Anus, Rectum, and Prostate

Chapter 25

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Chapter 25: Anus, Rectum, and Prostate

Structure and Function

Subjective DataHealth History Questions

Objective DataThe Physical Exam

Abnormal Findings

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 25-2

Chapter 25: Anus, Rectum, and Prostate

Structure and Function

Anus and Rectum
Anal canal
Sphincters
Anal columns
Anorectal junction
Anal valve
Anal crypt
Rectum
Valves of Houston
Peritoneal reflection

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 25-3

Chapter 25: Anus, Rectum, and Prostate

Anus and Rectum

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 25-4

Chapter 25: Anus, Rectum, and Prostate

Structure and Function

(cont.)

Prostate

Prostate gland

Position in pelvis

Lobes and median sulcus

Seminal vesicles

Bulbourethral glands

Regional structures

Sigmoid colon
Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 25-5

Chapter 25: Anus, Rectum, and Prostate

Anatomy of the Prostate Gland

and Seminal Vesicles

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 25-6

Chapter 25: Anus, Rectum, and Prostate

Subjective Data
Health History Questions

Usual bowel routine

Change in bowel habits

Rectal bleeding or blood in the stool

Medications (laxatives, stool softeners, iron)

Rectal conditions (pruritus, hemorrhoids, fissure, fistula)

Family history

Self-care behaviors (diet of high-fiber foods, most recent

examinations)
Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 25-7

Chapter 25: Anus, Rectum, and Prostate

Objective DataThe Physical Exam

Preparation

Position

Equipment needed

Penlight

Lubricating jelly

Glove

Guaiac test container

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 25-8

Chapter 25: Anus, Rectum, and Prostate

Rectal Examination Positions

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 25-9

Chapter 25: Anus, Rectum, and Prostate

Objective DataThe Physical Exam

(cont.)

Inspection of the Perianal Area

Skin

Anal opening

Sacrococcygeal area

Valsalva maneuver

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 25-10

Chapter 25: Anus, Rectum, and Prostate

Objective DataThe Physical Exam

(cont.)

Palpation of the Anus and Rectum

Palpation technique

Canal wall

Perianal tissue

Rectal wall

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 25-11

Chapter 25: Anus, Rectum, and Prostate

Objective DataThe Physical Exam

(cont.)

Palpation of the Anus and Rectum (cont.)

Prostate gland

Size

Shape

Surface

Consistency

Mobility

Sensitivity

Examination of stool for occult blood

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 25-12

Chapter 25: Anus, Rectum, and Prostate

Sample Charting

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 25-13

Chapter 25: Anus, Rectum, and Prostate

Sample Charting
(cont.)

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 25-14

Chapter 25: Anus, Rectum, and Prostate

Abnormal Findings

Anus and Perianal Region

Pilonidal cyst or sinus

Anorectal fistula

Fissure

Hemorrhoids

Rectal prolapse

Pruritus ani

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 25-15

Chapter 25: Anus, Rectum, and Prostate

Pilonidal cyst or sinus

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 25-16

Chapter 25: Anus, Rectum, and Prostate

Anorectal fistula

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 25-17

Chapter 25: Anus, Rectum, and Prostate

Fissure

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 25-18

Chapter 25: Anus, Rectum, and Prostate

Hemorrhoids

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 25-19

Chapter 25: Anus, Rectum, and Prostate

Pruritis Ani

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 25-20

Chapter 25: Anus, Rectum, and Prostate

Abnormal Findings
Rectum

Abscess

Rectal polyp

Fecal impaction

Carcinoma

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 25-21

Chapter 25: Anus, Rectum, and Prostate

Rectal prolapse

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 25-22

Chapter 25: Anus, Rectum, and Prostate

Abnormal Findings
Prostate Gland

Benign prostatic hypertrophy (BPH)

Prostatitis

Carcinoma

Abscess

Rectal polyp

Fecal impaction

Carcinoma
Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 25-23

Chapter 25: Anus, Rectum, and Prostate

Which of the positions illustrated

above would be appropriate for this
examination on an adult male patient?
A.

Left lateral

B.

Lithotomy

C.

Standing

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 25-24

Chapter 25: Anus, Rectum, and Prostate

Which of the positions illustrated above

would be appropriate for this examination
combined with the pelvic examination on
an adult female patient?
A.

Left lateral

B.

Lithotomy

C.

Standing

Elsevier items and derived items 2008, 2004, 2000, 1996, 1992 by Saunders, an imprint of Elsevier Inc.

Slide 25-25