tags:
- surgery/PEPer Rectal Examination
📌 Position:
- Lateral recumbent or dorsal lithotomy position
What findings you would expect:
📌 Inspection:
- skin excoriation
- skin tags
- anal fissure
- external haemorrhoid
- external bleeding
- fistula
📌 Prostate:
- Asses for size, symmetry and texture of gland
- A normal prostate is walnut sized with a palpable midline sulcus
- It should be symmetrical with firm consistency. Non- tender.
- Differentiate btwn BPH (smooth, symmetrically enlarged, medican sulcus intact, firm consistency) vs Prostate Ca (hard irregular nodular enlargement, or asymmetric area of induration)
📌 Anal canal:
- Rotate 360 degree & asses the rectum
- If any mass, note the size, location (clock position), & surface (smooth, irregular)
- Look for any impacted stool
- Asses anal tone by asking patient to ‘kemut’. Reduced anal tone causes includes spinal cord trauma, cauda equina syndrome or prev rectal surgery or childbirth.
📌 On finger after withdrawal:
- Brownish stool (normal)
- Melena (upper GI bleed)
- Fresh blood (lower GI bleed)
- Excess mucus (in IBD - UC)
p/s: don’t forget to thank patient!
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