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61 Cards in this Set
- Front
- Back
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How long is the rectum
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12 cm long
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Rectum: anorectal junction
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1. the distal line, the anorectal junction, is visible on proctoscopic examination as a sawtooth like edge but is not palpable
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rectal ampulla
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stores feces
1. above the inner rectal junction, the rectum dilates and turns posteriorly into the hollow of the coccyx and sacrum, forming the rectal ampulla, which stores flatus in feces |
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rectum: houston valves
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the rectal wall contains three semi lunar transverse fold (Houston valves).
the lowest of these folds can be palpated by the examiner |
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how long is the anal canal
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2.5-4 cm
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Internal Sphincter: Voluntary or Autonomic
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Autonomic
the urge to defecate occurs when the rectum fills a feces, which causes reflexive stimulation that relaxes the internal sphincter |
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External Sphincter: Voluntary or Autonomic
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Voluntary
defecation is controlled by the striated external sphincter, which is under voluntary control. |
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Columns of Morgagni
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internally the anal canal is lined by columns of mucosal tissue (columns of Morgagni) that fuse to form the anorectal junction.
The spaces between the columns are called crypts, into which anal glands empty. Inflammation of the crypts can result in fistula or fissure formation |
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Zona hemmorrhoidalis
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1. Anastomosing veins across the columns, forming a ring called the zona hemorrhoidalis.
a. Internal hemorrhage results from dilation of these veins 2. the lower section of the anal canal contains a venous plexus that drains into the inferior rectal veins. a. Dilation of this plexus results in external hemorrhoids |
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Prostate Gland: size
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i. 4×3×2 cm
1. composed of muscular and glandular tissue |
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Prostate Gland: Location
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ii. located at the base of the bladder and surrounds the urethra
iii. the posterior surface of the prostate gland is in close contact with the anterior rectal wall and is accessible by digital examination |
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Prostate Gland: Median Sulcus
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1. it is convex and is divided by a shallow median sulcus into the right in lateral lobes. A third or median lobe not palpable on examination, is composed of glandular tissue and lies between the ejaculatory duct and the urethra
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Prostate Gland: Lobes
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3 lobes
1. it is convex and is divided by a shallow median sulcus into the right in lateral lobes. A third or median lobe not palpable on examination, is composed of glandular tissue and lies between the ejaculatory duct and the urethra |
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Prostate Gland: Aveoli
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1. it contains active secretory alveoli that contribute to ejaculatory fluid.
2. The seminal vesicles extend outward from the prostate |
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PSA
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1. PSA is present in small quantities in the serum of men with healthy prostates, but is often elevated in the presence of prostate cancer and in other prostate disorders.While frequently used for prostate cancer screening, the United States Preventive Services Task Force (USPSTF) does not recommend its use in healthy men. This USPSTF recommendation, released in October 2011, is based on "review of evidence" studies concluding that "Prostate-specific antigen–based screening results in small or no reduction in prostate cancer–specific mortality and is associated with harms related to subsequent evaluation and treatments, some of which may be unnecessary." In those with prostate cancer, rising levels of PSA over time are associated with both localized and metastatic prostate cancer (CaP). Prostate test screening is controversial and may lead to unnecessary, even harmful, consequences in some patients.
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What indicates anal patency in infants?
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a. the first meconium stool is ordinarily passed within the first 24 to 48 hours after birth and indicate anal patency
i. therefore, it is common for newborns to have a stool after each feeding (the GASTROCOLIC REFLEX). |
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What ages does control of external anal sphincter happen?
