids? Peritoneal necrosis? Bleeding Rash or redness Swelling Warts or other lesions Fissures
RECTAL PALPATION
Lubricate a gloved finger
Explain what you are going to do
Test: stool for occult blood (may have a kit)
Assess for sphincter tone of the anus, tenderness, induration, irregularities, or nodules
Rotate hand clockwise and counterclockwise
**Do NOT Force if severe tenderness present!!!
Describe location of findings as a clock . . . “ at 12 o’clock”
Assess contour, shape and size of Prostate, nodules (characteristics of & position on prostate gland), tenderness?
ABNORMAL PROSTATE FINDINGS: PROSTATITIS
Dysuria Slow stream Nocturia Incomplete voiding, frequency Abdominal/pelvic pain - common N/V Fever/chills Tender prostate w/palpation Prostate may feel boggy or firm UA- may be normal STI testing should be done if risk is present (GC/CT) <35 y.o.
BPH
BPH Symptom Score:Incomplete emptying,Frequency,Intermittency,Urgency,Weak stream,Straining,Nocturia
Prostate enlarged- usually diffusely
Non-tender
Present in >50% of men 50 or older
CLINICAL CONSIDERATION for men
Vaccinations: HPV
STI testing (NAAT for GC/CT), HIV, Hep B & C
PCR for HSV
PSA- reliability, specificity? EBP recommendation
Individual decision for 55-69
No screening for prostate ca in men 70 and older
Testicular Cancer: USPSTF: Grade D “DO not recommend routine clinician or self-testicular exams for testicular cancer screening in asymptomatic males of any age”
