Seidel 20 Anus, Rectum, And Prostate

Front 1

Which part of the anal canal is sensitive to pain?

Back 1

lower canal

Front 2

Name of the Internal anal canal that is lined by columns of mucosal tissue that fuse to form the anorectal junction

Back 2

columns of Morgagni

Front 3

The spaces between the anal columns are called ___ into which anal glands empty.

Back 3

crypts

Front 4

Inflammation of the crypts can result in ___ or ___ formation

Back 4

fistula or fissure

Front 5

Anastomosing veins cross the columns, forming a ring called the ____

Back 5

zona hemorrhoidalis

Front 6

Internal hemorrhoids result from dilation of these veins

Back 6

zona hemorrhoidalis

Front 7

The lower segment of the anal canal contains a venous plexus that drains into the ____

Back 7

inferior rectal veins

Front 8

Dilation of this plexus results in external hemorrhoids

Back 8

plexus that drains into inferior rectal veins

Front 9

Name The rectal wall contains three semilunar transverse folds with as yet poorly defined function

Back 9

Houston valves

Front 10

Which prostate lobe, not palpable on examination, is composed of glandular tissue and lies between the ejaculatory duct and the urethra. It contains active secretory alveoli that contribute to ejaculatory fluid

Back 10

A third or median lobe

Front 11

At __weeks of gestation a portion of the caudal hindgut is divided by an anorectal septum into a urogenital sinus and a rectum.

Back 11

7 weeks

Front 12

The ___ is covered by a membrane that develops into the anal opening by 8 weeks of gestation

Back 12

urogenital sinus

Front 13

Most anorectal malformations result from abnormalities in this partitioning process.

Back 13

urogenital sinus

Front 14

The first meconium stool is ordinarily passed within the ____ after birth and indicates anal patency.

Back 14

first 24 to 48 hours

Front 15

In infants, Both the internal and external sphincters are under involuntary reflexive control because ___ of the spinal cord is incomplete.

Back 15

myelination

Front 16

Control of the external anal sphincter is gradually achieved between the ages of ___ months.

Back 16

18 and 24

Front 17

The prostate remains undeveloped until ___ at which time androgenic influences prompt its growth and maturation.

Back 17

puberty

Front 18

Degeneration of _____ in the rectal wall interferes with the process of relaxation of the internal sphincter in response to distention of the rectum

Back 18

afferent neurons

Front 19

In older adults, The muscular component of the prostate is progressively replaced by ____

Back 19

collagen

Front 20

In adult males, what two positions are satisfactory for most purposes and allow adequate visualization of the perianal and sacrococcygeal areas

Back 20

left lateral with hips and knees flexed or standing with the hips flexed and the upper body supported by the examining table

Front 21

In women, the rectal examination is most often performed in the ___ position

Back 21

lithotomy

Front 22

For perianal irritation, ___ infection is more common in adults with diabetes, and ___ are more common in children

Back 22

Fungal, pinworms

Front 23

While palpating the perianal region, the discovery of tenderness and inflammation should alert you to the possibility of a ___, ____, ___, ___

Back 23

perianal abscess, anorectal fistula or fissure, pilonidal cyst, or pruritus ani

Front 24

___ referents are used to describe the location of anal and rectal findings

Back 24

Clock, 12 o'clock is in the ventral midline and 6 o'clock is in the dorsal midline.

Front 25

A lax external anal sphincter may indicate ____ .

Back 25

neurologic deficit.

Front 26

An extremely tight external anal sphincter can result from ____, ____ ____, or anxiety about the examination.

Back 26

scarring, spasticity caused by a fissure or other lesion, inflammation

Front 27

While doing a DRE, An ___ or ___ may produce such extreme tenderness that you are not able to complete the examination without local anesthesia.

Back 27

anal fistula or fissure

Front 28

____ is almost always indicative of a local disease of the rectum

Back 28

Rectal pain

Front 29

How should the muscular anal ring feel?

