Digital rectal examination.pptx @

digital rectal examination
*defination
*indication
*contraindication
* patient technique
*equipment needed
*procedure
*prostatic examination
*point to be noted

1. D igital r ectal e xamination MUHAMMAD RAFAY Sindh Medical College, JSMU

2. DRE Dre is the internal examination of the rectum by using your index finger.

3. Why we do dre ? Digital rectal examination (DRE) is an essential step in evaluation and serves to identify anorectal lesions and confirm stool color.

4. An  anoscopy  is an examination using a small, rigid, tubular instrument called an  anoscope  (also called an anal speculum). anoscopy

5. I ndications urinary symptoms in old man (to assess the size of the prostate) bleeding per rectum constipation chronic diarrhea anal pain, rectal pain tenesmus * or lower abdominal pain Tenesmus: a sensation of incomplete evacuation

6. c ontraindications Absolute: Imperforate Anus Immunocompromised patient Stricture Moderate to severe anal pain Prolapsed thrombosed internal hemorroids Relative: Severe rectal pain may preclude an awake anoscopy and require sedation Recent acute myocardial infarction Acute abdomen Unwilling patient Major rectal trauma Post-operative status (anal surgery)

7. Preparing the patient  Introduce yourself. The reason and nature of the technique of rectal examination should be explained to the patient.  informed consent can then be gained .  Reassure the patient the that examination may be uncomfortable, but it should not be painful. The clinical room must be appropriate for an intimate examination and a chaperone present for the duration Patient privacy should be maintained

8. PREPATION OF POSITION LEFT LATERAL POSITION Patient should be put in left lateral position. Legs and spine being flexed. Buttocks should be at the edge of the bed

9. SIM’S POSITION

10. GATHER EQUIPMENT GLOVES APRON LUBRICANT (PETROLEUM JELLY) PAPER TOWEL

11. INSPECTION OF THE ANUS wash your hand & don a pair of disposable gloves. gently separate the buttocks & inspect natal cleft and anal verge. look for fissure , rashes , fistula haemorrhoids , warts, abscess the position of an anal lesion described in relation to the face of a clock the anterior aspect of anus assigned to 12 o’clock

12. RECTAL EXAMINATION Lubricate (gloved) index finger. Place pulp of index finger on posterior anal verge so a small angle exists between the palmar surface of the finger and the natal cleft. Press gently on the anus and slip the tip of the index finger into the anal canal by increasing the angle of the finger. Avoid using force, wait for the sphincter to relax, if still difficult do not continue with the examination. Insert the index finger into the rectum as far as it will go, following the sacral curve  If there is believed to be a problem with the anal sphincter, ask the patient to squeeze the examining finger to assess anal tone

13. RECTAL EXAMINATION Examine the posterior and lateral walls of the rectum for palpable lumps or tears (rectal walls should be smooth ). Assess the presence or absence of faeces . Rotate wrist so that finger pulp faces anteriorly and examine the anterior rectal wall . In the male examine the prostate gland (see slide 10) may be palpated. In the female the cervix may be palpable . Rotate wrist, so that your examining finger is facing posteriorly again and then withdraw finger . On withdrawal check gloved finger for stool (normal colour , pale stool, malena etc ) and any blood or mucus Clean patient, dispose of gloves and wash hands

14. The prostate gland is examined during a male rectal examination A normal prostate measures approximately 3.5cm from side to side and protrudes 1cm into the rectum.  It can be felt through the anterior rectal wall and has a median sulcus separating the two lobes The prostate should not be tender to palpation but the patient may experience discomfort or an urge to urinate Palpation of the prostate gland aims to assess * size * presence of two equally sized lobe * Consistency (firm ) * Surface (smooth or nodular ) * Tenderness Prostate examination

15. Comment: Anus inspection Anus tone rectal wall prostate any abnormal mass palpated *remember to describe your findings as fully as possible: Size Position(relative to face of clock) shape of swelling Recording your findings

16. Thank You