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128 Cards in this Set

  • Front
  • Back
Which part of the anal canal is sensitive to pain?
lower canal
Name of the Internal anal canal that is lined by columns of mucosal tissue that fuse to form the anorectal junction
columns of Morgagni
The spaces between the anal columns are called ___ into which anal glands empty.
crypts
Inflammation of the crypts can result in ___ or ___ formation
fistula or fissure
Anastomosing veins cross the columns, forming a ring called the ____
zona hemorrhoidalis
Internal hemorrhoids result from dilation of these veins
zona hemorrhoidalis
The lower segment of the anal canal contains a venous plexus that drains into the ____
inferior rectal veins
Dilation of this plexus results in external hemorrhoids
plexus that drains into inferior rectal veins
Name The rectal wall contains three semilunar transverse folds with as yet poorly defined function
Houston valves
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
A third or median lobe
At __weeks of gestation a portion of the caudal hindgut is divided by an anorectal septum into a urogenital sinus and a rectum.
7 weeks
The ___ is covered by a membrane that develops into the anal opening by 8 weeks of gestation
urogenital sinus
Most anorectal malformations result from abnormalities in this partitioning process.
urogenital sinus
The first meconium stool is ordinarily passed within the ____ after birth and indicates anal patency.
first 24 to 48 hours
In infants, Both the internal and external sphincters are under involuntary reflexive control because ___ of the spinal cord is incomplete.
myelination
Control of the external anal sphincter is gradually achieved between the ages of ___ months.
18 and 24
The prostate remains undeveloped until ___ at which time androgenic influences prompt its growth and maturation.
puberty
Degeneration of _____ in the rectal wall interferes with the process of relaxation of the internal sphincter in response to distention of the rectum
afferent neurons
In older adults, The muscular component of the prostate is progressively replaced by ____
collagen
In adult males, what two positions are satisfactory for most purposes and allow adequate visualization of the perianal and sacrococcygeal areas
left lateral with hips and knees flexed or standing with the hips flexed and the upper body supported by the examining table
In women, the rectal examination is most often performed in the ___ position
lithotomy
For perianal irritation, ___ infection is more common in adults with diabetes, and ___ are more common in children
Fungal, pinworms
While palpating the perianal region, the discovery of tenderness and inflammation should alert you to the possibility of a ___, ____, ___, ___
perianal abscess, anorectal fistula or fissure, pilonidal cyst, or pruritus ani
___ referents are used to describe the location of anal and rectal findings
Clock, 12 o'clock is in the ventral midline and 6 o'clock is in the dorsal midline.
A lax external anal sphincter may indicate ____ .
neurologic deficit.
An extremely tight external anal sphincter can result from ____, ____ ____, or anxiety about the examination.
scarring, spasticity caused by a fissure or other lesion, inflammation
While doing a DRE, An ___ or ___ may produce such extreme tenderness that you are not able to complete the examination without local anesthesia.
anal fistula or fissure
____ is almost always indicative of a local disease of the rectum
Rectal pain
How should the muscular anal ring feel?
smooth and exert even pressure on the finger
Internal hemorrhoids are not ordinarily felt unless they are ___
thrombosed
How do you perform bidigital palpation?
lightly press your thumb against the perianal tissue and bring your index finger toward the thumb
What is the bidigital palpation exam useful for?
detecting a perianal abscess.
A healthy prostate has a diameter of about ___ cm, with less than ___ cm protrusion into the rectum
4 cm, 1cm
A rubbery or boggy consistency prostate is indicative of ____
benign hypertrophy
A prostate that is stony hard nodularity may indicate ___, ___, ___
carcinoma, prostatic calculi, or chronic fibrosis
A prostate tht is Fluctuant softness suggests _____
prostatic abscess
The seminal vesicles are not palpable unless they are ____
inflamed
Prostate enlargement 1 to 2 cm
Grade I
Prostate enlargement 2 to 3 cm
Grade II
Prostate enlargement 3 to 4 cm
Grade III
Prostate enlargement more than 4 cm
Grade IV
When is it suggested to get a DRE for Age 40+?
higher risk (e.g., black, family history of prostate cancer).