Back 29

smooth and exert even pressure on the finger

Front 30

Internal hemorrhoids are not ordinarily felt unless they are ___

Back 30

thrombosed

Front 31

How do you perform bidigital palpation?

Back 31

lightly press your thumb against the perianal tissue and bring your index finger toward the thumb

Front 32

What is the bidigital palpation exam useful for?

Back 32

detecting a perianal abscess.

Front 33

A healthy prostate has a diameter of about ___ cm, with less than ___ cm protrusion into the rectum

Back 33

4 cm, 1cm

Front 34

A rubbery or boggy consistency prostate is indicative of ____

Back 34

benign hypertrophy

Front 35

A prostate that is stony hard nodularity may indicate ___, ___, ___

Back 35

carcinoma, prostatic calculi, or chronic fibrosis

Front 36

A prostate tht is Fluctuant softness suggests _____

Back 36

prostatic abscess

Front 37

The seminal vesicles are not palpable unless they are ____

Back 37

inflamed

Front 38

Prostate enlargement 1 to 2 cm

Back 38

Grade I

Front 39

Prostate enlargement 2 to 3 cm

Back 39

Grade II

Front 40

Prostate enlargement 3 to 4 cm

Back 40

Grade III

Front 41

Prostate enlargement more than 4 cm

Back 41

Grade IV

Front 42

When is it suggested to get a DRE for Age 40+?

Back 42

higher risk (e.g., black, family history of prostate cancer).

Front 43

___ is a glycoprotein that is specific to the prostate but not to prostate cancer.

Back 43

PSA

Front 44

PSA results less than 4 ng/mL are usually considered ___

Back 44

normal

Front 45

PSA results greater than 10 ng/mL are considered ___

Back 45

high

Front 46

PSA density (PSAD) is calculated by dividing the ____

Back 46

PSA number by the prostate volume (measured by transurethral ultrasonography [TRUS]).

Front 47

____ measures how quickly the PSA level rises over time. Serial testing may be appropriate for managing borderline results

Back 47

PSA velocity

Front 48

____ indicates how much PSA circulates unbound and how much is bound

Back 48

Free PSA ratio

Front 49

For PSA results in the borderline range, a ____ increases the chance that prostate cancer is present and suggests the need for biopsy.

Back 49

low free PSA ratio

Front 50

___ is used when the PSA is borderline and the DRE is normal

Back 50

Transurethral Ultrasonography (TRUS)

Front 51

___ may be able to indicate areas of the prostate that require biopsy. It can also be used to determine prostate volume, which can be used in the calculation of PSA density.

Back 51

Transurethral Ultrasonography (TRUS)

Front 52

In females a ___ or ____ uterus is usually palpable through rectal examination

Back 52

retroflexed or retroverted

Front 53

The nodules, called shelf lesions, are palpable just above the ___ in males and in the ___ of females

Back 53

prostate, cul-de-sac

Front 54

Very light tan or gray stool could indicate ____

Back 54

obstructive jaundice

Front 55

tarry black stool should make you suspect____

Back 55

upper intestinal tract bleeding

Front 56

Intermittent, pencil-like stools suggest a ____.

Back 56

spasmodic contraction in the rectal area

Front 57

Persistent, pencil-like stools indicate ____ from scarring or from pressure of a malignancy.

Back 57

permanent stenosis

Front 58

Pipestem stools and ribbon stools indicate_____.

Back 58

lower rectal stricture

Front 59

A large amount of mucus in the fecal matter is characteristic of ___ and ___.

Back 59

intestinal inflammation and mucous colitis

Front 60

Small flecks of blood-stained mucus in liquid feces are indicative of ___

Back 60

amebiasis

Front 61

Fatty stools are seen in patients with____ and ____.

