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Flashcards in GU exam Deck (17)
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1

Why do we perform GU/DRE?

- colorectal cancer screening
- part of comprehensive physical exam - sacrococcygeal and perianal areas, anus, rectum, scrotum, and prostate
- other rectal pathology
- allows for palpation of only posterior surface of prostate gland but stil widely used when there is a urinary complaint
- rectal mucosa exam: allows clinician to palpate - polpys or abnormally firm, irregular or raised areas that may indicate presence of carcinoma

2

Is DRE by itself adequate screening method for CRC?

- no
- also common practice for some clinicians to use stool sample obtained during DRE for FOBT

3

Common positions for the DRE?

- modified lithotomy (pt on back, knees flexed)
- sim's position (for bedridden pts) - left lateral
- standing, hips flexed w/ upper body on table
- have to carefully assess pt's strength and mobility b/f positioning him

4

Inspection part of GU exam?

- inspect penis, including foreskin, uretheral meatus (for d/c)
- inspect scrotum noting any visible rashes or underdevelopment

5

Palpation part of GU exam?

- palpate each testis and epididymis b/t your finger and 1st 2 fingers
- palpate each spermatic cord, including vas deferens

6

What should be done if there is any swelling found in scrotum other than in the testicles?

- should be eval by transillumination - swellings that contain serous fluid, such as hydrocecele, will transilluminate

7

Inspecting for hernias?

- inspection: inspect inguinal and femoral areas carefully for bulges - while observing - ask pt to strain down
- palpation: using R hand on pt's right side invaginate loose scrotal skin with index finger
- follow spermatic cord upward to above the inguinal ligament and find triangular slitlike opening of external inguinal ring
- ask pt to bear down or cough
- stand on L side using R hand for assessing other side

8

Steps of performing the DRE?

- make sure lighting is good
- glove both hads and spread buttocks apart
- inspect sacrococcygeal and perianal areas
- palpate any abnormal areas, noting lumps or tenderness
- ask pt about localized feelings or tenderness or pain
- lubricate gloved index finger
- warn pt b/f inserting finger - gently press on sphincter's edge and wait for it to relax and then insert finger into anal canal
- pause and allow pt to adjust to your finger, then continue to isnert finger fully
- assess sphincter tone by asking pt to squeeze anal muscles around finger

9

Examination inside the rectum?

- examine posterior and lateral walls of rectum by gently rotating finger through 180 degrees
- to palpate entire circumference of rectum - you should turn away from pt and hyperpronate wrist
- sweep your finger across anterior and anterolateral walls of rectum
- note texture and elasticity of rectal lining

10

What are possible findings on rectal exam?

- normal rectal mucosa feels uniformly smooth and pliable
- polyps - may be attached by a stalk or base
- masses or irregularly shaped nodules
- areas of unusual hardness
- abscesses (perirectal) may be indicated by extreme tenderness
- hemorrhoids (internal and external)

11

How do you examine the prostate?

- inform pt that you are going to examine his prostate gland
- sweep your finger over prostate gland (found anteriorly through rectal wall)
- ID 2 lobes w/ longitudinal groove (median sulcus) b/t them
- note size, nodularity, consistency and tenderness of prostate

12

Characteristics of a normal prostate?

- about 2.5 cm from side to side
- prominent median sulcus
- consistency is rubbery and smooth
- tenderness isn't usual and pts should feel urge to urinate when you palpate

13

Characteristics of BPH?

- enlargement of gland is symmetrical
- marked protrusion into rectal lumen
- smooth w/ no nodularity
- median sulcus may be indistinguishable
- consistency is rubbery or slightly elastic

14

Characteristics of prostate cancer?

- asymmetric shape
- hard consistency
- discrete nodule may be palpable
- median sulcus often observed

15

Characteristics of acute prostatitis?

- gland is swollen and boggy
- firm consistency (have pt f/u - worry about cancer)
- very tender to touch
- examine gland carefully
- pay attention to pt's verbal and nonverbal cues

16

What should you do if DRE yields suspicious results?

- explain findings to pt
- negotiate f/u plan for pt:
colonoscopy
PSA and possible bx
- address pt concerns

17

Use of DRE and PSA as screening tools?

- 2 principle screening tests for prostate cancer
- each has distinct limitations that warrant careful review w/ pt
- DRE reaches only posterior and lateral surfaces of prostate
- PSA can be elevated for benign conditions
- providers need to counsel all men undergoing screening about utility of testing and benefits and harms of early detection and tx