Rectal Examination - OSCE PDF

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Rectal Examination Introduction - Wash/Gel hands - Put on non-sterile gloves and apron - Introduce yourself - Confirm patients name and DOB and check the ID wrist - GAIN CONSENT before continuing - Explain what you want to do o “examination may feel uncomfortable but shouldn’t be too painful” - GAIN INFORMED CONSENT - Consider an appropriate chaperone o Has to be present - Adequate exposure of the patient whilst maintaining dignity o Bare between hips and knees o Allow time and privacy for the patient o Give them a blanket to cover up with - Position the patient appropriately o Knees pulled up towards chin o Buttocks at the edge of examination couch - Prepare tray o Tissue x2  One on the tray  One to clean the patient after o Lubrication o Alcohol wipe x2  Clean tray before  Clean tray after Indications - Rectal bleeding - Perianal itching - Rectal/anal pain - Abdominal pain - Passing blood/mucus - Presence of lumps - Urinary symptoms - Neurological symptoms - Prostate cancer suspected Inspection - “First I’m going to have a look down belo” - Part buttocks to expose anus - Inspect for o Skin integrity o Rash

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 Possible STI Skin tags Pilonidal sinus  Area above crease of buttocks where hole can form Fissures/fistula  Crohn’s – perianal fistula Swellings  Haemorrhoids  Polyps  Tumour  Rectal prolapse

Palpation - Lubricate right index finger - Insert finger into rectum o “I’m just about to start the examination” o “Relax” - Hand on spine and enter the anal canal - Is rectum clean or filled with faeces? o Mobile, putty substance o Constipation - hard - Assess anal tone o “can you try to squeeze my finger” o Poor tone – neurological pathology - Examine rectal walls o Anticlockwise and clockwise  Posterior wall checked first – following curvature of spine  Anterior checked after  Return to posterior then exit anal canal o Examine all of the walls  360 degrees checked  Any lumps/tears? - Examine prostate – normally 3.5cm with 1cm protrusion o Normal lobes – equally sized o Consistency  Firm o Surface  Smooth  Nodular o Tenderness - Exit anal canal o Posterior angle – same as enter - Check finger for o Blood o Faeces o Mucus - Clean lubricant from patient using tissue and cover back up

Recording findings - Patients name - Date of examination - Time - Your signature - Printed name - Anal inspection o Any skin tags, fistula etc - Anal tone o Normal o Decreased - Rectal wall o Smooth o No tears/fistula - Contents of rectum o No stool? - Prostate o Normal lobes – equally sized o Consistency  Firm o Surface  Smooth  Nodular o Tenderness - Cervix o If female - Hand o Bleeding o Mucus o Faeces o Malaena...