-
Structures
- Anus and Rectum
- Anal canal
- Sphincters
- Anal columns
- Anorectal junction
- Anal valve
- Anal crypt
- Rectum
- Valves of Houston: Slows down decent of stool
- Peritoneal reflection
-
What is a Fecal Occult Blood Test
- Test to see if there is blood in the stool.
- Collected from 3 BMs, placed in a little bottle, bottom of which will turn blue if blood is present.
- Do not eat raw meat or Vit C supplements.
-
Anatomy of the prostate gland and simal vesicles
- Prostate
- Prostate gland
- Position in pelvis
- Lobes and median sulcus
- Seminal vesicles: In center of prostate.
- Bulbourethral glands
- Regional structures
- Uterine cervix
- Sigmoid colon
-
Objective data about yur bum exam.
- Preparation
- Position
- Equipment needed
- Penlight
- Lubricating jelly
- Glove
- Guaiac test container: little cards for fecal occult blood test. Remind pt to not use sticks in their bums.
-
Objective Data of the PE
Inspection of the Perianal Area
- Skin: should be intact, not inflamed, all the normal stuff.
- Anal opening: Should not be prolapsed. Do not confuse with hemaroids. Will need to be corrected by surgery.
- Sacrococcygeal area
- Valsalva maneuver: Have pt bear down a little to open the sphincter. Will be more comfortable for pt.
-
Subjective data
Anus, Rectum, Prostate
- Steatorrhea:
- Change in bowel habits
- Rectal beeding/blood in stool
- Rectal conditions: pruritus (pin worms?), hemorrhoids, fissure, fistula (hole from colon to outside skin/vagina. Anywhere next door)
- Family Hx: colon cancer, remember to get age of diagnosis. Will begin screening 10 years before family members were diagnosed.
- Self care: diet of high fiber, colonoscopy, most recent exam and results
-
What is dyschezia?
Localized pain around rectum.
-
What is Melena
Blood in the stood. Will be black, tarry.
-
What is steatorrhea
- Fat in the stool due to gaul bladder issues, pancreatic disorder, etc.
- Stool will float, foamy, grey colored (lack of bile)
-
Rectal Exam positions
 - If standing, have pt turn toes in. Will prevent glutes from clenching. Also helps shots not hurt.
- If left lateral, have pt extend bottm leg out. Is left because it reduces risk of poking internal vicera.
-
Objective prostate data
- Size
- Shape
- Surface
- Consistency: should be smooth, elastic.
- Mobility
- Sensitivity: Normal to make man think he's going to pee.
-
More objective data
Whatever is left on the examining finger (gloved) always do fecal occult blood test.
-
Aging adult
- As an aging person performs Valsalva maneuver, you may note relaxation of perianal musculature and decreased sphincter control
- Otherwise, full examination proceeds as that described for younger adult
-
Colorectal cancer screening
- Currently second leading cancer killer in U.S. However, it should not be; if everyone age 50 or older had regular screening tests, one third of deaths from this cancer could be avoided
- Screening identifies precancerous polyps so they can be removed before they become cancer
- Screening can also find CRC early, when treatment can be effective
- CRC is most often found in people age 50 and older
- Older you get the higher your risk; both men and women get CRC
If precancer polyps, have screening every 3 years.
-
Promoting a healthy colon
- CRC screening tests include
- Fecal Occult Blood Test (FOBT)
- Flexible sigmoidoscopy
- Combination of FOBT and Flexible sigmoidoscopy
- Colonoscopy
- Double contrast barium enema
-
Abnormal findings anus and perianal region
- Fistula will often need to be closed with surgery. Will most often lead to GI, but can go to/from any two areas. Also common is vaginal/colon fistula.
- Hemorrhoids can be interal or external. Can also be thrombosed. Will need intervension to remove clot.
-
Abnormal findings, Rectum
Pedunculated vs sessile: Pedunculated has a stock.
-
Abnormal findings of the prostate
- Will need to biopsy to r/o cancer.
- Prostatitis: will need antibiotics for 6-12 weeks because it takes a while for the Rx to penetrate the gland.
|
|