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18-24 months
i. on average, children are developmentally ready to begin toilet training age 18 months and achieve complete toilet training by age 2 to 3 years |
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3. Anatomy and Physiology: Pregnant Women
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a. Development of hemorrhoids
i. two reasons that predispose pregnant women to the development of hemorrhoids 1. during pregnancy, pressure in the veins below the large uterus increases, as does blood flow 2. dietary habits and hormonal changes that decrease G.I. tract Tony motility produce constipation b. Protrusion/inflammation of hemorrhoids i. labor which results in pressure on the pelvic floor by the presenting part of the fetus and expulsive efforts of the woman, may also aggravate the condition, causing protrusion and inflammation of hemorrhoids |
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4. Anatomy and Physiology: Older Adults
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a. Increased pressure sensation threshold in rectum
i. degeneration of afferent neurons in the rectal wall interferes with the process of relaxation of the internal sphincter in response to distention of the rectum ii. this can result in elevated pressure threshold for the sensation of rectal distention in the older adult, with consequent retention of stool b. Stool retention i. degeneration of afferent neurons in the rectal wall interferes with the process of relaxation of the internal sphincter in response to distention of the rectum ii. this can result in elevated pressure threshold for the sensation of rectal distention in the older adult, with consequent retention of stool c. Loss of sphincter tone i. degeneration of afferent neurons in the rectal wall interferes with the process of relaxation of the internal sphincter in response to distention of the rectum ii. this can result in elevated pressure threshold for the sensation of rectal distention in the older adult, with consequent retention of stool d. Fecal incontinence i. as the autonomically controlled internal sphincter loses tone, the external sphincter cannot by itself controlled bowels, and the older adult may experience fecal incontinence e. Prostate atrophies/enlarges i. in men, the fibromuscular structures of the prostate gland atrophy, loss of function of the secretory alveoli; however, the atrophy of aging is often obscured benign hyperplasia of the glandular tissue. ii. The muscular component of the prostate is progressively replaced by collagen |
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Related History: Present Problem: Changes in bowel function
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i. Character
1. number, frequency, consistency of stools; presence of mucus or blood; color (dark, bright red, black, light, or Clay colored); odor ii. Onset/duration 1. sudden or gradual, relation to dietary change, relation to stressful events iii. Associated symptoms 1. incontinence, flatus, pain, fever, nausea, vomiting, cramping, abdominal distention iv. Medications 1. iron, laxatives, stool softeners |
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Related History: Present Problem: anal discomfort
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i. Relation to position/defecation
ii. Straining at stool iii. Blood/mucous iv. Interference with ADLs/sleep v. Medications 1. hemorrhoid preparations |
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Related History: Present Problem: rectal bleeding
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i. Color
1. bright or dark red, black ii. Relation to defecation iii. Amount 1. spotting on toilet paper versus active bleeding iv. Changes in stool 1. color, frequency, consistency, shape, odor, presence of mucus v. Associated symptoms 1. incontinence, flatus, rectal pain, abdominal pain or cramping, abdominal distention, weight loss vi. Medications 1. iron, fiber additives |
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Related History: Present Problem: males: changes in urinary function
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i. History of enlarged prostate/prostatitis
ii. Symptoms 1. hesitancy, urgency, nocturia, dysuria, change in force or caliber of stream, dribbling, urethral discharge iii. medications 1. anti-histamines, anticholinergics, tricyclic antidepressants, 5-alpha-reductase inhibitors |
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Related History: Past Medical History
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a. Hemorrhoids
b. Spinal cord injury c. Prostatic hypertrophy/cancer d. Episiotomy/4th-degree laceration |
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Related History: Family History
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a. Rectal polyps
b. Colon cancer c. Prostate cancer |
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Related History: Personal/Social History
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a. Bowel habits/characteristics
b. Travel history i. areas with high incidence of parasitic infestation, including zones in the United States c. Diet i. inclusion of fiber foods (cereals, breads, nuts, fruits, vegetables) and concentrated high fiber food; amount of animal fat d. Colorectal/prostate cancer risk factors i. colorectal cancer risk factors 1. older than 50 years of age 2. family history of colon cancer 3. personal history of colorectal cancer, intestinal polyps, chronic inflammatory disease (Crohn disease, ulcerative colitis), Gardner syndrome 4. personal history of ovarian, endometrial, or breast cancer 5. ethnic background: Ashkenzai Jewish descent 6. diet high in beef and animal fats, low in fiber 7. obesity 8. smoking 9. physical inactivity 10. alcohol intake: risk increases with increased amounts ii. prostate cancer risk factors 1. older than 50 years 2. brace: black (two times the risk compared with that of white men) 3. nationality: common in North America and northwestern Europe; less common in Asia, Africa, Central America, and South America 4. family history of prostate cancer (twice the risk with one first-degree relative; risk increases with more than one first-degree relative) 5. diet high in animal fat 6. hormones: cumulative exposure of the prostate to high levels of androgens 7. physical activity e. Use of alcohol |