___ is a glycoprotein that is specific to the prostate but not to prostate cancer.
PSA
PSA results less than 4 ng/mL are usually considered ___
normal
PSA results greater than 10 ng/mL are considered ___
high
PSA density (PSAD) is calculated by dividing the ____
PSA number by the prostate volume (measured by transurethral ultrasonography [TRUS]).
____ measures how quickly the PSA level rises over time. Serial testing may be appropriate for managing borderline results
PSA velocity
____ indicates how much PSA circulates unbound and how much is bound
Free PSA ratio
For PSA results in the borderline range, a ____ increases the chance that prostate cancer is present and suggests the need for biopsy.
low free PSA ratio
___ is used when the PSA is borderline and the DRE is normal
Transurethral Ultrasonography (TRUS)
___ 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.
Transurethral Ultrasonography (TRUS)
In females a ___ or ____ uterus is usually palpable through rectal examination
retroflexed or retroverted
The nodules, called shelf lesions, are palpable just above the ___ in males and in the ___ of females
prostate, cul-de-sac
Very light tan or gray stool could indicate ____
obstructive jaundice
tarry black stool should make you suspect____
upper intestinal tract bleeding
Intermittent, pencil-like stools suggest a ____.
spasmodic contraction in the rectal area
Persistent, pencil-like stools indicate ____ from scarring or from pressure of a malignancy.
permanent stenosis
Pipestem stools and ribbon stools indicate_____.
lower rectal stricture
A large amount of mucus in the fecal matter is characteristic of ___ and ___.
intestinal inflammation and mucous colitis
Small flecks of blood-stained mucus in liquid feces are indicative of ___
amebiasis
Fatty stools are seen in patients with____ and ____.
pancreatic disorders and malabsorption syndromes
Stools the color of aluminum (caused by a mixture of melena and fat) occur in ___, ____, and ___
tropical sprue, carcinoma of the hepatopancreatic ampulla, and children treated with sulfonamides for diarrhea.
In children, Shrunken buttocks suggests a ____
chronic debilitating disease
In kids, Asymmetric creases occur with ____.
congenital dislocation of the hips
In kids, Perirectal redness and irritation are suggestive of ___, ____, or other irritants of the diaper area.
pinworms, Candida
In children,____results from constipation, diarrhea, or sometimes severe coughing or straining
Rectal prolapse
Hemorrhoids are rare in children, and their presence suggests a serious underlying problem such as ____
portal hypertension
In children, Small flat flaps of skin around the rectum (condylomas) may be ___ in origin
syphilitic
In children, Sinuses, tufts of hair, and dimpling in the pilonidal area may indicate____.
lower spinal deformities
Lightly touch the anal opening, which should produce anal contraction (described by clinicians as an "anal wink"). Lack of contraction may indicate a _______
lower spinal cord lesion.
If there is no evidence of stool in the newborn, suspect___, ____ or ____.
rectal atresia, Hirschsprung disease (congenital megacolon), or cystic fibrosis
Sequence and Description of Stools in Infants: Greenish-black, viscous, contains occult blood; first stool is sterile
Newborn meconium
Sequence and Description of Stools in Infants: Transitional: thin, slimy, brown to green
3 to 6 days old
Sequence and Description of Stools in Infants: Mushy, loose, golden yellow; frequency varies from after each feeding to every few days; nonirritating to skin
Breast-fed
Sequence and Description of Stools in Infants: Light yellow, characteristic odor, irritating to skin
Formula-fed
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 ____.
sexual abuse
In children, A lax sphincter is associated with lesions of the peripheral spinal nerves or spinal cord, ___ infection, and previous fecal impactions
Shigella
Chronic constipation in children with mental deficiency or emotional problems is often associated with a ____
rectum distended with feces
A consistently empty rectum in the presence of constipation is a clue to the diagnosis of ____
Hirschsprung disease.
