JARVIS-CH 25: ANUS, RECTUM, & PROSTATE

JARVIS-CH 25: ANUS, RECTUM, & PROSTATE

1. ANAL CANAL

   • OUTLET OF THE GI TRACT. AUTONOMIC NERVES, NUMEROUS SOMATIC SENSORY NERVES ARE PRESENT AND MAKE AREAS SENSITIVE TO PAIN.
   • INTERNAL SPHINCTER
   • EXTERNAL SPHINCTER
     • PROVIDES VOLUNTARY CONTROL FOR THE EXPULSION OF FECES AND GAS

2. RECTUM

   • LONG DISTAL PORTION OF THE LARGE INTESTINE, EXTENDING FROM THE SIGMOID COLON TO THE ANAL CANAL. PERITONEUM COVERS ONLY THE UPPER TWO THRDS OF THE RECTUM.

3. MEN

   • PROSTATE GLAND
     • LIES IN FRONT OF THE ANTERIOR WALL OF THE RECTUM AND BEHIND THE SYMPHYSIS PUBIS. SECRETES ALKALINE FLUID THAT HELPS SPERM VIABILITY
     • TWO SEMINAL VESICLES PROJECT LIKE RABBIT EARS ABOUT THE PROSTATE. tHEY SECRETE A FLUID THAT IS RICJ IN FRUCTOSE, WHICH NOURISHES SPERM.

4. WOMEN

   • UTERINE CERVIX
     • LIES IN FRONT OF THE ANTERIOR RECTAL WALL AND MAY BE PALPATED THROUGH IT.

5. SUBJECTIVE DATA

   • SHOULD DISCUSS PT'S....
     • USUAL BOWEL ROUTINE
       • ANY CHANGES IN BOWEL HABITS
         • RECTAL BLEEDING OR BLOOD IN THE STOOL
           • USE OF MEDICATION
             • RECTAL CONDITIONS
               • FAMILY HISTORY
                 • SELF CARE BEHAVIORS
                   • SELF CARE BEHAVIORS SUCH AS HIGH-FIBER DIET AND COLORECTAL CANCER SCREENING

6. OBJECTIVE DATA

   • FIRST INSPECT PERINEAL AREA
     • OBSERVE ANUS AND PERIANAL REGION
       • PT SHOULD BE RELAXED.  THE ANAL OPENING SHOULD BE TIGHTLY CLOSED, AND NO LESIONS SHOULD BE PRESENT. INSPECT THE SACROCOCCYGEAL AREA, WHICH SHOULD APPEAR SMOOTH AND EVEN. ANY ABNORMALITY SHOULD BE DESCRIBED IN CLOCK FACE TERMS.
       • PALPATE THE ANUS AND RECTUM
         • BE SURE TO HAVE GLOVED AND LUBRICATED FINGER. -USING ONLY THE PADS OF THE INDEX FINGER, ASSESS THE SURFACE OF THE ENTIRE MUSCULAR RING. TO ASSESS MUSCLE TONE, HAVE THE PT TIGHTEN THE SPHINCTER AROUND THE FINGER. -USE BIDIGITAL PALPATATION WITH YOUR THUMB AGAINST THE PERIANAL TISSUE TO HIGHLIGHT SWELLING OR TENDERNESS AND ASSESS THE BULBOURETHRAL GLANDS. -INSERT YOUR FINGER FARTHER AND EXAMINE THE ENTIRE RECTAL WALL.
         • WOMEN
           • PALPATE CERVIX
             • PALPATE CERVIX THROUGH THE ANTERIOR RECTAL WALL
         • MALE
           • PALPATE PROSTATE GLAND
             • NOTE ITS: -SIZE -SHAPE -SURFACE -CONSISTENCY -MOBILITY -SENSITIVITY
         • ASSESS FECES ON FINGER AFTER WITHDRAWING FINGER FROM ANUS
           • INSPECT ANY FECES ON THE GLOVE, TEST ANY FECES FOR OCCULT BLOOD.
           • REMEMBER TO INCORPORATE HEALTH PROMOTION