Jarvis Chapter 26 - Anus, Rectum, and Prostate

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. Diffuse hardness

Define the condition benign prostatic hypertrophy, list the usual symptoms that the man experiences with this condition, and describe the physical characteristics.

Benign prostatic hypertrophy is a symmetric nontender enlargement of the prostate gland that commonly occurs in males beginning in the middle-age years. The male experiences urinary frequency, urgency, hesitancy, straining to urinate, weak stream, intermittent stream, nocturia, and a sensation of incomplete bladder emptying. Upon examination, the prostate surface feels smooth, rubbery, or firm (like the consistency of the tip of the nose), and the median sulcus is obliterated.

Which symptoms suggest benign prostatic hypertrophy?

Difficulty initiating urination and weak stream

State the method of promoting anal sphincter relaxation to aid palpation of the anus and rectum.

Don a glove and apply lubricating jelly to the index finger. Be sure to instruct the patient that palpation is not painful but may cause a feeling of needing to move the bowels. Place the pad of your index finger gently against the anal verge; the sphincter will tighten, 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. Never approach the anus at right angles with an extended finger; such a jabbing motion does not promote anal relaxation and is painful.

State the length of the anal canal and the rectum in the adult, and describe the location of these structures in the lower abdomen.

In the adult, the anal canal is about 3.8 cm long; the rectum is 12 cm long. The rectum is the distal portion of the large intestine; the anal canal is the outlet of the GI tract. The anal canal slants forward toward the umbilicus and forms a distinct right angle with the rectum, which rests back in the hollow of the sacrum.

Which is a structure that secretes a thin, milky alkaline fluid to enhance the viability of sperm?

Prostate gland

Describe the size, shape, and location of the male prostate gland.

The prostate gland measures 2.5 cm long and 4 cm in diameter, and it is a round or heart-shaped structure. It has two lateral lobes that are separated by a shallow groove called the median sulcus. It lies in front of the anterior wall of the rectum, 2 cm behind the symphysis pubis, and surrounds the bladder neck and the urethra.

A patients states that 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 symptoms are consistent with internal hemorrhoids.

Human Papillomavirus (HPV)

a double-stranded DNA virus that enters the nuclei of the squamous and basal cells in oral, nasal, genital, and anal regions; transmitted through vaginal, anal, and oral intercourse.

Foods that may be beneficial to reduce the risk for colon cancer include: a. Foods high in fiber b. Foods low in fat c. Foods high in protein d. Foods high in carbohydrates

a. Foods high in fiber

A patient states that he has frothy, foul-smelling stools that float on the surface of the water in the toilet bowl. What type of stool is this patient describing? a. Steatorrhea b. Melena c. Dyschezia d. A parasitic infection

a. Steatorrhea

Which population has the highest incidence of benign prostatic hypertrophy (BPH)? a. European Americans b. African Americans c. Hispanics d. Asians

b. African Americans

Which of these is the correct technique to assess the patency of the anal sphincter? a. Inspect the anus and ask the patient to strain b. Palpate the anus with a gloved finger to elicit sphincter control c. Percuss above the anal canal for dull resonance d. There are no sensory nerves in the anal canal or rectum

b. Palpate the anus with a gloved finger to elicit sphincter control

Melena

black, tarry stools; feces containing digested blood

Normal stool is described as:

brown in color and soft in consistency

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

c. 3.8-cm-long outlet of the gastrointestinal tract.

Which is true regarding the bulbourethral gland? a. It can be palpated during an examination of a female patient. b. It can be palpated during an examination of both male and female patients. c. It can be palpated during an examination of male patient. d. It cannot be assessed with a rectal examination.

c. It can be palpated during an examination of male patient.

Constipation

decrease in stool frequency, with difficult passing of very hard, dry stools

Steatorrhea

excessive fat in the stool, as in gastrointestinal malabsorption of fat

Hemorrhoid

flabby papules of the skin or mucous membrane in the anal region caused by a varicose vein of the hemorrhoidal plexus

Pruritus

itching or burning sensation in the skin

Anal Fissure

painful longitudinal tear in tissue (e.g., in the superficial mucosa at the anal margin)

The gastrocolic reflex is:

peristaltic wave

Valves of Houston

set of three semilunar transverse folds that cross half the circumference of the rectal lumen

List a few examples of high-fiber foods of the soluble type and of the insoluble type. What advantages do these foods have for the body?

• High-fiber foods of the soluble type: beans, prunes, barley, carrots, broccoli, cabbage. These have been shown to lower cholesterol levels. • High-fiber foods of the insoluble type: cereals, wheat germ. These have been shown to reduce the risk for colon cancer. • Fiber foods also help fight obesity, stabilize blood glucose levels, and may help certain gastrointestinal disorders.

List screening measures that are recommended for early detection of colorectal cancer and of prostate cancer.

• Screening measures for colon/rectal cancer: fecal occult blood test annually after age 40; colonoscopy every 10 years after age 50 for those at average risk. • Screening measures for prostate cancer: offer the prostate-specific antigen (PSA) blood test annually for men older than age 50, except black men beginning at age 45.

Describe the normal physical characteristics of the prostate gland that would be assessed by palpation: Size Shape Surface Consistency Mobility Sensitivity

• 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.