Rectal prolapse physical examination: Difference between revisions

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==Overview==
==Overview==


Patients with rectal prolapse usually have rectal mass or bulge in physical examination.
Patients with rectal prolapse usually have rectal mass, skin [[excoriation]] or [[irritation]] of anus in physical examination.


==Physical Examination==
==Physical Examination==
Rectal prolapse can be diagnosed in outpatient clinics by history taking and inspection of the protruded rectum.<ref name="pmid21431090">{{cite journal |vauthors=Shin EJ |title=Surgical treatment of rectal prolapse |journal=J Korean Soc Coloproctol |volume=27 |issue=1 |pages=5–12 |year=2011 |pmid=21431090 |pmc=3053504 |doi=10.3393/jksc.2011.27.1.5 |url=}}</ref> Physical examination of patients with rectal prolapse is usually remarkable for a large rectal mass or bulge that may or may not spontaneously reduce at the completion of a bowel movement or straining.<ref name="pmid24352613">{{cite journal |vauthors=Bordeianou L, Hicks CW, Kaiser AM, Alavi K, Sudan R, Wise PE |title=Rectal prolapse: an overview of clinical features, diagnosis, and patient-specific management strategies |journal=J. Gastrointest. Surg. |volume=18 |issue=5 |pages=1059–69 |year=2014 |pmid=24352613 |doi=10.1007/s11605-013-2427-7 |url=}}</ref>
Rectal prolapse can be diagnosed in outpatient clinics by history taking and inspection of the protruded rectum.<ref name="pmid21431090">{{cite journal |vauthors=Shin EJ |title=Surgical treatment of rectal prolapse |journal=J Korean Soc Coloproctol |volume=27 |issue=1 |pages=5–12 |year=2011 |pmid=21431090 |pmc=3053504 |doi=10.3393/jksc.2011.27.1.5 |url=}}</ref>
Anal inspection may reveal normal anal area, skin excoriation or irritation and the patulous anus and prolapsed rectum can become visible in a sitting position.<ref name="pmid29050194">{{cite journal |vauthors=Patcharatrakul T, Rao SSC |title=Update on the Pathophysiology and Management of Anorectal Disorders |journal=Gut Liver |volume= |issue= |pages= |year=2017 |pmid=29050194 |doi=10.5009/gnl17172 |url=}}</ref>


* Physical examination of patients with [disease name] is usually normal.
=== Appearance of the Patient: ===
OR
* Patients with rectal prolapse usually appear good
* Physical examination of patients with [disease name] is usually remarkable for:[finding 1], [finding 2], and [finding 3].
* The presence of [finding(s)] on physical examination is diagnostic of [disease name].
* The presence of [finding(s)] on physical examination is highly suggestive of [disease name].


=== Appearance of the Patient[edit | edit source] ===
=== Vital Signs: ===
* Patients with [disease name] usually appear [general appearance].
* Normal vital signs


=== Vital Signs[edit | edit source] ===
=== Skin: ===
* High-grade / low-grade fever
* Skin examination: Normal
* [[Hypothermia]] / hyperthermia may be present
=== HEENT: ===
* [[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
* HEENT examination: Normal
* [[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
=== Lungs: ===
* Tachypnea / bradypnea
* Pulmonary examination: Normal
* Kussmal respirations may be present in _____ (advanced disease state)
=== Heart: ===
* Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
* Cardiovascular examination: Normal
* High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]
=== Abdomen: ===
* Abdominal examination: Normal


=== Skin[edit | edit source] ===
=== '''Pelvic:''' ===
* Skin examination of patients with [disease name] is usually normal.
The following findings may be found on pelvic examination of a patient with rectal prolapse:<ref name="pmid29050194">{{cite journal |vauthors=Patcharatrakul T, Rao SSC |title=Update on the Pathophysiology and Management of Anorectal Disorders |journal=Gut Liver |volume= |issue= |pages= |year=2017 |pmid=29050194 |doi=10.5009/gnl17172 |url=}}</ref><ref name="pmid24352613">{{cite journal |vauthors=Bordeianou L, Hicks CW, Kaiser AM, Alavi K, Sudan R, Wise PE |title=Rectal prolapse: an overview of clinical features, diagnosis, and patient-specific management strategies |journal=J. Gastrointest. Surg. |volume=18 |issue=5 |pages=1059–69 |year=2014 |pmid=24352613 |doi=10.1007/s11605-013-2427-7 |url=}}</ref><ref name="pmid22379404">{{cite journal |vauthors=Goldstein SD, Maxwell PJ |title=Rectal prolapse |journal=Clin Colon Rectal Surg |volume=24 |issue=1 |pages=39–45 |year=2011 |pmid=22379404 |pmc=3140332 |doi=10.1055/s-0031-1272822 |url=}}</ref>
OR
* Large rectal mass or bulge (generally not tender to palpation) that may or may not spontaneously reduce at the completion of a bowel movement or straining
* [[Cyanosis]]
* Skin excoriation or [[irritation]] of [[anus]]
* [[Jaundice]]
* Patulous [[anus]]
* [[Pallor]]
* Bruises
 
=== HEENT[edit | edit source] ===
* HEENT examination of patients with [disease name] is usually normal.
OR
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]
* Extra-ocular movements may be abnormal
* Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
* Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
* [[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
* [[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
* Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae
 
=== Neck[edit | edit source] ===
* Neck examination of patients with [disease name] is usually normal.
OR
* [[Jugular venous distension]]
* [[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
* [[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
* [[Thyromegaly]] / thyroid nodules
* [[Hepatojugular reflux]]
 
