TERM 2-MY NOTES HEALTH ASSESSMENT CH.25 "Anus, Rectum, and Prostate" Flashcards Preview

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Flashcards in TERM 2-MY NOTES HEALTH ASSESSMENT CH.25 "Anus, Rectum, and Prostate" Deck (170):
1

Anus, Rectum, and Prostate

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2

STRUCTURE AND FUNCTION

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3

ANUS AND RECTUM

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4

The anal canal is the outlet of the gastrointestinal (GI) tract, and it is about 3.8 em long in the adult. It is lined with modified skin (having no hair or sebaceous glands) that merges with rectal mucosa at the anorectal junction.
A)true
B)false

A

5

The __________ is the outlet of the gastrointestinal (GI) tract, and it is about 3.8 em long in the adult. It is lined with modified skin (having no hair or sebaceous glands) that merges with rectal mucosa at the anorectal junction.

anal canal

6

The rectum, which is 12 cm long, is the distal portion of the large intestine. It extends from the sigmoid colon, at the level of the third sacral vertebra, and ends at the anal canal. Just above the anal canal, the rectum dilates and turns posteriorly, forming the rectal ampulla. The rectal interior has three semilunar transverse folds called the valves of Houston.
A)true
B)false

A

7

The _________, which is 12 cm long, is the distal portion of the large intestine. It extends from the sigmoid colon, at the level of the third sacral vertebra, and ends at the anal canal. Just above the anal canal, the rectum dilates and turns posteriorly, forming the rectal ampulla. The rectal interior has three semilunar transverse folds called the valves of Houston.

rectum

8

In the male, the prostate gland lies in front of the anterior wall of the rectum and 2 cm behind the symphysis pubis. It surrounds the bladder neck and the urethra and has 15 to 30 ducts that open into the urethra. The prostate secretes a thin, milky, alkaline fluid that helps sperm viability. It is a bilobed structure with a round or heart shape. It measures 2.5 cm long and 4 cm in diameter. The two lateral lobes are separated by a shallow groove called the median sulcus.
A)true
B)false

A

9

In the male, the _____________ lies in front of the anterior wall of the rectum and 2 cm behind the symphysis pubis. It surrounds the bladder neck and the urethra and has 15 to 30 ducts that open into the urethra. The prostate secretes a thin, milky, alkaline fluid that helps sperm viability. It is a bilobed structure with a round or heart shape. It measures 2.5 cm long and 4 cm in diameter. The two lateral lobes are separated by a shallow groove called the median sulcus.

prostate gland

10

DEVELOPMENTAL COMPETENCE

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11

The first stool passed by the newborn is dark green meconium and occurs within 24 to 48 hours of birth, indicating anal patency. From that time on, the infant usually has a stool after each feeding. This response to eating is a wave of peristalsis called the gastrocolic reflex. It continues throughout life, although children and adults usually produce no more than one or two stools per day.
A)true
B)false

A

12

gastrocolic reflex continues throughout life, although children and adults usually produce no more than one or two stools per day.
A)true
B)false

A

13

The infant passes stools by reflex. Voluntary control of the external anal sphincter cannot occur until the nerves supplying the area have become fully myelinated, usually around 1 1/2 to 2 years of age. Toilet training usually starts after age 2 years
A)true
B)false

A

14

Toilet training usually starts after age 2 years
A)true
B)false

A

15

At male puberty, the prostate gland undergoes a very rapid increase to more than twice its prepubertal size. During young adulthood, its size remains fairly constant.
A)true
B)false

A

16

The prostate gland commonly starts to enlarge during the middle adult years. This benign prostatic hypertrophy (BPH) is present in 1 of 10 males at the age of 40 years and grows larger with age. It is thought that the hypertrophy is caused by hormonal imbalance that leads to the proliferation of benign adenomas. These gradually impede(delay) urine output because they obstruct the urethra.
A)true
B)false

A

17

CULTURE AND GENETICS

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18

Prostate cancer (PC) is more common in North America and northwestern Europe and is less common in Central and South America, Africa, and Asia.
A)true
B)false