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colorectal cancer risk factors
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1. older than 50 years of age
2. family history of colon cancer 3. personal history of colorectal cancer, intestinal polyps, chronic inflammatory disease (Crohn disease, ulcerative colitis), Gardner syndrome 4. personal history of ovarian, endometrial, or breast cancer 5. ethnic background: Ashkenzai Jewish descent 6. diet high in beef and animal fats, low in fiber 7. obesity 8. smoking 9. physical inactivity 10. alcohol intake: risk increases with increased amounts |
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prostate cancer risk factors
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1. older than 50 years
2. brace: black (two times the risk compared with that of white men) 3. nationality: common in North America and northwestern Europe; less common in Asia, Africa, Central America, and South America 4. family history of prostate cancer (twice the risk with one first-degree relative; risk increases with more than one first-degree relative) 5. diet high in animal fat 6. hormones: cumulative exposure of the prostate to high levels of androgens 7. physical activity |
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Related History: Infants/Children
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a. Stool characteristics
b. Bowel movements i. bowel movements accompanied by crying, straining, bleeding c. Feeding habits i. types of foods, milk (bottle or breast or infants), appetite d. Bowel control/potty training i. age at which bowel control and toilet training were achieved e. Associated symptoms i. episodes of diarrhea or constipation; tenderness when cleaning after stool;. Anal irritations; weight loss; nausea, vomiting f. Congenital anomaly i. imperforate anus, myelomeningocele, aganglionic megacolon |
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Related History: Pregnant Women
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a. Gestation/expected date of delivery
b. Exercise c. Fluid intake/diet d. Medications i. prenatal vitamins, iron |
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Related History: Older Adults
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a. Change in bowel habits/character
i. frequency, number, color, consistency, shape, odor b. Associated symptoms i. weight loss, rectal or abdominal pain, incontinence, flatus, episodes of constipation or diarrhea, abdominal distention, rectal bleeding c. Dietary changes i. intolerances for certain foods, inclusion of high fiber foods, regularity of eating habits, appetite d. Males: enlarged prostate/urinary symptoms i. history of enlarged prostate, urinary symptoms (hesitancy, urgency, nocturia, dysuria, forests and caliber of urinary system, dribbling) |
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Exam & Findings: Inspection/Palpation: Pilonidal and perianal areas
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i. Texture
1. skin should be smooth and interrupted ii. Redness/swelling/tenderness iii. Excoriation/rashes iv. Lumps v. Scars vi. Dimpling vii. Hair tufts viii. fungal infection is more common in adult diabetes, and pinworms are more common in children ix. the best time to visualize pinworms in children is after they fall sleep. Inspection done of the anus (by the parent) often reveals some x. palpate 1. palpate the area, the discovery of tenderness and inflammation should alert you to the possibility of the perianal abscess, anorectal fistula or fissure, pilonidal cyst or pruritus ani. |
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Exam & Findings: Inspection/Palpation: anus
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i. Texture
1. the skin around the anus showed appear coarser and more darkly pigmented ii. Pigmentation 1. more darkly pigmented iii. Lesions iv. Warts v. Skin tags vi. Hemorrhoids vii. Fissures/fistulas viii. Prolapse/polyps ix. ask the patient to bear down. This will make fistulas, fissures, rectal prolapse, polyps, and internal hemorrhoids more readily apparent x. clock referents are used to describe the location of anal and rectal findings: 12 o'clock is the ventral midline and six o'clock if the dorsal midline |
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Exam & Findings: Inspection/Palpation: spinchter
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i. Tone
1. lubricate your index finger and press the pad of it against anal opening. 2. Ask the patient to bear down to relax the external sphincter 3. as relaxation occurs, slipped the tip of the finger into the anal canal 4. warned the patient that there may be a feeling of urgency for a bowel movement, and assure him or her that this will happen 5. asked the patient to tighten the external sphincter around your finger, noting its tone: it should appear evenly with no discomfort to the patient 6. a lax sphincter may indicate neurologic deficit 7. an extremely tight sphincter may can result from scarring, spasticity caused by fissure brother lesion, inflammation, or anxiety about the examination ii. Tenderness 1. and anal fistula or fissure may produce such extreme tenderness that you are not able to complete the examination without local anesthesia 2. rectal pain is almost always indicative of local disease iii. Irritation iv. Fissures v. Hemorrhoids vi. Stool consistency |
