A patient asks you… what is this? Verghese Welcome New Stanford Interns!!!! Teaching the teachers… Our methods. What is the Marcus Gunn Pupil? Abdominal Wall Pain Do you know what this is???
Measuring Central Venous Pressure with the Arm. Rectal Exam The rectal exam is important to make sure causes of rectal bleeding such as hemorrhoids are not missed. Introduction to the Rectal Exam. Rectal Exam Technique. Positions There are multiple positions that you can ask your patient to stand or lie.
Palpate Rectum and Prostate Use a small amount of lubricant on the index finger and ask the patient to take a deep breath and insert the finger facing down 6 o'clock position Appreciate the external sphincter tone then ask the patient to bear down and feel for tightening of the sphincter Palpate the prostate gland.
Note the following: Approximate size of the prostate gland normally about the size of a walnut, cm but wider at the top Feel for tenderness prostatitis Feel for nodules or masses Palpate the rectal wall starting from the 6 o'clock position clockwise to the 12 o'clock position.
Then return to the 6 o'clock position and palpate the other half of the rectal wall feeling for masses, nodules and tenderness. The user starts with the smallest size, moving through the larger instruments as he becomes comfortable. An individual uses a rectal dilator for two major reasons.
The first is that he has a medical condition or psychological hindrance that causes the anus to remain too tight when the person tries to have a bowel movement. This can lead to abdominal discomfort, pain while defecating and hemorrhoids from straining. The second reason is that a person wishes to train the anus to relax during anal intercourse. Regardless of which reason a person needs a rectal dilator, cultural influences can cause people to feel somewhat embarrassed about using one — depending on their background, a person may regard inserting anything into the anus as taboo or "dirty.
Individuals who need one these tools thus should not be afraid to seek physician assistance in obtaining a set. In fact, using the dilators under medical supervision is ideal, as the physician can monitor the patient's relaxation progress and underlying conditions. Wanda Marie Thibodeaux. Even still, anesthesia is not usually necessary for this procedure. Some of the longest rigid scopes are called rectoscopes. These can run 8 or more inches in length, and they provide visualization of more of the rectum than the smaller rigid scopes do.
For example, SapiMed rectoscopes, including the Multi-purpose Rectoscope , have lengths between 5 and 9 inches. SapiMed also offers rectoscopes with one-time use insufflators. Rectoscopes are useful for performing procedures in which the doctor needs access to farther ends of the rectum but does not require access to the colon:.
Because this instrument can extend far into the rectum, cleansing the bowels with an enema is an important pre-exam step. Depending on the procedures to be performed during the scoping, anesthesia may be required. Typically, when doctors need to examine past the rectum and into the colon, flexible scopes are used. These scopes are comprised of long, flexible tubes that can be guided through the colon.
Each scope is equipped with a light and a camera for observing the appearance of the tissue. A sigmoidoscope is used to examine the rectum and the left side of the colon. This portion of the colon is also known as the lower colon or the sigmoid colon. Sigmoidoscopes can actually be rigid or flexible.
However, because flexible sigmoidoscopes extend farther into the sigmoid colon, they are the preferred and more common instrument. For this exam, bowel preparation is required. The patient may not require sedation. Sigmoidoscopy is a less intense procedure than colonoscopy, but it does not view the entire colon.
Therefore, when this procedure is used for cancer screening, it should be done in conjunction with a fecal occult blood test. This type of flexible scope is longer than a sigmoidoscope, so it can examine the full length of the colon.
Therefore, a colonoscope may detect cancer or other problems that are hiding in the far end of the colon. Furthermore, small polyps can be removed during a colonoscopy procedure. Doctors often use rectal instruments to perform surgery in that region. Minor colorectal surgery procedures can include hemorrhoidectomy for treating hemorrhoids and internal sphincterotomy for treating anal fissures. Doctors can also use surgical tools to obtain tissue samples for biopsy. Colorectal specialists often need specialized proctology instruments for addressing particular concerns.
Anal dilation stretches the opening of the anus. These plastic or metal cylinders come in graduated sizes, and patients progress from a smaller size to a larger one as their anal opening becomes more stretched.
These instruments are often rounded on one end to ease insertion. SapiMed Dilatan dilators, for example, have conical ends that widen into cylinders. These dilators can be used hot or cold to enhance the therapy.
Dilators can be used to stretch the anus after surgery to prevent the formation of scar tissue and the narrowing of the opening. They can also be useful in the treatment of anal fissures or hemorrhoids.
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