Back 61

pancreatic disorders and malabsorption syndromes

Front 62

Stools the color of aluminum (caused by a mixture of melena and fat) occur in ___, ____, and ___

Back 62

tropical sprue, carcinoma of the hepatopancreatic ampulla, and children treated with sulfonamides for diarrhea.

Front 63

In children, Shrunken buttocks suggests a ____

Back 63

chronic debilitating disease

Front 64

In kids, Asymmetric creases occur with ____.

Back 64

congenital dislocation of the hips

Front 65

In kids, Perirectal redness and irritation are suggestive of ___, ____, or other irritants of the diaper area.

Back 65

pinworms, Candida

Front 66

In children,____results from constipation, diarrhea, or sometimes severe coughing or straining

Back 66

Rectal prolapse

Front 67

Hemorrhoids are rare in children, and their presence suggests a serious underlying problem such as ____

Back 67

portal hypertension

Front 68

In children, Small flat flaps of skin around the rectum (condylomas) may be ___ in origin

Back 68

syphilitic

Front 69

In children, Sinuses, tufts of hair, and dimpling in the pilonidal area may indicate____.

Back 69

lower spinal deformities

Front 70

Lightly touch the anal opening, which should produce anal contraction (described by clinicians as an "anal wink"). Lack of contraction may indicate a _______

Back 70

lower spinal cord lesion.

Front 71

If there is no evidence of stool in the newborn, suspect___, ____ or ____.

Back 71

rectal atresia, Hirschsprung disease (congenital megacolon), or cystic fibrosis

Front 72

Sequence and Description of Stools in Infants: Greenish-black, viscous, contains occult blood; first stool is sterile

Back 72

Newborn meconium

Front 73

Sequence and Description of Stools in Infants: Transitional: thin, slimy, brown to green

Back 73

3 to 6 days old

Front 74

Sequence and Description of Stools in Infants: Mushy, loose, golden yellow; frequency varies from after each feeding to every few days; nonirritating to skin

Back 74

Breast-fed

Front 75

Sequence and Description of Stools in Infants: Light yellow, characteristic odor, irritating to skin

Back 75

Formula-fed

Front 76

In children, The presence of bruises around the anus, scars, anal tears (especially those that extend into the surrounding perianal skin), and anal dilation may be evidence of ____.

Back 76

sexual abuse

Front 77

In children, A lax sphincter is associated with lesions of the peripheral spinal nerves or spinal cord, ___ infection, and previous fecal impactions

Back 77

Shigella

Front 78

Chronic constipation in children with mental deficiency or emotional problems is often associated with a ____

Back 78

rectum distended with feces

Front 79

A consistently empty rectum in the presence of constipation is a clue to the diagnosis of ____

Back 79

Hirschsprung disease.

Front 80

A fecal mass in the rectum accompanying diarrhea suggests ____

Back 80

overflow diarrhea

Front 81

A palpable prostate in preadolescent boys suggests ___ or ___ disease, which should be apparent from examination of the genitalia.

Back 81

precocious puberty or some virilizing

Front 82

During pregnancy the stool color may be dark green or black due to the____

Back 82

consumption of iron preparations

Front 83

First diagnosed in young adults, although they are usually a congenital anomaly. Located in the midline, superficial to the coccyx and lower sacrum, the cyst or sinus is seen as a dimple with a sinus tract opening. The opening may contain a tuft of hair and be surrounded by erythema. A cyst may be palpable. The condition is usually asymptomatic, but it is sometimes complicated by an abscess, secondary infection, or fistula.

Back 83

PILONIDAL CYSTS

Front 84

____, are pink to whitish growths that occur on the anus and genitalia as a result of infection with the papilloma virus

Back 84

Anal warts, condyloma acuminata

Front 85

___ is associated with anal cancer

Back 85

HPV infection

Front 86

Anal cancers are skin cancers. The majority of anal cancers are ____, which are associated with HPV infection

Back 86

squamous cell carcinomas

Front 87

About 15% of anal cancers are ___, which originate in the glands near the anus

Back 87

adenocarcinomas

Front 88

Most anal cancers are ___ and ___

Back 88

basal cell carcinoma and malignant melanoma

Front 89

appear as an area of swelling with variable degrees of erythema of the anus, both internally and externally. painful and tender, and usually the patient has a fever. truly hidden and the search for an unexplained fever should always include the rectal examination.