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Exam & Findings: Inspection/Palpation: anal ring
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i. Tone/texture
1. rotate your finger (pad facing upward) to examine the muscular anal ring 2. it should feel smooth and exert even pressure on the finger ii. Nodes/irregularities |
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Exam & Findings: Inspection/Palpation: rectal walls
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i. Texture
1. in search your finger further past the anal ring and palpate in sequence the lateral and posterior rectal walls. 2. The walls should feel smooth, even, and on interrupted ii. Nodules iii. Masses iv. Irregularities v. Polyps vi. Tenderness |
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Exam & Findings: Inspection/Palpation: prostate
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i. Size
1. diameter of 4 cm, with less than 1 cm protrusion into the rectum 2. greater protrusion denotes prostatic enlargement, which should be noted with the amount of protrusion recorded ii. Contour 1. lobes should feel symmetric iii. Consistency 1. should feel like a pencil eraser-firm, smooth, and slightly movable-and it should be nontender 2. a boggy or rubbery consistency is indicative of benign hypertrophy, whereas stony hard nodular rarity may indicate carcinoma, prostatic calculi, or chronic fibrosis iv. Mobility 1. slightly movable v. Secretions 1. palpation of the prostate can for secretions do the urethral orifice. 2. Any secretions that appear at the meatus should be cultured and examined microscopically |
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Exam & Findings: Inspection/Palpation: stool
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i. Characteristics
1. slowly withdraw your finger from the rectum and examine it for any fecal material, which should be soft and brown 2. very light tan or gray stool could indicate obstructive jaundice, whereas tarry black stool should make you suspect upper intestinal tract bleeding. 3. A more subtle blood loss can result in virtually unchanged color of the stool, but even a small amount will yield a positive test for occult blood. 4. If indicated fecal material can be tested for blood using a chemical guaiac procedure ii. Blood or blood 1. note any blood or pus 2. tarry black stool should make you suspect upper intestinal tract bleeding. 3. A more subtle blood loss can result in virtually unchanged color of the stool, but even a small amount will yield a positive test for occult blood. 4. If indicated fecal material can be tested for blood using a chemical guaiac procedure |
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Exam & Findings: Infants/Children
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a. Inspect anus/perineum/buttocks
i. Redness/irritation 1. perirectal redness and irritation are suggestive the pinworms, Candida, or other irritants of the diaper area ii. Masses iii. Discharge/bleeding iv. Perirectal protrusion 1. rectal prolapse resulting constipation, diarrhea, or sometimes severe coughing or straining v. Rectal abscesses vi. Texture/tone 1. inspects the tone of the real sphincter, it should feel snug but neither too tight nor too loose 2. a very tight sphincter can cause enough tension to produces stenosis, which leads to stool retention and pain during a bowel movement. 3. A lack sphincter is associated with lesions of the peripheral spinal nerves or spinal cord, Shigella infection, and previous fecal impaction's vii. Anal contraction 1. lightly touched the anal opening, we should produce anal contraction ("anal wink"). 2. Lack of contraction may indicate a lower spinal cord lesion b. Examine newborn for patency of anus i. usually confirmed by passage of meconium ii. to determine patency when there is a concern, answer lubricated catheter no more than 1 cm into the rectum. iii. Occasionally it. Anal fistula may be confused with that anal orifice. iv. Be careful in making this judgment. v. Sometimes the anal orifice can seem appropriate, yet there may be atresia just inside or if you centimeters within the rectum vi. rectal examination or insertion of catheter does not always provide definitive assessment, and radiologic studies may be necessary vii. if there is no evidence of stool and the rectum of a newborn, suspect rectal atresia, Hirschsprung disease (congenital megacolon), or cystic fibrosis c. Rectal exam not routine infants/children i. rectal examination not always performed on infants and children unless there is a particular problem-required whenever there is it any symptom that suggest intra-abdominal or public problem, a mass or tenderness, butter distention, bleeding, or rectal or bowel abnormalities d. Perform rectal exam when i. Pain ii. Bleeding iii. Rectal protrusion/abscesses iv. Stool abnormalities e. Rectal exam routine for adolescents i. rectal examination should be part of the physical assessment for adolescents who have symptoms related to lower intestinal tract. |
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Exam & Findings: Pregnant Women
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a. Inspect/palpate for expected changes
i. Hemorrhoids 1. assessment hemorrhoids should include both are external and internal evaluation. 2. Hemorrhoids are usually not found early in pregnancy; however, they maybe an expected variation late pregnancy. 3. Evaluate hemorrhoids for size, extent, location (internal or external), discomfort to the patient, and signs of infection or bleeding ii. Stool changes 1. may change to dark green or black due to consumption of by preparations 2. iron may also cause diarrhea or constipation |
