Rectal Examination Station

introduction

Introduce yourself with your name and role, and confirm the patient's name and date of birth. Briefly explain the procedure and the degree of exposure required. The patient must be undressed from the waist down, including underwear.

Obtain consent and proceed with handwashing. A chaperone is absolutely necessary for this exam.

Lay the bed flat, then put on a pair of non-sterile gloves and an apron. Instruct the patient to lie down on the bed.left lateral positionwith knees bent to chest. Offer the patient a blanket to maintain her dignity. Ask if they are in onepainand they areconvenient.

Left side position.

Many patients are uncomfortable with the process of a digital rectal exam, so it is important to have good communication skills to feel comfortable. Be clear and to the point with your explanations; Do not hesitate. It is important that you reassure the patient that this is a normal exam.

A good way to explain the procedure is as follows:
"During this exam, I will use my gloved hand to insert a lubricated finger into your anus. This allows me to check for prostatic and surrounding abnormalities. This can be a bit uncomfortable. If you would like to pause at any point for a moment, please let me know." ”.

equipment

Before beginning the exam, prepare the following equipment in a plastic tray:

(Video) Rectal Examination (PR) - OSCE Guide

Non-sterile gloves.
disposable apron.
Tissue.
lubricant

Inspection

warn patientlook around the area.

Spread the buttocks apart with your non-dominant hand and examine the anus and birth cleft. Check the following signs:

external hemorrhoids(see “Hemorrhoids” below).
skin tags(extra fleshy skin that hangs from the anus): They are usuallyharmless growthsthat can be confusedwartsor hemorrhoids. They can be caused by inflammation, injury, or residual skin left after hemorrhoid removal.
abrasions(Scratches): They are the result ofpicor analwhich may be due to infection, haemorrhoids, bowel incontinence, long-term constipation/diarrhoea, or repeated topical use of glycerol trinitrate cream (used to treat anal fissures).
anal fissures(Skin Tear): These occur inlong term chargehard stools such as chronic constipation or inflammatory bowel disease.
anal fistulas(small opening often with discharge): These may also be present in inflammatory bowel diseases (especially Crohn's disease). Other causes include non-healing abscesses and diverticulitis.

Ask the patient to cough and check if it is presentinternal hemorrhoidsoProlapso rectal.

Hemorrhoids are torn and enlarged anal vascular pads that tend to burst. There are three anal cushions in15, 19 y 23 h(12 o'clock is closest to the genital area). They are classified according to their location.InternalHemorrhoids are located above the dentate line and have visceral innervation. usually they arewithout pain(unless it happened).ExternalHemorrhoids are located below the dentate line and are somatically innervated. you can be prettypainful.

Internal hemorrhoids can be classified as follows:

First grade:No prolapse, just dilated blood vessels.
Second grade:They prolapse on exertion but shrink spontaneously.
Third degree:Prolapse on loading and manual reduction is required.
Fourth grade:permanent prolapse and cannot be reduced.

This is a group of two diseases that cause chronic inflammation of the gastrointestinal tract:

Ulcerative colitis:A relapsing and remitting (patient is relatively well between attacks) condition of the mucosa and submucosa of the colon. It starts in the rectum andpropagates proximally and continuously. patient experiencebloody diarrheaconboogerYTenesmo.

Crohn's disease:A chronic disease that hasskip injuries(unbroken irregular regions) that can affect any part of the gastrointestinal tract. There isnon-caseifying granulomaswhich aretransmural(through the entire organ wall) in nature; As a result, Crohn's disease can lead to fistulas and fissures. Patients also sufferUlcers, stricturesYabscesses. These patients probably haveweightlossand it will be consistently awkward in presentation.

(Video) Rectal Exam

analyze your

Lubricate the index finger of your dominant hand with a little lubricantGooand place the other hand on the patient's hip. Place a finger in the anal opening and feel gently.hardening(a hardened/fibrous section under the skin) associated with inflammatory conditions such as Crohn's disease.

Ask the patient to take a deep breath and then relax.resolverthe sphincter

Warn the patient that they may feel some cold jelly, and then insert your index finger into the anal canal. Ask the patient to press your finger for the evaluationAnal tone. Decreased anal toneit may be due to prolonged diarrhea, diabetes, spinal trauma, or simply old age.

Palpation

canal anal

giro 360°around the entire rectum. The front walls can be more easily examined by turning the body and wrist. look for anybulk; this can be hemorrhoids, polyps or a tumor. feel forpalpable stoolYsensitivity. when the patient is thereStrong painConsider an anal fissure, abscess, or ulcer during the exam.

Record the location using a clock face and the texture of anything you find. for example, 1 cm irregular mass at 9 o'clock.

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After advancing the finger, it may be worth pausing for a few seconds to allow the patient to acclimate and relax.

Look for signs of the patient's face during palpationanguish/pain.

Prostate

In men, identify theProstate, Escentral grooveand assess the size. A normal prostate isseedsYwalnut size. checksymmetry, the presence of anynodulesand allsensitivity. Abnormalities in these features may indicate pathology:

enlargedwith adeep groove:Benign prostatic hyperplasia.
enlargedYvery tender:Prostatitis.
enlargedwith athick knot:Unilateral Cancer.
heart, asymmetricalYirregularwith anon-palpable groove:Prostate cancer.

Benign prostatic hyperplasia:A common condition defined as slowly progressive nodular hyperplasia of the periurethral area. It is a common cause of lower urinary tract symptoms in men and can often be treated with a combination of an α-blocker (tamsulosin) and a 5α-reductase inhibitor (finasteride).

Prostatitis: swellingYinflammationof the prostate characterized bypainaround the perineum and penis, more common in young men. It can be divided into acute and chronic:

Inacute prostatitis, patients also experience urinary symptoms includingretentionand a thick urethradescargar. Treatment with analgesia and immediate antibiotics.
Inchronic inflammation of the prostate, patients suffer from dysuria, pelvic pain and erectile dysfunction. These patients should receive analgesics and an α-blocker (tamsulosin) and be referred to a urologist.

Prostate cancer:This is the second leading cause of cancer death in men and is also often asymptomatic until the late stages. Presents with urinary symptoms such as dysuria and hesitancy to spread metastases, which the patient also experiencesbone-ache, umbilical cord compression and systemic symptoms(fever, lethargy, weight loss).

termination

gloved finger inspection

Remove the gloved finger and examine it.sangreobooger, suggesting ulcerative colitis. Thank the patient, remove the gloves, and dispose of them in a clinical trash can. wash your hands

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Clean the jelly from the anus and offer the patient additional tissues for his own comfort. Give the patient privacy to dress.

check

Offer to take onefocused story, aabdominal examinationand the corresponding tests according to the pathology.

Gastrointestinal discomfort:

stool culture.
Blood tests (complete blood count and fecal occult blood test).
sigmoidoscopia.

Discomfort in the urine:

Orinamessstab.
Blood tests (complete blood count and prostate specific antigen).
Transrectal Ultrasound Biopsy (TRUS).

PSA is produced by the epithelial cells of the prostate and is used in screening, although it is a notoriously poor marker. The test has ahigh specificity, stilllow sensitivityThis means that up to 1 in 7 men with prostate cancer may get a false negative result.

Other disorders that increase PSA include benign prostatic hyperplasia and prostatitis. It can also be increased after strenuous exercise or ejaculation.

Tale

The following are some of the key elements to consider when taking a focused DRE history based on the complaint in question.

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