A

19

African-American men are more likely to be diagnosed at an advanced stage of the disease, and mortality rates are two times higher for African-American men than for white men.
A)true
B)false

A

20

Diets high in red meat and processed meat, animal and saturated fats, and dairy products may increase risk/ whereas diets high in fiber, fruits, and vegetables may lower risk
A)prostate cancer
B)herpes

A

21

Men at average risk for PC should receive information at 50 years; at higher risk (African Americans and positive family history) at 45 years; and at very high risk (multiple family members with PC) at 40 years.
A)true
B)false

A

22

Colorectal cancer has a racial variation as well. The incidence rates are almost 20% higher for African-American women and men than for whites, and the mortality rates are almost 50% higher for African Americans than for whites
A)true
B)false

A

23

SUBJECTIVE DATA

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24

1. Usual bowel routine
2. Change in bowel habits
3. Rectal bleeding, blood in the stool
4. Medications (laxatives, stool softeners, iron)
5. Rectal conditions (pruritus, hemorrhoids, fissure, fistula)
6. Family history
7. Self-care behaviors (diet of high-fiber foods, most recent examinations)

True

25

Usual bowel routine. Bowels move regularly? How often? Usual color? Hard or soft?
A)Assess usual bowel routine. Constipation is

A

26

Any straining at stool, incomplete evacuation, urge to have bowel movement but nothing comes? • Eat breakfast? (This increases colon motility and prompts a bowel movement in many.)
A)assessing
B)false

A

27

Pain while passing a bowel movement?
A)Dyschezia. Pain due to a local condition (hemorrhoid, fissure) or constipation
B)false

A

28

Dyschezia. Pain due to a local condition (hemorrhoid, fissure) or constipation
A)true
B)false

A

29

Change in bowel habits. Any change in usual bowel habits? Loose stools or diarrhea? When did this start? Is the diarrhea associated with nausea and vomiting, abdominal pain, something you ate recently?
A)Diarrhea occurs with gastroenteritis, colitis, irritable colon syndrome.
B)false

A

30

Diarrhea occurs with gastroenteritis, colitis, irritable colon syndrome.
A)true
B)false

A

31

Eaten at a restaurant recently? Anyone else in your group or family have the same symptoms?
A)Consider food poisoning.
B)false

A

32

Traveled to a foreign country during the past 6 months?
A)Consider parasitic infection
B)false

A

33

Stools have a hard consistency? When did this start?
A)assessing for Constipation
B)false

A

34

Rectal bleeding, blood in the stool. Ever had black or bloody stools? When did you first notice blood in the stools? What is the color, bright red or dark red-black? How much blood: spotting on the toilet paper or outright passing of blood with the stool? Do the bloody stools have a particular smell?
A)assessing for Melena
B)false

A

35

Black stools may be tarry due to occult blood (melena) from GI bleeding.
A)true
B)false

A

36

nontarry from ingestion of iron medications.
A)true
B)false

A

37

Red blood in stools occurs with GI bleeding or local bleeding around the anus and with colon and rectal cancer.
A)true
B)false

A

38

Ever had clay-colored stools?
A)Clay color indicates absent bile pigment.
B)false

A

39

Ever had mucus or pus in stool?
A)assessing
B)false

A

40

Frothy stool?
A)assessing for Steatorrhea is excessive fat in the stool as in malabsorption of fat.
B)false

A

41

Need to pass gas frequently?
A)assessing for Flatulence
B)false

A

42

Medications. What medications do you take-prescription and over-the-counter? Laxatives or stool softeners? Which ones? How often? Iron pills? Do you ever use enemas to move your bowels? How often?
A)assessing
B)false

A

43

Rectal conditions. Any problems in rectal area: itching, pain or burning, hemorrhoids? How do you treat these? Any hemorrhoid preparations? Ever had a fissure or fistula? How was this treated?
A)assessing for Pruritus
B)false