Back 89

PERIANAL AND PERIRECTAL ABSCESSES

Front 90

A tear in the anal mucosa (fissure) appears most often in the ____ midline, although it can also occur in the ___ midline

Back 90

posterior, anterior

Front 91

The anorectal fissure is usually caused by____.

Back 91

traumatic passage of large, hard stools

Front 92

An____ is an inflammatory tract that runs from the anus or rectum and opens onto the surface of the perianal skin or other tissue. It is caused by drainage of a perianal or perirectal abscess. Serosanguineous or purulent drainage may appear with compression of the area. The external opening is usually seen as elevated red granular tissue.

Back 92

anorectal fistula

Front 93

Chronic inflammation of perianal skin results in excoriation, thickening, and pigmentation. The patient complains of burning or itching that may interfere with sleep. It is commonly caused by fungal infection in adults and by parasites in children.

Back 93

PRURITUS ANI

Front 94

____ are varicose veins that originate below the anorectal line and are covered by anal skin. They may cause itching and bleeding with defecation. Usually not visible at rest, they can protrude on standing and on straining at stool. If not reduced, they can become edematous and thrombosed and may require surgical removal

Back 94

External hemorrhoids

Front 95

___ appear as blue, shiny masses at the anus

Back 95

Thrombosed hemorrhoids

Front 96

_____, which can appear at the site of resolved hemorrhoids, are fibrotic or flaccid and painless

Back 96

Hemorrhoidal skin tags

Front 97

____ are varicose veins that originate above the anorectal junction and are covered by rectal mucosa. They produce soft swellings that are not palpable on rectal examination and are not visible unless they prolapse through the anus

Back 97

Internal hemorrhoids

Front 98

When do Internal hemorrhoids cause discomfort?

Back 98

thrombosed, prolapsed, or infected

Front 99

___ are usually evidenced by rectal bleeding, and it is not uncommon to find one protruding through the rectum. They are sometimes palpable on rectal examination as soft nodules and can be either pedunculated (on a stalk) or sessile (closely adhering to the mucosal wall).

Back 99

Polyps

Front 100

____ is usually felt as a sessile polypoid mass with nodular raised edges and areas of ulceration. The consistency is often stony, and the contour is irregular.

Back 100

RECTAL CARCINOMA

Front 101

___ comprise the large majority of rectal cancers.

Back 101

Adenocarcinomas

Front 102

____ may develop in the pelvis anterior to the rectum. These can be felt as a hard, nodular shelf at the tip of the examining finger.

Back 102

INTRAPERITONEAL METASTASES

Front 103

A prolapse of the ___ is pink and looks like a doughnut or rosette

Back 103

mucosa

Front 104

___ prolapse involving the muscular wall is larger, red, and has circular folds

Back 104

Complete

Front 105

Rectal prolapse in children is associated with ___

Back 105

cystic fibrosis

Front 106

In ______, the prostate is enlarged, acutely tender, and often asymmetric. The patient may also have urethral discharge and fever. An abscess may develop, which is felt as a fluctuant mass in the prostate. The seminal vesicles are often involved and may be dilated and tender on palpation

Back 106

acute prostatitis

Front 107

____ is usually asymptomatic; however, the prostate may feel boggy, enlarged, and tender or have palpable areas of fibrosis that simulate neoplasm.

Back 107

Chronic prostatitis

Front 108

The adult nematode (parasite) lives in the rectum or colon and emerges onto perianal skin to lay eggs while the child sleeps. The patient experiences intense itching of the perianal area, and perianal irritation often results from scratching. The parents often describe unexplained irritability in the infant or child, especially at night.

