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- Anus and Rectum
- Anal canal
- Anal columns
- Anorectal junction
- Anal valve
- Anal crypt
- 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 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.
- Equipment needed
- Lubricating jelly
- 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.
Anus, Rectum, Prostate
- 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
- Consistency: should be smooth, elastic.
- 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.
- 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
- 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.