Dr Bruce 2 Anus/rectum

Front 1

Anal canal is ____.____ to ____ cm long

Back 1

2.5 to 4

Front 2

External sphincter under _______ control: _______ muscle

Back 2

voluntary
striated

Front 3

Internal sphincter under________ ______ control: _______ muscle

Back 3

involuntary, autonomic
smooth

Front 4

Internal sphincter ________ when feces enters the lower rectum and person feels urge to defecate

Back 4

relaxes

Front 5

Defecation is voluntary except in ______ _______

Back 5

severe diarrhea

Front 6

The rectum lies ______ the anus and is about ___ cm long.

Back 6

above
12

Front 7

It’s proximal end is continuous with the sigmoid colon.

Back 7

rectum

Front 8

the rectum turns _________ into the hollow of the sacrum and stores the feces as it is received from above.

Back 8

posteriorly

Front 9

The rectum has ______ partial valves, the valves of ________

Back 9

three
houston

Front 10

In males the prostate lies at the base of the bladder surrounding the _______.
In adults it is __ x __ x __ cm in size and is convex

Back 10

urethra
4x3x2

Front 11

men over 50 produce more ________ causing them to go bald and prostate enlarge

Back 11

DHT

Front 12

the prostate enlarges in most older men over age ____

Back 12

50

Front 13

prostate is subject to three problems:
1
2
3

Back 13

Benign prostatic hyperplasia (BPH)
Prostatitis
Prostate cancer

Front 14

BPH affects ______% of men age 50-60, then incidence increases or decreases

Back 14

50
increases

Front 15

BPH affects ____% of men by age 80

Back 15

90%

Front 16

By age 75, well over ____% of men have a decrease in force and caliber of their urinary stream due to abnormal growth of their prostate

Back 16

50%

Front 17

increase in the size of an organ or a tissue (like a muscle) without any increase in the number of the cells: the cells already there simply get bigger (most growth is this way)

Back 17

Hypertrophy

Front 18

increase in size due to an increase in the number of cells (tumors; prostate enlargement).

Back 18

Hyperplasia

Front 19

A combination of DHT (dihydrotestosterone) and aging are causes of???

Back 19

BPH

Front 20

________ is a true hyperplastic process, with increased cell numbers (as opposed to muscle hypertrophy with exercise)

Back 20

BPH

Front 21

Difficulty or delay in starting urinary stream
Decreased force of urinary stream
Feeling of incomplete emptying
Double voiding (need to urinate again within two hours)
Post-voiding dribbling
Nocturia (1-4 times is common)
are symptoms of?

Back 21

BPH

Front 22

Enlarged prostate on digital rectal exam by skilled examiner
Creatinine: increased level in blood
Urinalysis: may contain protein
PSA (Prostate specific antigen): increased
Flow rate: diminished
Pressure of flow: diminished
Residual urine: increased over 10 cc’s
are symptoms of?

Back 22

BPH

Front 23

in BPH At least half of men with symptoms improve on their own or have mild problems that do not get worse

t or f?

Back 23

t

Front 24

In BPH
Those who are very symptomatic: can take medication that will block the conversion of _____________ to ______________

Back 24

testosterone to
dihydrotestosterone

Front 25

men over 50 produce more _____________ causing them to go bald and prostate enlarge...

Back 25

dihydrotestosterone

Front 26

_________ and _________ are two diseases that create disease in anus and rectum

Back 26

crohns and diabetes

Front 27

seminal vesicle stores extra ______ ________

Back 27

seminal fluid

Front 28

urethra runs in ________ side of penis

Back 28

ventral

Front 29

_______'s are 100 times more common in women then men in 30's

Back 29

uti's

Front 30

over age of_____ a lot of men get uti's

Back 30

65

Front 31

infectious prostatitis in men of what age usually?

Back 31

70-80

Front 32

what type of bacteria cause non specific prostatitis?