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Exam & Findings: Older Adults
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a. Inspect/palpate for
i. Decreased sphincter tone ii. Stool character iii. Enlarged prostate iv. Polyps |
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Pilonidal cyst/sinus
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i. Pathophysiology
1. loose hairs penetrate the skin in a sacrococcygeal area 2. local inflammatory reaction causes assistive form around the ingrown hair 3. excessive pressure a repetitive trauma to sacrococcygeal predisposes to the development of the cyst 4. most first diagnosed in adults, although they are usually a congenital anomaly ii. subjective data 1. usually asymptomatic 2. may have pain and inflammation secondary infection iii. objective data 1. cyst or sinus seen as a dimple with the sinus tract opening 2. located in the midline, superficial to the coccyx and lower sacrum 3. opening may contain a soft appear and be surrounded by erythema 4. a cyst may be palpable |
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Perianal Abcess
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i. Pathophysiology
1. perianal abscess: infection of the soft tissue surrounding anal canal, with formation of the discrete abscess cavity Subjective Data: ii. subjective data 1. painful and tender 2. fever 3. pain and defecation or would sitting or walking iii. objective data 1. perianal abscess: tender swollen fluctuant mass in the superficial subcutaneous tissue just adjacent to the anus |
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Peri-rectal Abscess
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Patho
infection of the mucus secreting anal glands, which drain into the anal crypts; abscess formation occur in the deeper tissues 3. infections caused by anaerobic organism, usually polymicrobial subjective data 1. painful and tender 2. fever 3. pain and defecation or would sitting or walking objective data: 2. perirectal abscess: tender mass that may be indurated, fluctuant, or draining |
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anorectal fissure
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patho
1. anorectal fissure: tear in the anal mucosa usually caused by traumatic passage of large hard stools subjective data: 1. anorectal fissure history of hard stools, pain, itching, or bleeding objective data: 1. anorectal fissure: examination is painful may require local anesthesia; most often in the posterior midline, although it can also occur in the interior midline; Sentinel skin tag may be seen at the lower edge of the fissure; may be ulceration through which muscles of the internal sphincter are seen; in turtle sphincter is spastic |
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anorectal fistual
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Patho
2. anal fistula: inflammatory tract that runs from the anus or rectum and opens onto the surface of the perianal skin or other tissue; caused by drainage of a perianal or perirectal abscess subjective data: 2. anal fistula: may report chills, fever, nausea, vomiting, and malaise objective data: 2. anal fistula: external opening of the fistula appears as a pink or red, elevated, elevated red granular tissue on the skin near the anus; palpable indurated tract may be present on digital rectal examination; serosanguineous or purulent drainage may appear with compression of the area |
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Pruritus ani
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i. Pathophysiology
1. commonly caused by fungal infection in adults and I parasites in children ii. subjective data 1. anal burning or itching that may interfere with sleep iii. objective data 1. excoriation, thickening, and pigmentation of anal and perianal tissue |
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Hemorrhoids
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i. Pathophysiology
1. external hemorrhoids: varicose veins originate below the anorectal line that are covered by anal skin 2. internal hemorrhoids: varicose veins originate above the anorectal junction and are covered by rectal mucosa ii. subjective data 1. may cause itching and bleeding and discomfort 2. internal: no discomfort unless they are thrombosed, prolapsed, or infected 3. bleeding may occur with or without defecation iii. objective data 1. usually not visible at rest, they can protrude understanding and straining at stool 2. if not reduce, they can become edematous and thrombosed and may require surgical removal 3. thrombosed hemorrhoids appear as blue, shiny masses at the anus 4. internal: soft swellings that are not palpable on rectal examination and are not visible unless they prolapsed through the anus; proctoscopy is usually required for diagnosis 5. hemorrhoidal skin tags, which can appear at the site of resolve hemorrhoids, or fibrotic or phosphate in painless |
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polyps
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i. Pathophysiology
1. occur anywhere in the intestinal tract 2. may be malignant or benign 3. can occur singly or in profusion ii. subjective data 1. asymptomatic 2. rectal bleeding iii. objective data 1. rectal polyp may protrude through rectum 2. rectal polyps sometimes palpable on rectal examination a soft nodules and can be either pedunculated (on a stalk) or sessile (closely adhering to the mucosal wall) 3. colonoscopy or proctoscopy is usually required for diagnosis, and biopsy is necessary to distinguish benign from malignant |
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rectal cancer
