Phys Dx Anus, Rectum, Prostate

Front 1

How long is the anal canal?

Back 1

2.5-4 cm long

Front 2

What is the nervous control of the upper half of the anal canal?**

Back 2

Autonomic control. Insensitive to pain.

Front 3

What is the nervous control of the lower half of the anal canal?**

Back 3

Somatic sensory nerves. Painful to stimuli

Front 4

What are internal hemorrhoids?***

Back 4

From dilation of vein/ venous plexus in zona hemorrhoidalis

Front 5

What are external hemorrhoids?***

Back 5

From dilation of venous plexus that drains into inferior rectal veins.

Front 6

What are houston valves?

Back 6

3 semilunar transverse folds of the rectum

Front 7

What part of the prostate is palpable by digital exam?

Back 7

Posterior surface. Convex. Divided by shallow median sulcus into right and left lateral lobes.

**Median lobe NOT palpable on exam!

Front 8

Seminal vesicles in relation to the prostate?

Back 8

Seminal vesicles extend outward from prostate.

Front 9

When and where are most anorectal malformations from?

Back 9

Abnormalities in division of caudal hindgut to urogenital sinus and rectum.

At 7 weeks gestation.

Front 10

Where is first meconium passed?**

Back 10

W/in first 24-48 hours after birth. Indicates anal patency.

Front 11

When do most newborns have have stool?**

Back 11

Common after each feeding (gastrocolic reflex)

Front 12

At what age do most children gain voluntary control of external sphincter?

Back 12

18-24 months

Front 13

When does prostate become palpable?

Back 13

Puberty

Front 14

Reasons pregnant women develop hemorrhoids?

Back 14

Increased pressure in veins, increased blood flow, constipation (due to hormones, dietary changes, Fe supps), labor.

Front 15

Why might older adults experience retention of stool?

Back 15

Degeneration of afferent neurons causes decreased relatxation of internal sphincter

Front 16

Why might older adults experience fecal incontinence?

Back 16

Internal sphincter loses tone and external sphincter can't control bowels.

Front 17

Why might older men have problems with the prostate?

Back 17

Loss of function of secretory alveoli and benign hyperplasia of glandular tissue

Front 18

How would you describe where an irregularity is on the anus?*

Back 18

Describe using clock reference:
12 o'clock is ventral midline (anterior).
6 o'clock is dorsal midline (posterior)

Front 19

When feeling for nodularities, etc in/around the anus, what might make it easier to feel?**

Back 19

Bi-digital palpation w/ thumb and index finger by lightly pressing thumb against perianal tissue and bringing index finger toward thumb.

Front 20

Approximate size of prostate as felt by digital exam?

Back 20

4 cm diameter w/ < 1 cm protruding into rectum

Front 21

What position should a child be in should you have to perform a rectal exam?

Back 21

On back w/ knees and hips flexed.

Use gloved index finger or 5th digit.

Front 22

3 things that could cause a lax rectal sphincter?

Back 22

Peripheral spinal nerve lesions,
Shigella infection,
Previous fecal impaction

Front 23

What might you expect in regards to bowels in Hirschsprung disease?

Back 23

Constipation w/ empty vault

Front 24

What do you really need to watch for in the rectum of older adults?**

Back 24

More likely to have polyps and higher risk for cancer

Front 25

Clinical presentation of perianal and perirectal abscess?

Back 25

Pain and tenderness in anal area, usually accompanied by fever

Front 26

Clinical presentation of enterobiasis infestation (pinworm)?

Back 26

Nocturnal perianal and vulvular pruritis; insomnia, restlessness and irritability.

Children.
Vague GI sx.
Collect eggs by scotch tape test.
Treat all household members

Front 27

What would you see clinically in an anal fistula?

Back 27

Elevated, red, granular tissue at external opening, possibly w/ serosanguinous or purulent drainage on compression of area.

Front 28

What would you see clinically in external hemorrhoids?

Back 28

Itching and bleeding w/ defecation. Thrombosed hemorrhoids appear blue, shiny masses at anus.

Front 29

What would you see clinically in internal hemorrhoids?

Back 29

Bleeding w/ or w/out defecation. Don't cause discomfort unless thrombosed, prolapsed or infected.

Front 30

Clinical sign of rectal carcinoma?***

Back 30

Generally asymptomatic****

Front 31

Risk factors of rectal carcinoma? (9)

Back 31

>5o.
Fam hx: colon ca, familial polyposis, Gardner syndrom, Peutz-Jehgers syndrome.
Personal hx: colon polyps, crohns, gardner, ovarian breast or endometrial ca, uc >10 yrs.
Diet high in beef, animal fats, low in fiber.
Ashkenazi jewish descent.
Obesity.
Smoking.
Physical inactivity.
ETOH.

Front 32

New diagnostic testing for colorectal cancer?

Back 32

Virtual colonoscopy using helical CT.

Also, fecal DNA testin

Front 33

Most common serotypes of anal cancer?

Back 33

HPV

Front 34

Risks for anal cancer? (7)

Back 34

Smoking.
Anal intercourse.
HIV.
Females w/ HPV cervical co-infection.
HPV infection.
Cervical ca
Immunosuppression.

Front 35

Clinical presentation of anal cancer?

Back 35

Anal bleeding, pain, sensation of mass, pruritus, anal discharge, irritation, tenesmus, or could be asymptomatic!

Front 36

Testing for anal cancer?

Back 36

Anal swab for HPV

Front 37

Prevention for anal cancer?

Back 37

HPV vaccination (Gardasil)

Front 38

11 Risk factors for prostate cancer?

Back 38

>50, African american, Fam hx, Residence of US or NW europe, Diet high in animal fat, ETOH, occ exposure to cadmium fertilizer exhaust fumes and rubber, PSA >4, High levels of androgens, physical inactivity

Front 39

S & S of prostate cancer?

Back 39

No sx early!
Advanced:
Bladder outlet obstruction
Decreased stream
Incomplete emptying
Anuria
Azotemia

Front 40

2 adverse effects of treating prostate cancer?

Back 40

Urinary incontinence, ED

Front 41

What is BPH?

Back 41

Urinary hesitancy, intermittent stream, straining to initiate, reduced force and caliber of urine stream, nocturia, frequency, urgency.
Palpably enlarged prostate.
May be complicated by acute urinary retention or azotemia following obstruction.

Front 42

What is acute bacterial prostatitis?

Back 42

Fever, dysuria, urinary urgency and freq, perineal or suprapubic pain, tender prostate, leukocytosis, pyuria, bacteriuria, hematuria.
Caused by: N. gonorrhoaea, C. trachomatis, GNR or GP organisms.
No prostatic massage! Can spread infection

Front 43

What is chronic prostatits?

Back 43

Older men, may be asymptomatic. In some: urinary urgency/ freq, dysuria, perineal or suprapubic pain, prostate boggy, non-tender.
Increased leukocytes, culture occas pos for gnrs or enterococcus.