Back 32

cell wall deficient bacteria that do not show up in culture or microscope

Front 33

is kinda like thyroid cancer... slow growing.... men who have this type will usually die of something else

Back 33

prostate cancer

Front 34

controlled cut of perenial body

Back 34

episiotomy

Front 35

can extend upwards and cause rectal vagina fistula

Back 35

verticle episiotomy

Front 36

Second leading cause of cancer death in men, 32,000 died last year

Back 36

prostate cancer

Front 37

The most common cancer in American men
218,000 new cases in 2009

Back 37

prostate

Front 38

what kind of prostate cancer is more common... severe or mild?

Back 38

mild

Front 39

Those with PSA above _____ are candidates for prostatectomy if biopsy is positive (we will discuss the controversy over this).

Back 39

10

Front 40

Bone scan if pt has bone pain or if PSA >___ (plus prostate biopsies).

Back 40

10

Front 41

The gleason grading system is used to help evaluate the __________ of men with ________ ________.

Back 41

prognosis
prostate cancer

Front 42

A Gleason score is given to prostate cancer based upon its __________ ___________.

Back 42

microscopic appearance

Front 43

Cancers with a________ Gleason score are more aggressive and have a worse prognosis.

Back 43

higher

Front 44

The Gleason score is the sum of the ______ most common types seen in the slide

Back 44

two

Front 45

in the gleason score Lowest score is ____; highest score is ____

Back 45

2
10

Front 46

the gleason score is put together with the _______ of the ________ to assess the _________

Back 46

stage of the cancer to asses prognosis

Front 47

in tnm staging t is the

Back 47

the extent of the primary tumor

Front 48

in tnm staging n is the

Back 48

the presence or absence of nodal invasion

Front 49

in tnm staging m is the

Back 49

the presence of absence of metastasis to other organs

Front 50

post op complications of prostate surgery

Back 50

Impotency – all patients have some trouble
Partial urinary incontinence in 40%; complete in about 5-10%
Fecal incontinence in 5-10%

Front 51

Hormonal therapy: for those with metastatic disease you can increase horomones or decrease... it is the change in horomone level the tumors react to... true or false?

Back 51

true

Front 52

anus is separated from the vagina by the ________ _________

Back 52

rectovaginal septum

Front 53

This is thick externally but becomes thin inside the vagina.

Back 53

rectovaginal septum

Front 54

which type of prostatitis is most common... infectious or non specific?

Back 54

non-specific

Front 55

infectious prostatitis in men of what age usually?

Back 55

70-80

Front 56

what type of bacteria cause non specific prostatitis?

Back 56

cell wall deficient bacteria that do not show up in culture or microscope

Front 57

__________ episiotomy more common and more painful but less chance of deteriorating the perinium

Back 57

lateral

Front 58

________ of all colon cancers can be found with finger exam

Back 58

half

Front 59

position for rectal exam in adult men?

Back 59

bent over with chest on table

Front 60

position of rectal exam in women, children, infants

Back 60

lithotomy

Front 61

position of elderly men and women in rectal exam?

Back 61

lithotomy

Front 62

means removal of kd stone but has been adapted to mean a position of patient

Back 62

lithotomy

Front 63

type of hemorrhoids above the dentate line, covered with colon mucosa

Back 63

internal hemorrhoids

Front 64

type of hemorrhoid from the veins below dentate line, covered with squamous epithelium of the anal canal

Back 64

external hemorrhoids

Front 65

May gradually enlarge and then protrude from anal canal (prolapse), requiring manual replacement after bowel movement

Back 65

internal hemorrhoids

Front 66

cause bleeding: bright red blood streaking on the stool or into the toilet bowl directly with bowel movements.

Back 66

internal hemorrhoids

Front 67

what type of hemorrhoids Usually do NOT cause pain unless large and prolapsed.

Back 67

internal hemorrhoids

Front 68

type of hemorrhoids in prenancy?
does it stay after pregnancy?

