Chapter 25 Anus, Rectum, And Prostate

The anal canal in the outlet of the gastrointestinal tract, and it is about 3.8 centimeters long in the adult. The rectal interior has three semilunar transverse folds called the Valves of Houston. Prostate In the male, the prostate gland lies in front of the anterior wall of the rectum and 2 cm behind the symphysis pubis. It surrounds the bladder neck and the urethra and has 1 to 3! ducts that open into the urethra. The prostate secretes a thin, milky, alkaline fluid that helps sperm viability. It is a bilobed structure with a round or heart"shaped. The two seminal vesicles pro#ect like rabbit years about the prostate the seminal vesicles secrete a fluid that is rich in fructose, which nourishes the sperm and contains prostaglandins. The two bulbourethral $%owper& glands are each the si'e of a pea and are located inferior to the prostate on either side of the urethra. Culture And Genetics (rostate cancer $(%& is more common in )orth *merica and )orthwestern +urope and is less common in %entral and ,outh *merica, *frica, and *sia. The incidence of (% is higher for *frican"*merican men than for men of other racial groups. -hat are the risk factors. /amily history is positively associated0 men with one first"degree relative $father or brother& are 2 to 3 times more likely to develop (%. +nvironmental factors may account for more risk than genetics because migration studies show men of *sian and *frican heritage living in the 1nited ,tates have a higher risk for (% than their counterparts living in *sia and *frica. 2en at average risk or (% should receive information at ! years0 at higher risk $*frican"*mericans and positive family history& at 3 years0 and at very high risk $multiple family members with (%& at 3! years. ,creening includes the blood test for prostate specific antigen $(,*& and a physical e4amination $i.e. a digital rectal e4am 567+8&. Colorectal cancer has a racial variation as well. The incidence rates are almost 2!9 higher for *frican *merican woman and men than for whites, and the mortality rates are almost !9 higher for *frican"*mericans than for whites. :ecause colorectal cancer can largely be prevented by removal of adenomatous polyps, guidelines for average risk of adults start at age ! years and include health teaching about options for screening. ;ptions include a colonoscopy every 1! years with bowel preparation and conscious sedation, and an annual guaiac"based fecal occult blood test or fecal immunochemical test. o!el Assessment *sses usual bowel routine. %onstipation is less than or e<ual to three stools per week and is a common concern among aging adults = Dyschezia is pain due to a local condition (hemorrhoid, fissure) or constipation. Steatorrhea is excessive fat in the stool as in malabsorption of fat. >igh fiber foods of the soluble type $beans, prunes, barley, carrots, broccoli, cabbage& lower cholesterol, whereas insoluble fiber foods $cereals, wheat germ& reduced risk for colon cancer. *lso, fiber foods fight obesity, stabili'e blood sugar, and help some ?.I. disorders. "arl# $etection %or Cancer@ DRE is performed annually after age !. " Fecal ccult !lood "est is performed annually after age !. " Si#moidoscopy, every five years, or $olonoscopy, every 1! years, after age !. " %sa !lood "est annually for men over ! e4cept black men who begin at age 3 . &nspect 'he Perianal Area ,pread the buttocks wide apart and observe the perianal region. The anus normally looks moist and hairless, with coarse, folded skin that is more pigmented than the perianal skin. The anal opening is tightly closed. )o lesions are present %la((# )*in )ac Hemorrhoid + )hin# lue )*in )ac 'hrom(osed Hemorrhoid Prostate Gland , -ormal Range .f %indings )ote these characteristics@ )i/e " 2. cm long by 3 cm wide0 should not protrude more than 1 cm into the rectum. )hape , heart,shaped, !ith palpa(le central group )urface = smooth, Consistenc# = elastic, rubbery 0o(ilit# = slightly movable )ensitivit# = nontender to palpation

"1amination .f )tool :right red blood on stool surface indicates rectal bleeding. :right red blood mi4ed with feces indicates possible colonic bleeding " lac* tarr# stool !ith distinct mal,odor indicates upper G.&. (leeding !ith (lood partiall# digested. 20ust lose more than 53 m4 from upper G.&. tract to (e considered melena.5 lac* stools also occurs !ith ingesting iron or (ismuth preparations. Gra#, 'an )tool a(sent (ile pigment 2e.g., o(structive 6aundice5. enign Prostatic H#pertroph# 2 PH5 ,@ 1rinary fre<uency, urgency, hesitancy, straining to urinate, weak stream, intermittent stream, sensation of incomplete emptying, nocturia. ;@ * symmetric nontender enlargement, commonly occurs in males beginning in the middle years. The prostate surface feels smooth, rubbery, or firm $like the consistency of the nose&, with the median sulcus obliterated.