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Chapter 22

Chapter 22. Anus, Rectum, and Prostate. Competencies. Identify anatomic landmarks of the rectum and the prostate gland. Describe the characteristics of the most common rectal and prostatic chief complaints. Perform inspection and palpation of the anus, rectum, and prostate on an adult.

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Chapter 22

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  1. Chapter 22 Anus, Rectum, and Prostate Copyright 2002, Delmar, A division of Thomson Learning

  2. Competencies • Identify anatomic landmarks of the rectum and the prostate gland. • Describe the characteristics of the most common rectal and prostatic chief complaints. • Perform inspection and palpation of the anus, rectum, and prostate on an adult. (continues) Copyright 2002, Delmar, A division of Thomson Learning

  3. Competencies • Explain the pathophysiologic rationale for abnormal findings. • Document assessment findings. • Describe the changes that occur in the rectum and the prostate with the aging process. Copyright 2002, Delmar, A division of Thomson Learning

  4. Assessment to Include • Male • Anus, rectum, prostate • Female • Anus, rectum Copyright 2002, Delmar, A division of Thomson Learning

  5. Health History • Age • Young adult • Middle-aged adult • Older adult • Sex • Female • Male • Race Copyright 2002, Delmar, A division of Thomson Learning

  6. Common Chief Complaints • Rectal bleeding • Rectal pain • Anal incontinence • Constipation • Diarrhea • Pruritis • Palpable mass Copyright 2002, Delmar, A division of Thomson Learning

  7. Characteristics of Chief Complaint • Quality • Quantity • Associated manifestations • Aggravating factors • Alleviating factors • Timing Copyright 2002, Delmar, A division of Thomson Learning

  8. Past Health History • Medical history • Anorectal specific • Systemic • Surgical history • Anorectal specific • Prostate • Medications (continues) Copyright 2002, Delmar, A division of Thomson Learning

  9. Past Health History • Communicable diseases • Allergies • Injuries/accidents • Childhood illnesses • Anal stenosis • Hirschsprung’s disease (continues) Copyright 2002, Delmar, A division of Thomson Learning

  10. Past Health History • Family history • Rectal polyps • Rectal cancer • Pilonidal cyst • Prostate cancer (continues) Copyright 2002, Delmar, A division of Thomson Learning

  11. Past Health History • Social history • Substance use • Sexual practices • Work environment • Hobbies/leisure • Stress (continues) Copyright 2002, Delmar, A division of Thomson Learning

  12. Past Health History • Health maintenance • Sleep • Diet • Exercise • Safety devices • Health checkups Copyright 2002, Delmar, A division of Thomson Learning

  13. Assessment • Special equipment • General approach • Minimize apprehension • Privacy • Comfort • Patient position • Left lateral decubitus • Standing • Knee-chest Copyright 2002, Delmar, A division of Thomson Learning

  14. Inspection • Assess the following areas for lesions, swelling, inflammation, tenderness, color, appearance • Perineum • Sacrococcygeal area • Anal mucosa Copyright 2002, Delmar, A division of Thomson Learning

  15. Palpation • Anus and rectum • Assess for masses, anal sphincter, nodules • Prostate • Bidigital exam • Assess for tenderness, masses, or swelling • Assess posterior surface for size, shape, consistency, mobility Copyright 2002, Delmar, A division of Thomson Learning

  16. Gerontological Variations • Decreased muscle elasticity in the rectum • Increased risk for rectal prolapse • Bowel function changes • Enlarged prostate • Increased risk for prostate cancer Copyright 2002, Delmar, A division of Thomson Learning

  17. Normal Findings • Perineum and sacrococcygeal areas • Tissue is smooth, intact, free from tenderness • Anal mucosa • Tissue is pigmented, coarse, moist, and hairless • Rectum • Good sphincter tone • No excessive pain, tenderness, induration, or nodules Copyright 2002, Delmar, A division of Thomson Learning

  18. Common Abnormal Findings • Excoriation of the perineal skin • Hemorrhoids • Anal fissures • Anorectal abscess • Anorectal fistula (continues) Copyright 2002, Delmar, A division of Thomson Learning

  19. Common Abnormal Findings • Rectal prolapse • Anal incontinence • Anal stenosis • Internal hemorrhoids • Rectal polyps • Benign prostatic hypertrophy (continues) Copyright 2002, Delmar, A division of Thomson Learning

  20. Common Abnormal Findings • Variations in stool color • Bright red stool • Black stool • Melena • Gray, tan • Pale yellow, greasy, fatty Copyright 2002, Delmar, A division of Thomson Learning

  21. Risk Factors for Rectal Cancer • Age > 50 • Familial history • History of adenomatous polyps, familial polyposis, endometrial or ovarian or breast cancer • Diet low in fiber, high in fat Copyright 2002, Delmar, A division of Thomson Learning

  22. Risk Factors for Prostate Cancer • Age > 50 • Family history • African American • Diet high in fat, oil, sugar • High levels of serum testosterone Copyright 2002, Delmar, A division of Thomson Learning

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