A

44

Ever had a problem controlling your bowels?
A)assessing for Fecal incontinence
B)assessing for Mucoid discharge and soiled underwear occur with prolapsed hemorrhoids.
C)both a and b

C

45

Mucoid discharge and soiled underwear occur with prolapsed hemorrhoids.
A)true
B)false

A

46

Family history. Any family history: polyps or cancer in colon or rectum, inflammatory bowel disease, prostate cancer?
A)assessing for Risk factors for colon cancer, rectal cancer, prostate cancer.
B)false

A

47

Self-care behaviors. What is the usual amount of high-fiber foods in your daily diet: cereals, apples or other fruits, vegetables, whole-grain breads? How many glasses of water do you drink each day?
A)assessing High-fiber foods of the soluble type (beans, prunes, barley, carrots, broccoli, cabbage) lower cholesterol, whereas insoluble fiber foods (cereals, wheat germ) reduce risk for colon cancer. Also, fiber foods fight obesity, stabilize blood sugar, and help some GI disorders.
B)false

A

48

High-fiber foods of the soluble type (beans, prunes, barley, carrots, broccoli, cabbage) lower cholesterol, whereas insoluble fiber foods (cereals, wheat germ) reduce risk for colon cancer. Also, fiber foods fight obesity, stabilize blood sugar, and help some GI disorders
A)true
B)false

A

49

Date of last: digital rectal examination, stool blood test, colonoscopy, (for men) prostate-specific antigen blood test.
A)assessing for Early detection for cancer: DRE performed annually after age 50 years; fecal occult blood test annually after age 50 years; sigmoidoscopy every 5 years or colonoscopy every 10 years after age 50 years; PSA blood test annually for men older than 50 years, except Black men beginning at age 45 years.
B) false

A

50

Early detection for cancer: DRE performed annually after age 50 years; fecal occult blood test annually after age 50 years; sigmoidoscopy every 5 years or colonoscopy every 10 years after age 50 years; PSA blood test annually for men older than 50 years, except Black men beginning at age 45 years.
A)true
B)false

A

51

Additional History for Infants and Children

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52

Have you ever noticed any irritation in your child's anal area: redness, raised skin, frequent itching?
A)assessing for In children, pinworms are a common cause of intense itching and irritated anal skin.
B)false

A

53

In children, pinworms are a common cause of intense itching and irritated anal skin.
A)true
B)false

A

54

How are your child's bowel movements? Frequency? Any problems? Any pain or straining with BM?
A)Assess usual stooling pattern. Constipation is a decrease in BM frequency, with difficult passing of very hard, dry stools. Encopresis is persistent passing of stools into clothing in a child older than 4 years, at which age continence would be expected.
B)false

A

55

Constipation is a decrease in BM frequency, with difficult passing of very hard, dry stools.
A)true
B)false

A

56

Encopresis is persistent passing of stools into clothing in a child older than 4 years, at which age continence would be expected
A)true
B)false

A

57

OBJECTIVE DATA

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58

PREPARATION

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59

Examine the male in the left lateral decubitus or standing position. Instruct the standing male to point his toes together; this relaxes the regional muscles, making it easier to spread the buttocks.
A)true
B)false

A

60

Place the female in the lithotomy position if examining genitalia as well; use the left lateral decubitus position for the rectal area alone.
A)true
B)false

A

61

EQUIPMENT NEEDED

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62

Penlight
Lubricating jelly
Glove
Guaiac test container
A)true
B)false

A

63

INSPECT THE PERIANAL AREA

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64

Spread the buttocks wide apart and observe the perianal region. The anus normally looks moist and hairless, with coarse, folded skin that is more pigmented than the perianal skin. The anal opening is tightly closed. No lesions are present
A)true
B)false

A

65

Inflammation.
Lesions or scars.
Linear split-fissure.
Flabby skin sac-hemorrhoid.
Shiny blue skin sac- thrombosed hemorrhoid.
Small round opening in anal area-fistula
A)abnormal findings of peri area
B) false

