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Flashcards in The Male GU /Digital Rectal Examination Deck (21)
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1

Reasons to Perform the GU/DRE
3

1. Colorectal Cancer Screening
2. Part of a comprehensive physical exam
3. Other rectal pathology

2

The GU/DRE has long been considered an integral part of a comprehensive physical examination for adult males.
1. Which body parts are involved? 6
2. The advantage is what?

1.
-sacrococcygeal and
-perianal areas,
-the anus,
-rectum,
-scrotum and
-prostate.

2. The advantage is that it can be easily performed without special instruments or advanced clinical training.

3

Although the DRE allows palpation of only the __________ surface of the prostate gland, this exam is widely used when there is a urinary complaint

posterior

4

1. Rectal mucosa examination allows the clinician to palpate what? 2


2. The DRE by itself is not an adequate screening method for what?

3. It may also be common practice for some clinicians to use a what with the DRE?

1.
-polyps or
-abnormally firm, irregular or raised areas that may indicate the presence of a carcinoma.

2. CRC.

3. a stool sample obtained during the DRE for the fecal occult blood test.

5

Skills Checklist: Communications checklist?
4

1. Explaining procedures
2. Showing sensitivity to patient needs or responding to discomfort
3. Talking the patient though the exam
4. Sharing exam findings with the patient

6

Skills checklist: Technical skills? 3

1. Positioning the patient
2. Performing the exam
3. After explaining exam results, arranging appropriate follow up

7

Performing the GU exam: Inspection
2

1. Inspect the penis, including the foreskin, uretheral meatus (for discharge)

2. Inspect the scrotum noting any visible masses, rashes or underdevelopment

8

Performing the GU exam: Palpation?
4

Palpate each
1. testis and
2. epididymis between your thumb and first two fingers
3. spermatic cord,
4. including the vas deferens

9

Performing the GU exam
Any swelling in the scrotum other than the testicles should be evaluated by what?

transillumination.

10

Swellings that transilluminate contain what?

Example?

serous fluid

such as a hydrocele,

11

Performing the GU exam
Hernias
1. Inspect what areas for bulges?
2. While observing as the patient to do what?

3. Palpation steps? 4

Hernias
1. Inspection – Inspect the inguinal and femoral areas carefully for bulges.

2. While observing, ask the patient to strain down.

3. Palpation
-Using your right hand on the patient’s right side, invaginate loose scrotal skin with your index finger.

-Follow the spermatic cord upward to above the inguinal ligament and find the triangular slitlike opening of the external inguinal ring.

-Ask the patient to bear down or cough.

-Stand on the left side using your left hand for the assessing the other side.

12

Performing the DRE
Exam steps?
10

1. Make sure lighting is sufficient
2. Glove both hands and spread the buttocks apart
3. Inspect the sacrococcygeal and perianal areas
4. Palpate any abnormal areas, noting lumps or tenderness
5. Ask the patient about localized feelings of tenderness or pain
6. Lubricate the gloved index finger
7. Warn the patient before inserting finger
8. Gently press on the sphincter’s edge and wait for it to relax, then insert your finger into anal canal
9. Pause and allow patient to adjust to your finger, then continue to insert finger fully
10. Assess sphincter tone by asking the patient to squeeze anal muscles around finger

13

Examining the Rectum
Steps in the process? 4

1. Examine the posterior and lateral walls of the rectum by gently rotating the finger through 180 degrees

2. To palpate the entire circumference of the rectum, you should turn away from patient and hyperpronate your wrist

3. Sweep your finger across the anterior and anterolateral walls of the rectum

4. Note texture and elasticity of the rectal lining

14

Rectal Exam: Possible Findings
6

1. Normal rectal mucosa feels uniformly smooth and pliable

2. Polyps--may be attached by a stalk or base

3. Masses or irregularly shaped nodules

4. Areas of unusual hardness

5. Abscesses (perirectal) may be indicated by extreme tenderness

6. Hemorrhoids (internal and external)

15

Examining the Prostate
Steps in the process? 4

1. Inform the patient that you’re going to examine his prostate gland

2. Sweep your finger over the prostate gland (found anteriorly through rectal wall)

3. Identify the two lobes with a longitudinal groove (median sulcus) between them

4. Note the size, nodularity, consistency and tenderness of the prostate

16

Prostate Exam: Possible Findings
Normal prostate? 4

1. About 2.5 cm from side to side
2. Prominent median sulcus
3. Consistency is rubbery and smooth
4. Tenderness not usual, and patients should feel urge to urinate when you palpate

17

Prostate Exam: Possible Findings
Benign Prostatic Hypertrophy (BPH)? 5

1. Enlargement of gland is symmetrical
2. Marked protrusion into rectal lumen
3. Smooth with no nodularity
4. Median sulcus may be indistinguishable
5. Consistency is rubbery or slightly elastic

18

Prostate Exam: Possible Findings
Prostate Cancer? 4

Prostate Cancer
1. Asymmetric shape
2. Hard consistency
3. Discrete nodule may be palpable
4. Median sulcus often obscured

19

Prostate Exam: Possible Findings
Acute Prostatitis? 5

Acute prostatitis
1. Gland is swollen and “boggy”
2. Firm consistency
3. Very tender to touch
4. Examine the gland carefully
5. Pay attention to patient’s verbal and nonverbal cues

20

Explaining Screening Exam Results
If the DRE yields suspicious results what should we discuss with the pt? 3

1. Explain your findings to the patient
2. Negotiate a follow up plan for the patient (Colonoscopy, PSA and possible biopsy)
3. Address patient concerns

21

1. DRE reaches only the what surfaces of the prostate?

2. PSA can be elevated when?

1. posterior and lateral

2. benign conditions as well as cancer