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i. Pathophysiology
1. adenocarcinoma is comprise a large majority of rectal cancers ii. subjective data 1. bleeding most common symptom 2. often asymptomatic iii. objective data 1. usually felt as a sessile polypoid mass with nodular raised edges in areas of ulceration 2. consistency is often stony, and the contour is a regular |
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Prostatitis
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i. Pathophysiology
1. inflammation of the prostate gland 2. acute: bacterial infection including E. coli, Klebsiella, and Proteus 3. may be acquired as a sexually transmitted disease or from infection of a adjacent organ, or as a complication a prostate biopsy 4. chronic bacterial 5. chronic: May bacterial or nonbacterial (chronic pelvic pain syndrome) ii. subjective data 1. acute a. pain b. urinary problems c. sexual dysfunction d. fever, chills, shakes 2. chronic a. asymptomatic b. frequent bladder infections c. frequent urination d. persistent pain in the lower abdomen or back iii. objective data 1. acute a. gentle exam imperative; the size of the prostate can cause bacteremia b. prostate enlarged, acutely tender, and often asymmetric c. abscess may develop, felt as a fluctuant mass in the prostate d. seminal vesicles are often involved in may be dilated and tender on palpation; however, the prostate may feel boggy, and large, tender out palpable areas of fibrosis that simulate neoplasm e. bacteria in the urine 2. chronic a. prostate may be normal sizing consistency b. maybe enlarged boggy iv. Swollen, tender and boggy prostate v. Milk, culture discharge vi. Long course of antibiotics (6-8 weeks) vii. Not all prostatis is sexually transmitted |
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Prostate Cancer
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i. Pathophysiology
1. over 99% of prostate cancers are adenocarcinomas, developing from the gland cells within the prostate 2. in most cases, prostate cancer is a relatively slow-growing cancer; a small percentage is rapidly growing, aggressive form 3. incidence increases with age and is less frequent in men younger than 50 years of age ii. subjective data 1. early carcinoma asymptomatic 2. as the symptoms advances symptoms of urinary obstruction occur iii. objective data 1. a hard, a regular nodule may be palpable on prostate examination 2. prostate feels asymmetric, and the median sulcus may be obliterated 3. biopsy required for diagnosis |
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Benign Prostatic Hypertrophy
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i. Pathophysiology
1. Common in men older than 50 years 2. gland begins to grow adolescents, continuing to enlarge the dancing age 3. growth of the prostate parallels the increased incidence of BPH ii. subjective data 1. symptoms of urinary obstruction: hesitancy, decreased forests and caliber of stream, dribbling, incomplete emptying the bladder, frequency, urgency, nocturia, and dysuria iii. objective data 1. prostate feel smooth, rubbery, symmetric, an enlarged 2. median sulcus may or may not be obliterated |
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Common Abnormalities: Children: Enterobiasis
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i. Roundworm/Pinworm
ii. pathophysiology 1. adult nematode (parasite) lives in the rectum or: emerges onto perianal skin to lay eggs while the child sleeps iii. subjective data 1. intense itching of the perianal area 2. parents often described unexplained irritability in the child or infant, especially at night iv. objective data 1. perianal irritation often results from scratching 2. can be diagnosed using scotch tape test: press the sticky side of cellulose tape against the perianal folds and then press the tape on a glass slide; nematodes can be seen on microscopic examination |
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Common Abnormalities: Children: Imperforate anus
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i. Pathophysiology
1. a variety of anorectal malformations can occur during fetal development 2. rectum a and finally, be stenosis, or have a fistulous connection to the perineum, urinary tract or, in females, the vagina ii. subjective data 1. none iii. objective data 1. condition is usually diagnosed by rectal examination and confirm by lack of passage of stool within the first 48 hours of life 2. radiographic confirmation may be necessary 3. be aware that the imperforation maybe just out of reach of the examining finger on infrequent occasion |
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Common Abnormalities: Children:
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z
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The prostatic sulcus
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divides the prostate into right and left lateral lobes
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The adult internal rectal sphincter is controlled by the
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autonomic nervous system
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When performing a rectal examination in a man, in which position is the patient generally placed?
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Left lateral
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Which of the following is a risk factor for colorectal cancer
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High-fiber diet
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In males, which surface of the prostate gland is accessible by digital examination
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posterior
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