A fecal mass in the rectum accompanying diarrhea suggests ____
overflow diarrhea
A palpable prostate in preadolescent boys suggests ___ or ___ disease, which should be apparent from examination of the genitalia.
precocious puberty or some virilizing
During pregnancy the stool color may be dark green or black due to the____
consumption of iron preparations
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.
PILONIDAL CYSTS
____, are pink to whitish growths that occur on the anus and genitalia as a result of infection with the papilloma virus
Anal warts, condyloma acuminata
___ is associated with anal cancer
HPV infection
Anal cancers are skin cancers. The majority of anal cancers are ____, which are associated with HPV infection
squamous cell carcinomas
About 15% of anal cancers are ___, which originate in the glands near the anus
adenocarcinomas
Most anal cancers are ___ and ___
basal cell carcinoma and malignant melanoma
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.
PERIANAL AND PERIRECTAL ABSCESSES
A tear in the anal mucosa (fissure) appears most often in the ____ midline, although it can also occur in the ___ midline
posterior, anterior
The anorectal fissure is usually caused by____.
traumatic passage of large, hard stools
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.
anorectal fistula
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.
PRURITUS ANI
____ 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
External hemorrhoids
___ appear as blue, shiny masses at the anus
Thrombosed hemorrhoids
_____, which can appear at the site of resolved hemorrhoids, are fibrotic or flaccid and painless
Hemorrhoidal skin tags
____ 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
Internal hemorrhoids
When do Internal hemorrhoids cause discomfort?
thrombosed, prolapsed, or infected
___ 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).
Polyps
____ 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.
RECTAL CARCINOMA
___ comprise the large majority of rectal cancers.
Adenocarcinomas
____ 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.
INTRAPERITONEAL METASTASES
A prolapse of the ___ is pink and looks like a doughnut or rosette
mucosa
___ prolapse involving the muscular wall is larger, red, and has circular folds
Complete
Rectal prolapse in children is associated with ___
cystic fibrosis
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
acute prostatitis
____ is usually asymptomatic; however, the prostate may feel boggy, enlarged, and tender or have palpable areas of fibrosis that simulate neoplasm.
Chronic prostatitis
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.
ENTEROBIASIS (ROUNDWORM, PINWORM)
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
IMPERFORATE ANUS
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
Benign prostatic hypertrophy (BPH)
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
PROSTATIC CARCINOMA
lined by columns of mucosal tissue (columns of Morgagni)
Anal canal
a tear in the anal muscosa appears most often in the posterior midline
Anorectal fissure
benign growth of the prostate gland common in men older than 50 years of age
Benign prostatic hypertrophy (BPH)
varicose veins in the rectum, external below the anorectal line and internal above the anorectal line.
Hemorrhoids
cyst or sinus tract located in the midline superficial to the coccyx and lower sacrum
Pilonidal cysts
located at the base of the bladder and surronding the urethra
Prostate gland
forms terminal portion of GI tract
Rectum
Severe rectal pain with a fever
Perianal abscess
Absence of meconium stool passage in infant
Imperforate Anus
Feels smooth and firm with 4cm protrusion into the rectum
BPH with purulent drainage
Elevated red granular tissue opening on perianal skin
Anorectal fistula
Feels boggy, enlarged, and tender to palpation
Prostatitis
Feels hard, nodular; unable to palpate sulcus
Prostatic carcinoma
Soft nodules palpated with rectal examination
Rectal polyp
* 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
Risk Factors
Colorectal Cancer
* 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)
Risk Factors
Prostate Cancer
Nocturia
Urine dribbles
Tried to void, but can't
Small stream
Mnemonics
Benign Prostatic Hypertrophy: NUTS