👆Per Rectal Examination

--- tags: year 3,clinical,surgery --- # 👆Per Rectal Examination <img src="https://codimd.s3.shivering-isles.com/demo/uploads/6968b8ec-5d4b-4274-97e6-73306327cbad.jpg" style="width:600px;"> ### 📌 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! ### Youtube {%youtube tKF8GFc4z2w %}