Back 68

externel, no... they usually dissapear after pregnancy

Front 69

Straining can cause blood clots (thrombosis) with exquisite pain and tenderness describes what kind of hemorrhoids

Back 69

external hemorrhoids

Front 70

Symptoms relieved with warm sitz baths, ointments, analgesics
May require surgical drainage (simple office procedure)

Back 70

external hemorrhoids

Front 71

inflammation of the rectum, with pain, constipation, spasm, and prurulent discharge
 usually caused by an STD, esp. with anal-receptive intercourse (gonorrhea, chlamydia, genital herpes).

Back 71

proctitis

Front 72

anal mucus glands in the dentate line become infected, then burrow upwards in surrounding soft tissues to form secondary abscesses away from the anus.

Back 72

anal abscesses and fistulas

Front 73

can lead to perirectal abscesses (sometimes huge).
Occur more often in situations where there is poor hygiene.
Common in pts. with Crohn’s disease.

Back 73

anal abscesses and fistulas

Front 74

inflammation of the rectum, with pain, constipation, spasm, and prurulent discharge
usually caused by an STD, esp. with anal-receptive intercourse (gonorrhea, chlamydia, genital herpes).
Treatment with antibiotics, sitz baths (herpes will recur)

Back 74

Proctitis

Front 75

Linear ulcers or splits of the anal mucosa, usually posterior
Extremely tender and painful
Caused by straining, hard stools
Lead to severe discomfort with bowel movements
More common in pts with inflammatory bowel disease (ulcerative colitis, Crohn’s disease)
Treatment is with sitz baths, neosporin ointment, high fiber diet or supplements: very slow to heal!
New treatment: injection with botulinum toxin

Back 75

anal fissures

Front 76

treatment for anal abscesses and fistulas?

Back 76

surgical excision and drainage

Front 77

intense perianal itching and discomfort.

Back 77

Pruritis Ani

Front 78

Affects almost everyone at one time or another.
It is the itch you should not scratch! (medical and social reasons)
Often an allergic reaction to soap, or to eating chocolate, nuts, citrus fruits, berries, shelled seafood, beer, coffee
Vit C allergy less common but possible
Can also result from too little or too much anal hygiene (fecal soiling versus over-aggressive wiping or cleansing, esp. with irritant solutions)

Back 78

pruritis ani

Front 79

too little or too much anal cleansing can lead to?

Back 79

pruritis ani

Front 80

In children, suspect pinworms: scotch tape test for eggs. Itching usually worse at night. Worms crawl out of anus to lay eggs.

Back 80

Pruritis Ani

Front 81

Pruritis Ani treatment?

Back 81

allergic form: 1% hydrocortisone ointment (NOT hydrocortisone cream: this causes it to become worse!)
can be treatment for worms or change of diet... depends the cause

Front 82

% men wet their pants after prostate surgery

Back 82

40

Front 83

growth of an organ because of the growth of the amoutn of cells

Back 83

hyperplasia-

Front 84

cells of an organ grow in size

Back 84

hypertrophy

Front 85

some one gains weight do they add new cells?

Back 85

no
fat cells grow in size
hypertrophy

Front 86

_________ and ________ are hyperplasia, almost everything else are hypertrophy

Back 86

tumors and prostate enlargement

Front 87

a ring of rectal mucosa prolapses out of the anus with coughing, straining, or defecating, then goes back to normal position is ________ rectal prolapse

Back 87

mild

Front 88

part of the rectum, or the entire rectum, descends outside the anus and remains there at all times is ________ to _________ prolapse

Back 88

moderate to severe

Front 89

never put a _________ on a mucous membrane

Back 89

cream

Front 90

__________ fistula- into the bladder

Back 90

colovesicle

Front 91

rectum to bladder: causes a continuous urinary tract infection until corrected.

Back 91

Rectovesical fistula

Front 92

 an abnormal connection between the rectum and the bladder or vagina

Back 92

rectal fistula

Front 93

very common, to bypass the rectum, temporarily or permanently

Back 93

sigmoid colostomy

Front 94

 after removal of the colon for cancer or ulcerative colitis

Back 94

Ileostomy