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

Copyright 2002, Delmar, A division of Thomson Learning 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

Copyright 2002, Delmar, A division of Thomson Learning 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

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

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

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

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

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

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

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

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

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

Copyright 2002, Delmar, A division of Thomson Learning 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

Copyright 2002, Delmar, A division of Thomson Learning 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

Copyright 2002, Delmar, A division of Thomson Learning 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

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

Copyright 2002, Delmar, A division of Thomson Learning 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

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

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

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

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

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