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Chapter 22. Anus, Rectum, and Prostate. Competencies. Identify anatomic landmarks of the rectum and the prostate gland. Describe the characteristics of the most common rectal and prostatic chief complaints. Perform inspection and palpation of the anus, rectum, and prostate on an adult.

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Chapter 22 l.jpg

Chapter 22

Anus, Rectum, and Prostate

Copyright 2002, Delmar, A division of Thomson Learning


Competencies l.jpg
Competencies

  • Identify anatomic landmarks of the rectum and the prostate gland.

  • Describe the characteristics of the most common rectal and prostatic chief complaints.

  • Perform inspection and palpation of the anus, rectum, and prostate on an adult.

(continues)

Copyright 2002, Delmar, A division of Thomson Learning


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Competencies

  • Explain the pathophysiologic rationale for abnormal findings.

  • Document assessment findings.

  • Describe the changes that occur in the rectum and the prostate with the aging process.

Copyright 2002, Delmar, A division of Thomson Learning


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Assessment to Include

  • Male

    • Anus, rectum, prostate

  • Female

    • Anus, rectum

Copyright 2002, Delmar, A division of Thomson Learning


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Health History

  • Age

    • Young adult

    • Middle-aged adult

    • Older adult

  • Sex

    • Female

    • Male

  • Race

Copyright 2002, Delmar, A division of Thomson Learning


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Common Chief Complaints

  • Rectal bleeding

  • Rectal pain

  • Anal incontinence

  • Constipation

  • Diarrhea

  • Pruritis

  • Palpable mass

Copyright 2002, Delmar, A division of Thomson Learning


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Characteristics of Chief Complaint

  • Quality

  • Quantity

  • Associated manifestations

  • Aggravating factors

  • Alleviating factors

  • Timing

Copyright 2002, Delmar, A division of Thomson Learning


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Past Health History

  • Medical history

    • Anorectal specific

    • Systemic

  • Surgical history

    • Anorectal specific

    • Prostate

  • Medications

(continues)

Copyright 2002, Delmar, A division of Thomson Learning


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Past Health History

  • Communicable diseases

  • Allergies

  • Injuries/accidents

  • Childhood illnesses

    • Anal stenosis

    • Hirschsprung’s disease

(continues)

Copyright 2002, Delmar, A division of Thomson Learning


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Past Health History

  • Family history

    • Rectal polyps

    • Rectal cancer

    • Pilonidal cyst

    • Prostate cancer

(continues)

Copyright 2002, Delmar, A division of Thomson Learning


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Past Health History

  • Social history

    • Substance use

    • Sexual practices

    • Work environment

    • Hobbies/leisure

    • Stress

(continues)

Copyright 2002, Delmar, A division of Thomson Learning


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Past Health History

  • Health maintenance

    • Sleep

    • Diet

    • Exercise

    • Safety devices

    • Health checkups

Copyright 2002, Delmar, A division of Thomson Learning


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Assessment

  • Special equipment

  • General approach

    • Minimize apprehension

    • Privacy

    • Comfort

  • Patient position

    • Left lateral decubitus

    • Standing

    • Knee-chest

Copyright 2002, Delmar, A division of Thomson Learning


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Inspection

  • Assess the following areas for lesions, swelling, inflammation, tenderness, color, appearance

    • Perineum

    • Sacrococcygeal area

    • Anal mucosa

Copyright 2002, Delmar, A division of Thomson Learning


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Palpation

  • Anus and rectum

    • Assess for masses, anal sphincter, nodules

  • Prostate

    • Bidigital exam

    • Assess for tenderness, masses, or swelling

    • Assess posterior surface for size, shape, consistency, mobility

Copyright 2002, Delmar, A division of Thomson Learning


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Gerontological Variations

  • Decreased muscle elasticity in the rectum

  • Increased risk for rectal prolapse

  • Bowel function changes

  • Enlarged prostate

  • Increased risk for prostate cancer

Copyright 2002, Delmar, A division of Thomson Learning


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Normal Findings

  • Perineum and sacrococcygeal areas

    • Tissue is smooth, intact, free from tenderness

  • Anal mucosa

    • Tissue is pigmented, coarse, moist, and hairless

  • Rectum

    • Good sphincter tone

    • No excessive pain, tenderness, induration, or nodules

Copyright 2002, Delmar, A division of Thomson Learning


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Common Abnormal Findings

  • Excoriation of the perineal skin

  • Hemorrhoids

  • Anal fissures

  • Anorectal abscess

  • Anorectal fistula

(continues)

Copyright 2002, Delmar, A division of Thomson Learning


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Common Abnormal Findings

  • Rectal prolapse

  • Anal incontinence

  • Anal stenosis

  • Internal hemorrhoids

  • Rectal polyps

  • Benign prostatic hypertrophy

(continues)

Copyright 2002, Delmar, A division of Thomson Learning


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Common Abnormal Findings

  • Variations in stool color

    • Bright red stool

    • Black stool

    • Melena

    • Gray, tan

    • Pale yellow, greasy, fatty

Copyright 2002, Delmar, A division of Thomson Learning


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Risk Factors for Rectal Cancer

  • Age > 50

  • Familial history

  • History of adenomatous polyps, familial polyposis, endometrial or ovarian or breast cancer

  • Diet low in fiber, high in fat

Copyright 2002, Delmar, A division of Thomson Learning


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Risk Factors for Prostate Cancer

  • Age > 50

  • Family history

  • African American

  • Diet high in fat, oil, sugar

  • High levels of serum testosterone

Copyright 2002, Delmar, A division of Thomson Learning