Chapter 26: Anus, Rectum, and Prostate Exam

Chapter 26: Anus, Rectum, and Prostate Exam Anal Canal - -the outlet of the gastrointestinal (GI) tract; it is about 3.8 cm long in the adult. Rectum - -12 cm long -distal portion of the large intestine -extends from the sigmoid colon at the level of the 3rd sacral vertebra, and ends at the anal canal Prostate - -male gland that lies in front of the anterior wall of the rectum and 2 cm behind the symphysis pubis -Secretes a thin, milky, alkaline fluid that supports sperm -Has 2 seminal vesicles that project like rabbit ears above the prostate -The 2 bulbourethral (Cowper) glands are each the size of a pea and are located inferior to the prostate on either side of the urethra Sigmoid Colon - named from its S- shaped course in the pelvic cavity benign prostatic hyperplasia (BPH) - -The prostate gland commonly starts to enlarge during the middle adult years, but this is NOT cancer -This benign prostatic hyperplasia is present in 80% of men over 60 years -Symptoms include urinary frequency, urgency, hesitancy, straining to urinate, weak stream, intermittent stream, sensation of incomplete emptying, nocturia -Observations: A symmetric nontender enlargement; commonly occurs in males beginning in the middle years. The prostate surface feels smooth, rubbery, or firm (like the consistency of the nose), with the median sulcus obliterated Prostate Cancer - - most frequently diagnosed cancer in men -Known risk factors include increasing age, African ancestry, a family history of PC (brother or father), and inherited mutations of the BRCA1 and BRCA2 genes -Men with metastatic PC are more likely to have a lower socioeconomic status (SES), to lack insurance or have Medicaid, and to be of black or Hispanic race/ethnicity -The American Urological Association recommends that men of African ancestry and men with a family history of prostate cancer should be offered the blood test of PSA screenings Colorectal cancer (CRC) - - incidence rates are high in Alaska Natives and african americans when compared to whites, and lower in Asian/ Pacific Islanders - Recommendations include beginning screening at age 50 for those at average risk but earlier with a family history of CRC. Subjective Data - -Usual bowel movements -Changes in bowel habits -Rectal bleeding, blood in the stool -Medications -Rectal conditions Rome III criteria for constipation - -<3 stools/week, straining, lumpy or hard stools, and incomplete evacuation, sensation of blockage -Risks: older age, women, inactivity -Helps to increase fiber and water, change position, and stool softeners Dyschezia - -pain due to a local condition (hemorrhoid, fissure) or constipation Rectal bleeding and blood in the stool - Check for: -Melena -Black stools may be tarry due to occult blood (melena) from GI bleeding or non-tarry from ingestion of iron medications -Red blood occurs with GI bleeding, local bleeding around the anus, with colon and rectal cancer -Is the stool frothy (brb vomiting) Steatorrhea - excessive fat in stool; malabsorption as in celiac disease, cystic fibrosis, chronic pancreatitis, Crohn disease Symptomatic hemorrhoids - pruritus, painless rectal bleeding, red blood on tissue or in bowl Fissure - Painful bowel movements like "shards of glass" Fiber in diet - -High fiber foods of the soluble type include beans, prunes, barley, carrots, broccoli, cabbage -High fiber foods of the soluble type lower cholesterol levels -Insoluble fiber foods include cereals and wheat germ -Insoluble fiber foods reduce the risk for colon cancers Early detection for cancers - -Colonoscopies after age 50, then every 10 years -Fecal occult blood test annually after age 50; age 45 for African Americans left lateral decubitus position for rectal exams - laying down on left side; use for rectal area alone Lithotomy position for rectal exams - GYN position Standing position for rectal exams - BEND OVER Hemorrhoid - flabby skin sac thrombosed hemorrhoid - shiny blue skin sac palpating the prostate gland - -On the anterior wall in the male, note the elastic, bulging prostate gland -The surface should feel smooth and muscular; search for any distinct nodule or diffuse firmness, and note the characteristics Characteristics of the prostate gland - -Size: 2.5 cm long by 4 cm wide; should not protrude more than 1 cm into the rectum -Shape- heart shape, with a palpable central groove -Surface: Smooth -Consistency: Elastic, rubbery -Mobility: Slightly movable -Sensitivity: Nontender to palpation.........