Rectal examination

Question 1

How do you start a rectal examination?

Answer 1

• introduce self
• check name & DOB
• explain procedure
• gain consent
• ask for chaperone
• wash hands

Question 2

What steps should you take prior to the examination?

Answer 2

• prepare equipment
• posiion patient
• put on gloves
• inspect peri-anal region
• lubricate right index finger
• warns patient that they are about to insert the index finger and informs patient they may have the sensation of needing to open their bowels

Question 3

How should you perform a rectal examination?

Answer 3

• insert gloved finger
• ask patient to clench against fingers to check anal tone

Examines:

• right lateral wall
• posterior wall
• left later wall
• anterior wall

Withdraw finger and examine glove

Question 4

What should you do after the examination?

Answer 4

• clean peri-anal area
• cover patient
• inform patient that exam is complete

Question 5

How should you end a rectal exam?

Answer 5

• dispose of waste in the clinical waste bin
• wash hands
• summarise findings
• thank patient

Question 6

How should you explain a rectal examination to a patient?

Answer 6

you will be examining
the patients back passage with a gloved index finger and lubrication. Explain this is done to examine
the bowel and prostate/cervix. Reassure them that it may be uncomfortable but not painful.

Question 7

Why is a chaperone required during a rectal exam?

Answer 7

for the patients comfort and as a witness against any false allegations of
inappropriate behaviour.

Question 8

What equipment should you organise prior to the exam?

Answer 8

• gloves
• lubrication
• tissue

Question 9

How should a patient be positioned?

Answer 9

lying on their left side with their knees brought up towards the chin

Question 10

What should you inspect the peri-anal region for?

Answer 10

• erythema
• discolouration
• skin lesions
• fissures
• fistulae
• external haemorrhoids
• leakage of faeces
• blood or mucus

Question 11

What are causes of abnormally pale stools?

Answer 11

biliary obstruction

Question 12

What is a cause of pale and greasy stools?

Answer 12

steatorrhoea

Question 13

What is the cause of black and tarry stools?

Answer 13

melaena

• bleeding from the upper GI tract

Question 14

What is the cause of grey or black stools?

Answer 14

• oral iron or bismuth therapy

Question 15

What is the cause of silvery stools?

Answer 15

• steatorrhoea plus upper GI bleeding

- e.g. pancreatic cancer

Question 16

What is the cause of fresh blood in the stool?

Answer 16

• large bowel, rectal or anal bleeding

Question 17

What is the cause of stool mixed with pus?

Answer 17

• infective colitis or IBD

Question 18

What is the cause of rice water stool?

Answer 18

(watery mucus and cell debris)

- cholera