A

66

Flabby skin sac-hemorrhoid.
A)abnormal findings of peri area
B) false

A

67

Shiny blue skin sac- thrombosed hemorrhoid.
A)abnormal findings of peri area
B) false

A

68

Small round opening in anal area-fistula
A)abnormal findings of peri area
B) false

A

69

Inspect the sacrococcygeal area. Normally, it appears smooth and even.
A)true
B)false

A

70

Inflammation or tenderness, swelling, tuft of hair, or dimple at tip of coccyx may indicate pilonidal cyst
A)abnormal finding
B)false

A

71

Instruct the person to hold the breath and bear down by performing a Valsalva maneuver. No break in skin integrity or protrusion through the anal opening should be present. Describe any abnormality in clock-face terms, with the 12 o'clock position as the anterior point toward the symphysis pubis and the 6 o'clock position toward the coccyx.
A)true
B)false

A

72

Appearance of fissure or hemorrhoids. Circular red doughnut of tissue-rectal prolapse.
A)abnormal finding around anal area
B)false

A

73

PALPATE THE ANUS AND RECTUM

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74

Drop lubricating jelly onto your gloved index finger. Instruct the person that palpation is not painful but may feel like needing to move the bowels. Place the pad of your index finger gently against the anal verge. You will feel the sphincter tighten and then relax. As it relaxes, flex the tip of your finger and slowly insert it into the anal canal in a direction toward the umbilicus.
A)true
B)false

A

75

Never approach the anus at right angles with your index finger extended. Such a jabbing motion does not promote sphincter relaxation and is painful.
A)true
B)false

A

76

Rotate your examining finger to palpate the entire muscular ring. The canal should feel smooth and even. Note the intersphincteric groove circling the canal wall. To assess tone, ask the person to tighten the muscle. The sphincter should tighten evenly around your finger with no pain to the person.
A)true
B)false

A

77

Decreased tone.
Increased tone occurs with inflammation and anxiety.
Tenderness.
A)abnormal findings of anal sphincter
B)false

A

78

Use a bi-digital palpation with your thumb against the perianal tissue. Press your examining finger toward it. This maneuver highlights any swelling or tenderness and helps assess the bulbourethral glands.
A)true
B)false

A

79

Above the anal canal, the rectum turns posteriorly, following the curve of the coccyx and sacrum. Insert your finger farther and explore all around the rectal wall. It normally feels smooth with no nodularity. Promptly report any mass you discover for further examination
A)true
B)false

A

80

Internal hemorrhoid above anorectal junction is not palpable unless thrombosed.
A)true
B)false

A

81

A soft, slightly movable mass may be a polyp.
A)true
B)false

A

82

A firm or hard mass with irregular shape or rolled edges may signify carcinoma
A)true
B)false

A

83

Prostate Gland. On the anterior wall in the male, note the elastic, bulging prostate gland. Palpate the entire prostate in a systematic manner, but note that only the superior and part of the lateral surfaces are accessible to examination
A)true
B)false

A

84

Press into the gland at each location, because when a nodule occurs, it will not project into the rectal lumen.
A)prostate gland
B)false

A

85

The surface should feel smooth and muscular; search for any distinct nodule or diffuse firmness. Note these characteristics:

Size-2.5 cm long by 4 cm wide; should not protrude more than 1 cm into the rectum

Shape-heart shape, with palpable central groove Surface-smooth

Consistency-elastic, rubbery

Mobility-slightly movable

Sensitivity- nontender to palpation

True

86

Enlarged or atrophied gland.
Flat with no groove.
Nodular.
Hard; or boggy, soft, fluctuant.
Fixed.
Tender
Are all abnormal findings of the prostate gland
A)true
B)false

A

87

Enlarged, firm, smooth prostate gland with central groove obliterated suggests benign prostatic hypertrophy.
A)true
B)false

A

88

Swollen, exquisitely tender prostate gland accompanies prostatitis.
A)true
B)false

