MAL.Z PRESENTS DIGITAL RECTAL EXAMINATION.pptx

Presentation about Digital Rectal Examination to help you with your practical skills.

1. MAL.Z Presents DIGITAL RECTAL EXAMINATION.

2. DIGITAL RECTAL EXAMINATION Aim . To understand the reason for performing a DRE . To know the issues around consent and chaperones . To be knowledgeable in the procedure of DRE Indications . Suspected appendicitis . Lower GI bleeding characterized by bleeding from below the ligament of Trietz . Change in bowel habits . A part of the abdominal examination . Genitourinary problems . Pelvic/Spinal trauma

3. Steps Wash hands and introduce yourself to the pt. (Name and Title) Confirm the pt. by checking their names and DOB Explain the procedure (DRE) Explain to the pt. that for intimate procedures, it’s normal to have a second person present Get their verbal consent and ensure the pts. privacy and ask them to undress from the waist downwards; to lay on the bed and cover themselves up If the pt. is under general anaesthesia; . Check the name band against the pts. notes . Check consent form signed and dated or documentation done in order to perform a DRE under a GA.

4. Equipments . Non-sterile gloves . Lubrication, it could be; * Water-based gel * Silicone oil though mostly used on mannequins . Gauze/tissue

5. Preparation . Wash hands and put on gloves Ask pt to lie on their left side on the edge of the bed with their knees brought up to the chest   Inspection Make sure there’s a good light source Inspect around the perianal area looking for; (Haemorrhoids, Fistulae, Abscesses, Lesions or Warts and general cleanness of the area) (Explain to the pt. what you’re looking for) Ask the pt. to strain/bend down in order to look for signs of a prolapse.

6. Palpation First, start by lubricating the index finger Then place the index finger down the natal cleft on to the anal margin (This area is the groove btwn the buttocks that extends from just below the sacrum to the perineum above the anus. Ask pt. to relax and take a deep breath As the sphincter relaxes, advance the finger into the anal canal Then, check the sphincter tone by asking the pt. to squeeze the finger with their anal muscles After, rotate the finger through 360 sweep ( in order to feel for thickening and masses) Warn the pt. and insert the finger deeper into the rectum And rotate the finger through 360 sweep again and feel for thickness, masses and feaces .

7. Prostate Examination The prostate is felt through the anterior rectal wall. This is done by identifying 2 lobes either side which should normally be smooth and rubbery and identify the central sulcus in order to check for masses. Finally … Warn the pt. then gently withdraw the finger Then inspect the glove for blood, feaces and mucus Then tell the pt. that the examination is over and offer to wipe the natal cleft for them Remove the gloves and wash hands Explain to the pt if any further examinations need to be performed.