Back 108

ENTEROBIASIS (ROUNDWORM, PINWORM)

Front 109

The rectum may end blindly, be stenosed, or have a fistulous connection to the perineum, urinary tract, or, in females, the vagina. The condition is usually diagnosed by rectal examination and confirmed by lack of passage of stool within the first 48 hours of life

Back 109

IMPERFORATE ANUS

Front 110

Urinary symptoms include hesitancy, decreased force and caliber of stream, dribbling, incomplete emptying of the bladder, frequency, urgency, nocturia, and dysuria. On rectal examination, the prostate feels smooth, rubbery, symmetric, and enlarged. The median sulcus may or may not be obliterated

Back 110

Benign prostatic hypertrophy (BPH)

Front 111

On rectal examination, a hard, irregular nodule may be palpable. The prostate feels asymmetric, and the median sulcus is obliterated as it enlarges. Prostatic calculi and chronic inflammation produce similar findings, and biopsy is required for differential diagnosis

Back 111

PROSTATIC CARCINOMA

Front 112

lined by columns of mucosal tissue (columns of Morgagni)

Back 112

Anal canal

Front 113

a tear in the anal muscosa appears most often in the posterior midline

Back 113

Anorectal fissure

Front 114

benign growth of the prostate gland common in men older than 50 years of age

Back 114

Benign prostatic hypertrophy (BPH)

Front 115

varicose veins in the rectum, external below the anorectal line and internal above the anorectal line.

Back 115

Hemorrhoids

Front 116

cyst or sinus tract located in the midline superficial to the coccyx and lower sacrum

Back 116

Pilonidal cysts

Front 117

located at the base of the bladder and surronding the urethra

Back 117

Prostate gland

Front 118

forms terminal portion of GI tract

Back 118

Rectum

Front 119

Severe rectal pain with a fever

Back 119

Perianal abscess

Front 120

Absence of meconium stool passage in infant

Back 120

Imperforate Anus

Front 121

Feels smooth and firm with 4cm protrusion into the rectum

Back 121

BPH with purulent drainage

Front 122

Elevated red granular tissue opening on perianal skin

Back 122

Anorectal fistula

Front 123

Feels boggy, enlarged, and tender to palpation

Back 123

Prostatitis

Front 124

Feels hard, nodular; unable to palpate sulcus

Back 124

Prostatic carcinoma

Front 125

Soft nodules palpated with rectal examination

Back 125

Rectal polyp

Front 126

* Older than 50 years of age
* Family history of colon cancer, familial adenomatous polyposis (FAP), familial hereditary nonpolyposis colorectal cancer (HNPCC), Gardner syndrome
* Personal history of colorectal cancer, intestinal polyps, chronic inflammatory bowel disease (Crohn disease, ulcerative colitis), Gardner syndrome
* Personal history of ovarian, endometrial or breast cancer
* Ethnic background: Ashkenazi Jewish descent
* Diet high in beef and animal fats, low in fiber
* Obesity
* Smoking
* Physical inactivity (regular physical activity reduces risk)
* Alcohol intake: risk increases with increased amounts

Back 126

Risk Factors
Colorectal Cancer

Front 127

* Older than 50 years of age
* Race: black (two times the risk compared to that of white men)
* Nationality: common in North America and northwestern Europe; less common in Asia, Africa, Central America, and South America
* Family history of prostate cancer (twice the risk with one first-degree relative; risk increases with more than one first-degree relative)
* Diet high in animal fat
* Hormones: cumulative exposure of the prostate to high levels of androgens
* Physical inactivity (regular physical activity reduces risk)

Back 127

Risk Factors
Prostate Cancer

Front 128

Nocturia
Urine dribbles
Tried to void, but can't
Small stream

Back 128

Mnemonics
Benign Prostatic Hypertrophy: NUTS