A

89

Any stone-hard, irregular, fixed nodule on the prostate gland indicates carcinoma.
A)true
B)false

A

90

In the female, palpate the cervix through the anterior rectal wall. It normally feels like a small, round mass. You also may palpate a retroverted uterus or a tampon in the vagina. Do not mistake the cervix or a tampon for a tumor.
A)true
B)false

A

91

Withdraw your examining finger; normally, no bright red blood or mucus is on the glove. To complete the examination, offer the person tissues to remove the lubricant and help the person to a more comfortable position.
A)true
B)false

A

92

Examination of Stool. Inspect any feces remaining on the glove. Normally, the color is brown and the consistency is soft.
A)true after prostate exam
B)false

A

93

Jelly-like mucus shreds mixed in stool indicate inflammation.
A)true
B)false

A

94

Bright red blood on stool surface indicates rectal bleeding.
A)true
B)false

A

95

Bright red blood mixed with feces indicates possible colonic bleeding.
A)true
B)false

A

96

Test any stool on the glove for occult blood using the specimen container that your agency directs. A negative response is normal. If the stool is Hematest positive, it indicates occult blood. Note that a false-positive finding may occur if the person has ingested significant amounts of red meat within 3 days of the test
A)true
B)false

A

97

Black tarry stool with distinct malodor indicates upper Gl bleeding with blood partially digested. (Must lose more than 50 ml from upper Gl tract to be considered melena.)
A)true
B)false

A

98

Enhance self-care by providing the average-risk patient an at-home collection kit to screen for asymptomatic colorectal cancer and precancerous lesions (highrisk adenomas).
A)true
B)false

A

99

A patient collects the stool specimen at home and mails it to the laboratory. The guaiac-based fecal occult blood test has long been in use but it requires three separate stool samples to yield a sensitivity of 92%. Also, false positives can occur due to ingestion of red meat and other foods and certain medications.
A)true
B)false

A

100

Evidence shows the newer fecal immunochemical test is easier and requires only one stool sample. It detects antibodies specific for human hemoglobin and is sensitive to invasive cancers and precancerous lesions
A)true
B)false

A

101

Black stool-also occurs with ingesting iron or bismuth preparations.
A)true
B)false

A

102

Gray, tan stool-absent bile pigment (e.g., obstructive jaundice).
A)true
B)false

A

103

Pale yellow, greasy stool-increased fat content (steatorrhea), as occurs with malabsorption syndrome.
A)true
B)false

A

104

Occult bleeding usually indicates cancer of the colon.
A)true
B)false

A

105

DEVELOPMENTAL COMPETENCE
Infants and Children

,

106

For the newborn, hold the feet with one hand and flex the knees up onto the abdomen. Note the presence of the anus. Confirm a patent rectum and anus by noting the first meconium stool passed within 24 to 48 hours of birth.
A)true
B)false

A

107

To assess sphincter tone, check the anal reflex. Gently stroke the anal area and note a quick contraction of the sphincter.
A)infant
B)adults

A

108

Imperforate anus is abnormal finding in an infant
A)true
B)false

A

109

For each infant and child, note that the buttocks arc firm and rounded with no masses or lesions. Recall that the mongolian spot is a common variation of hyperpigmentation in Black, American Indian, Mediterranean, and Asian newborns
A)true
B)false

A

110

Recall that the mongolian spot is a common variation of hyperpigmentation in Black, American Indian, Mediterranean, and Asian newborns
A)true
B)false

A

111

Flattened buttocks in cystic fibrosis or celiac syndrome
A)infant
B)adult

A

112

Coccygeal mass is an abnormal finding in an infant.
A)true
B)false

A

113

Meningocele (sac containing meninges that protrude through a defect in the bony spine)
A)abnormal finding in an infant
B)false

A

114

Tuft of hair or pilonidal dimple. Is an abnormal finding in an infant
A)true
B)false

A

115

The perianal skin is free of lesions. However, diaper rash is common in children younger than 1 year and is exhibited as a generalized reddened area with papules or vesicles.
A)true
B)false

