---
# System prepended metadata

title: "\U0001F446Per Rectal Examination"
tags: [clinical, year 3, surgery]

---

---
tags: year 3,clinical,surgery
---

# 👆Per Rectal Examination

<p style="text-align:center;">
     <img src="https://codimd.s3.shivering-isles.com/demo/uploads/6968b8ec-5d4b-4274-97e6-73306327cbad.jpg" style="width:600px;">
</p>

### 📌 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)


<i style="font-size:15px; position:relative; left:15px; top:5px;">p/s: don’t forget to thank patient!</i>
<br>

### Youtube
{%youtube tKF8GFc4z2w %}