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Digital Rectal Examination for Medical Student OSCE

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1. Introduction

   1. Introduce, identify, explain, consent, WASH HANDS!

   2. Explain procedure:

      1. “Because of the history you have presented with, the doctors would like me to perform an examination of your back passage, to check for any bleeding, lumps, … Is that alright?”

      2. Does the patient have any pain?

      3. Pt will go behind curtain, and remove clothing from the waist down. There is a blanket they can keep themselves covered with.

      4. There will be a chaperone present.

      5. To examine the back passage, I will need to insert my finger.

      6. It should not be painful, but may be uncomfortable; lubrication used

      7. When you are ready, please lie on your left side, curl up your knees and bring your back as close to the edge of the bed as you can

2. Wait for patient to be ready. Collect gloves, KY jelly and paper towel

3. Inspection:

   1. General hygiene

   2. Discolouration

   3. Blood, stools, mucus

   4. Skin tags, ulcers, fissures, polyps

   5. Prolapsed piles / external haemorrhoids

4. “I will now very slowly insert my finger. Please take a big breath in.” Insert with palm of hand facing towards head. Feel for:

   1. Anal sphincter tone

   2. Stools + describe. Ensure masses are not attached / grown from wall of the rectum

   3. Mucosa

   4. Cervix – note size and shape, feel for any ovarian masses

   5. Prostate gland

      1. Size – normal / enlarged

      2. Shape – regular (bilobed) / irregular

      3. Surface – smooth / uneven

      4. Consistency – firm / rubbery / hard

      5. Central Sulcus – present / absent

      6. Rectal mucosa – mobile / fixed

      7. Causes – check for other explanations, e.g. dislocated hip, weak abductor muscles, shortened femoral neck, pain in hip

5. Remove finger, with palm facing feet. Inspect glove for blood, mucus, or stool. Dry area with paper towel. Allow patient to dress.

6. Further investigations: Full abdominal examination, proctoscopy, rigid sigmoidoscopy, flexible rectal endoscopy

7. Differential Diagnosis

   1. Normal prostate

2-3 cm diameter, central sulcus, smooth, firm and rubbery. Mobile rectal mucosa

1.  

   1. Benign prostatic hypertrophy

Benign hyperplasia of prostatic cells ? generalised enlargement, mildly distorted shape. Enlarged, smooth, asymmetrical, but firm and rubbery as normal. Central sulcus = one of last features to disappear. Mobile rectal mucosa

1.  

   1. Prostate carcinoma

Hard, irregular, asymmetrical (these features can be unilateral, affecting just 1 lobe). Central sulcus often obliterated. Rectal mucosa may be tethered

 

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by: Admin
Total views: 0
Word Count: 706
Date: Fri, 22 Jan 2010 Time: 4:09 PM
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