A

116

Pustules indicate secondary infection of diaper rash.
A)infants
B)adults

A

117

Signs of physical or sexual abuse (e.g., anal abrasions, perianal tears).
A)true
B)false

A

118

Fissure-common cause of constipation or rectal bleeding in child. (Painful, so the child does not defecate.)
A)true
B)false

A

119

Omit palpation unless the history or symptoms warrant. When internal palpation is needed, position the infant or child on the back with the legs flexed and gently insert a gloved, well-lubricated finger into the rectum. Your fifth finger usually is long enough, and its smaller size is more comfortable for the infant or child. However, you may need to use the index finger because of its better control and increased tactile sensitivity. On withdrawing the finger, scant bleeding or protruding rectal mucosa may occur.
A)true
B)false

A

120

On withdrawing the finger, scant bleeding or protruding rectal mucosa may occur. On the infant, this is normal
A)true
B)false

A

121

Inspect the perianal region of the school-age child and adolescent during examination of the genitalia. Internal palpation is not performed routinely.
A)true
B)false

A

122

DEVELOPMENTAL COMPETENCE
The Aging Adult

,

123

As an aging person performs the Valsalva maneuver, you may note relaxation of the perianal musculature and decreased sphincter control. Otherwise, the full examination proceeds as that described earlier for the younger adult.
A)true
B)false

A

124

PROMOTING A HEALTHY LIFESTYLE: COLORECTAL CANCER SCREENING Screen for Life: National Colorectal Cancer Action Campaign

,

125

Colorectal cancer (CRC), or colon cancer for short, is currently the second leading cancer killer in the United States
A)true
B)false

A

126

CRC is most often found in people age 50 years and older.
A)true
B)false

A

127

Whereas some people with colorectal polyps or CRC are asymptomatic, others have symptoms that include blood in stools, pain, aches, abdominal cramping, a change in bowel habits, iron deficiency anemia, or unexplained weight loss. Several tests are used to screen for CRC.
A)true
B)false

A

128

ABNORMAL FINDINGS ---- -

,

129

Abnormalities of the Anal Region

,

130

A hair-containing cyst or sinus located in the midline over the coccyx or lower sacrum. Often opens as a dimple with visible tuft of hair and, possibly, an erythematous halo. Or, may appear as a palpable cyst. When advanced, has a palpable sinus tract. Although it is a congenital disorder, the lesion is first diagnosed between the ages of 15 and 30 years.
A)Pilonidal Cyst or Sinus
B)Anorectal Fistula

A

131

A chronically inflamed gastrointestinal tract creates an abnormal passage from inner anus or rectum out to skin surrounding anus. Usually originates from a local abscess. The red, raised tract opening may drain serosanguineous or purulent matter when pressure is applied. Bi-digital palpation may reveal an indurated cord.
A)Anorectal Fistula
B)Fissure

A

132

A painful longitudinal tear in the superficial mucosa at the anal margin. Most ________ (>90%) occur in the posterior midline area. They are frequently accompanied by a papule of hyperplastic skin, called a sentinel tag, on the anal margin below. ________ often result from trauma (e.g., passing a large, hard stool) or from irritant diarrheal stools. The person has itching, bleeding, and exquisite pain. A resulting spasm in the sphincters makes the area painful to examine; local anesthesia may be indicated.
A)Fissure
B)Hemorrhoids

A

133

These painless, flabby papules are due to a varicose vein of the hemorrhoidal plexus. An external hemorrhoid originates below the anorectal junction and is covered by anal skin. When thrombosed, it contains clotted blood and becomes a painful, swollen, shiny blue mass that itches and bleeds with defecation. When it resolves, it leaves a painless, flabby skin sac around the anal orifice. An internal hemorrhoid originates above the anorectal junction and is covered by mucous membrane. When the person performs a Valsalva maneuver, it may appear as a red mucosal mass. It is not palpable. All _______ result from increased portal venous pressure, as occurs with straining at stool, chronic constipation, pregnancy, obesity, chronic liver disease, or the low-fiber diet common in Western society.
A)Hemorrhoids
B)fissures