=== Lungs[edit | edit source] ===
* Pulmonary examination of patients with [disease name] is usually normal.
OR
* Asymmetric chest expansion / Decreased chest expansion
* Lungs are hypo/hyperresonant
* Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
* Rhonchi
* Vesicular breath sounds / Distant breath sounds
* Expiratory/inspiratory wheezing with normal / delayed expiratory phase
* [[Wheezing]] may be present
* [[Egophony]] present/absent
* [[Bronchophony]] present/absent
* Normal/reduced [[tactile fremitus]]
 
=== Heart[edit | edit source] ===
* Cardiovascular examination of patients with [disease name] is usually normal.
OR
* Chest tenderness upon palpation
* PMI within 2 cm of the sternum (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
* [[Heave]] / [[thrill]]
* [[Friction rub]]
* [[Heart sounds#First heart tone S1.2C the .22lub.22.28components M1 and T1.29|S1]]
* [[Heart sounds#Second heart tone S2 the .22dub.22.28components A2 and P2.29|S2]]
* [[Heart sounds#Third heart sound S3|S3]]
* [[Heart sounds#Fourth heart sound S4|S4]]
* [[Heart sounds#Summation Gallop|Gallops]]
* A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope
 
=== Abdomen[edit | edit source] ===
Abdominal examination of patients with [disease name] is usually normal.
 
OR
* [[Abdominal distention]]
* [[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
* [[Rebound tenderness]] (positive Blumberg sign)
* A palpable abdominal mass in the right/left upper/lower abdominal quadrant
* Guarding may be present
* [[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
* Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test
 
=== Back[edit | edit source] ===
* Back examination of patients with [disease name] is usually normal.
OR
* Point tenderness over __ vertebrae (e.g. L3-L4)
* Sacral edema
* Costovertebral angle tenderness bilaterally/unilaterally
* Buffalo hump
 
=== Genitourinary[edit | edit source] ===
* Genitourinary examination of patients with [disease name] is usually normal.
OR
* A pelvic/adnexal mass may be palpated
* Inflamed mucosa
* Clear/(color), foul-smelling/odorless penile/vaginal discharge
 
=== Neuromuscular[edit | edit source] ===
* Neuromuscular examination of patients with [disease name] is usually normal.
OR
* Patient is usually oriented to persons, place, and time
* Altered mental status
* Glasgow coma scale is ___ / 15
* Clonus may be present
* Hyperreflexia / hyporeflexia / areflexia
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
* Unilateral/bilateral upper/lower extremity weakness
* Unilateral/bilateral sensory loss in the upper/lower extremity
* Positive straight leg raise test
* Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
* Positive/negative Trendelenburg sign
* Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
* Normal finger-to-nose test / Dysmetria
* Absent/present dysdiadochokinesia (palm tapping test)
 
=== Extremities[edit | edit source] ===
* Extremities examination of patients with [disease name] is usually normal.
OR
* [[Clubbing]]
* [[Cyanosis]]
* Pitting/non-pitting [[edema]] of the upper/lower extremities
* Muscle atrophy
* Fasciculations in the upper/lower extremity


=== Genitourinary: ===
* Genitourinary examination of patients with rectal prolapse is usually normal
==References==
==References==
{{reflist|2}}
{{reflist|2}}
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{{WS}}
{{WS}}


[[Category:Needs content]]
[[Category:Medicine]]
[[Category:Gastroenterology]]
[[Category:Gastroenterology]]
[[Category:Surgery]]
[[Category:Surgery]]

Latest revision as of 17:36, 16 February 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shaghayegh Habibi, M.D.[2]

Overview

Patients with rectal prolapse usually have rectal mass, skin excoriation or irritation of anus in physical examination.

Physical Examination

Rectal prolapse can be diagnosed in outpatient clinics by history taking and inspection of the protruded rectum.[1]

Appearance of the Patient:

  • Patients with rectal prolapse usually appear good

Vital Signs:

  • Normal vital signs

Skin:

  • Skin examination: Normal

HEENT:

  • HEENT examination: Normal

Lungs:

  • Pulmonary examination: Normal

Heart:

  • Cardiovascular examination: Normal

Abdomen:

  • Abdominal examination: Normal

Pelvic:

The following findings may be found on pelvic examination of a patient with rectal prolapse:[2][3][4]

  • Large rectal mass or bulge (generally not tender to palpation) that may or may not spontaneously reduce at the completion of a bowel movement or straining
  • Skin excoriation or irritation of anus
  • Patulous anus

Genitourinary:

  • Genitourinary examination of patients with rectal prolapse is usually normal

References

  1. ↑ Shin EJ (2011). "Surgical treatment of rectal prolapse". J Korean Soc Coloproctol. 27 (1): 5–12. doi:10.3393/jksc.2011.27.1.5. PMC 3053504. PMID 21431090.
  2. ↑ Patcharatrakul T, Rao S (2017). "Update on the Pathophysiology and Management of Anorectal Disorders". Gut Liver. doi:10.5009/gnl17172. PMID 29050194. Vancouver style error: initials (help)
  3. ↑ Bordeianou L, Hicks CW, Kaiser AM, Alavi K, Sudan R, Wise PE (2014). "Rectal prolapse: an overview of clinical features, diagnosis, and patient-specific management strategies". J. Gastrointest. Surg. 18 (5): 1059–69. doi:10.1007/s11605-013-2427-7. PMID 24352613.
  4. ↑ Goldstein SD, Maxwell PJ (2011). "Rectal prolapse". Clin Colon Rectal Surg. 24 (1): 39–45. doi:10.1055/s-0031-1272822. PMC 3140332. PMID 22379404.

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