A

134

An _________ hemorrhoid originates below the anorectal junction and is covered by anal skin. When thrombosed, it contains clotted blood and becomes a painful, swollen, shiny blue mass that itches and bleeds with defecation. When it resolves, it leaves a painless, flabby skin sac around the anal orifice.
A)external
B)internal

A

135

An ________ hemorrhoid originates above the anorectal junction and is covered by mucous membrane. When the person performs a Valsalva maneuver, it may appear as a red mucosal mass. It is not palpable.
A)external
B)internal

A

136

The rectal mucous membrane protrudes through the anus, appearing as a moist red donut with radiating lines. When prolapse is incomplete, only the mucosa bulges. When complete, it includes the anal sphincters. Occurs following a Valsalva maneuver, such as straining at stool, or with exercise.
A)Rectal Prolapse
B)Pruritus Ani

A

137

Intense perianal itching is manifested by red, raised, thickened, excoriated skin around the anus. Common causes are pinworms in children and fungal infections in adults. The area is swollen and moist, and with a fungal infection, it appears dull grayish pink. The skin is dry and brittle with psychosomatic itching.
A)Pruritus Ani
B)fissures

A

138

Abnormalities of the Rectum

,

139

A localized cavity of pus from infection in a pararectal space. Infection usually extends from an anal crypt. Characterized by persistent throbbing rectal pain. Termed by the space it occupies (e.g., a perianal abscess is superficial around the anal skin) and appears red, hot, swollen, indurated, and tender. An ischiorectal abscess is deep and tender to bi-digital palpation. It occurs laterally between the anus and ischial tuberosity and is uncommon
A)Abscess
B)Rectal Polyp

A

140

A protruding growth from the rectal mucous membrane that is fairly common. The polyp may be pedunculated (on a stalk) or sessile (a mound on the surface, close to the mucosal wall). The soft nodule is difficult to palpate. Proctoscopy is needed as well as biopsy to screen for a malignant growth
A)Fecal Impaction
B)Rectal Polyp

B

141

A collection of hard, desiccated feces in the rectum. The obstruction often results from decreased bowel motility, in which more water is reabsorbed from the stool. Also occurs with retained barium from gastrointestinal x-ray examination. The person may complain of constipation or of diarrhea as a fecal stream passes around the impaction.
A)Carcinoma.
B)Fecal Impaction

B

142

A malignant neoplasm in the rectum is asymptomatic, thus the importance of routine rectal palpation. An early lesion may be a single firm nodule. You may palpate an ulcerated center with rolled edges. As the lesion grows, it has an irregular cauliflower shape and is fixed and stone-hard. Refer a person with any rectal lesion for further study because about half are malignant.
A)Carcinoma
B)fissures

A

143

ABNORMAL FINDINGS FOR ADVANCED PRACTICE

,

144

Abnormalities of the Prostate Gland

,

145

S: Urinary frequency, urgency, hesitancy, straining to urinate, weak stream, intermittent stream, sensation of incomplete emptying, nocturia.
0: A symmetric nontender enlargement, commonly occurs in males beginning in the middle years. The prostate surface feels smooth, rubbery, or firm (like the consistency of the nose), with the median sulcus obliterated.
A)Benign Prostatic Hypertrophy (BPH)
B)Prostatitis

A

146

S: Fever, chills, malaise, urinary frequency and urgency, dysuria, urethral discharge; dull, aching pain in perineal and rectal area.

0: An exquisitely tender enlargement is acute inflammation of the prostate gland yielding a swollen, slightly asymmetric gland that is quite tender to palpation.
A)tumor
B)Prostatitis

B

147

With a chronic inflammation, the signs can vary from tender enlargement with a boggy feel to isolated firm areas due to fibrosis. Or the gland may feel normal.
A)Prostatitis
B)tumor

A

148

S: Frequency, nocturia, hematuria, weak stream, hesitancy, pain or burning on urination; continuous pain in lower back, pelvis, thighs.

0 : A malignant neoplasm often starts as a single hard nodule on the posterior surface, producing asymmetry and a change in consistency. As it invades normal tissue, multiple hard nodules appear, or the entire gland feels stonehard and fixed. The median sulcus is obliterated.

A)Carcinoma
B)fissures

A

149

Summary Checklist: Anus, Rectum, and Prostate Examination

,

150

1.Inspect anus and perianal area.
2.Inspect during Valsalva maneuver
3.Palpate anal canal and rectum on all adults.
4.Test stool for occult blood.

,

151

Extra Information

,

152

anus moist, color darken than adjacent tissues.no lesions or discharge. opening tightly closed is an normal assessment of the perineal area
A)true
B)false

a

153

a prostate gland that is enlarged,non tender,firm and smooth with a palpable groove.this assessment finding indicates BPH
A)true
B)false

A

154

long term use of laxatives leads to dependence in GI system
A)true
B)false

A

155

asia has the lowest prevalence rate of prostate cancer
A)true
B)false

A

156

anorectal fistula is caused by a chronically inflamed GI tract
A)true
B)false

A

157

fissures are tears that occur in the superficial mucosa and often result from trauma
A)true
B)false

A

158

etiology of a pilondal cyst is a congenital disorder dx between ages 15 and 30
A)true
B)false

A

159

anorectal fistula is usually caused by a chronically inflamed GI tract
A)true
B)false

A

160

2. The incidence of benign prostatic hypertrophy (BPH) is highest among:
a. European Americans.
b. African Americans.
c. Hispanics.
d. Asians.

B

161

3. Select the best description of the anal canal.
a. a 12-cm-long portion of the large intestine
b.under involuntary control of the parasympathetic nervous system
c.a 3.8-cm-long outlet of the gastrointestinal tract
d.an S-shaped portion of the colon



C

162

4. While good nutrition is important for everyone, foods believed to help reduce risk of colon cancer are:
a. high in fiber.
b. low in fat.
c. high in protein.
d. high in carbohydrate.

A

163

5. Which finding in the prostate gland suggests prostate cancer?
a. symmetric smooth enlargement
b. extreme tenderness to palpation
c. boggy soft enlargement
d. diffuse hardness

D

164

6. The bulbourethral gland is assessed:
a. during an examination of a female patient.
b. during an examination of both male and
female patients.
c. during an examination of a male patient.
d. cannot be assessed with a rectal
examination.

C

165

7. Inspection of stool is an important part of the rectal examination. Normal stool is:
a. black in color and tarry in consistency.
b. brown in color and soft in consistency.
c. clay colored and dry in consistency.
d. varies depending upon the individual's
diet.

B

166

8. Which symptoms suggest benign prostatic hypertrophy?
a. weight loss and bone pain
b. fever, chills, urinary frequency, and urgency
c. difficulty initiating urination and weak
stream
d. dark, tarry stools

C

167

9. A false positive may occur on fecal occult blood tests of the stool if the person has ingested significant amounts of:
a. red meat.
b. candies with red dye #2.
c. cranberry juice.
d. red beets.

A

168

A patient states he is frequently constipated and when he has a bowel movement, he has rectal bleeding and pain. He does not feel any mass at his anal opening. "Do I have hemorrhoids, or is there something else wrong with me?" The examiner completes a rectal examination and explains that:
a. there is an indication of rectal prolapse.
b. it appears to be a pilonidal cyst.
c. the symptoms are consistent with internal
hemorrhoids.
d. the problem is probably encopresis.

C

169

12. A patient states he has frothy, foul-smelling stools that float on the surface of the water in the toilet bowl. What condition is this patient describing?
a. steatorrhea
b. melena
c. dyschezia
d. a parasitic infection

A

170

The gastrocolic reflex is:
a. a peristaltic wave.
b. the passage of meconium in the newborn.
c. another term for borborygmi.
d. reverse peristalsis.

A