Physical Exam & Associated Pathology Part IX Male Genitalia, Hernias & Rectum

Transcription

1 Functinal Medicine University s Functinal Diagnstic Medicine Training Prgram Mdule 1 * Lessn 6 Physical Exam & Assciated Pathlgy Part IX Male Genitalia, Hernias & Rectum By Wayne L. Sdan, D.C., D.A.B.C.I., & Rn Grisanti, D.C., D.A.B.C.O., M.S. Limits f Liability & Disclaimer f Warranty We have designed this bk t prvide infrmatin in regard t the subject matter cvered. It is made available with the understanding that the authrs are nt liable fr the miscnceptins r misuse f infrmatin prvided. The purpse f this bk is t educate. It is nt meant t be a cmprehensive surce fr the tpic cvered, and is nt intended as a substitute fr medical diagnsis r treatment, r intended as a substitute fr medical cunseling. Infrmatin cntained in this bk shuld nt be cnstrued as a claim r representatin that any treatment, prcess r interpretatin mentined cnstitutes a cure, palliative, r amelirative. The infrmatin cvered is intended t supplement the practitiner s knwledge f their patient. It shuld be cnsidered as adjunctive and supprt t ther diagnstic medical prcedures. This material cntains elements prtected under Internatinal and Federal Cpyright laws and treaties. Any unauthrized reprint r use f this material is prhibited. Functinal Medicine University; Functinal Diagnstic Medicine Training Prgram/Insider s Guide Mdule 1 * Lessn 6: Physical Exam & Assciated Pathlgy Pt IX Cpyright 2010 Functinal Medicine University, All Rights Reserved

2 Functinal Medicine University s Functinal Diagnstic Medicine Training Prgram Mdule 1 * Lessn 6: Part IX: Male Genitalia, Hernias & Rectum Physical Exam & Assciated Pathlgy By Wayne L. Sdan, D.C., D.A.B.C.I., & Rn Grisanti, D.C., D.A.B.C.O., M.S. Cntents Male Genitalia & Hernias 2 Cmmn r Cncerning Symptms 2 Palpatin f the Rectum and Assciated Structures 4 Examinatin 5 References 5 1

3 Male Genitalia and Hernias Functinal Medicine University s Functinal Diagnstic Medicine Training Prgram Mdule 1 * Lessn 6: Part IX: Male Genitalia, Hernias & Rectum Physical Exam & Assciated Pathlgy By Wayne L. Sdan, D.C., D.A.B.C.I., & Rn Grisanti, D.C., D.A.B.C.O., M.S. The inguinal canal is parallel and abve the inguinal ligament. The canal, which is apprximately 4 cm lng in adults, allws structures t pass frm the abdmen t the testes. (In the female, it permits the passage f the rund ligament f the uterus t the labia majra). Just lateral t the pubic tubercle is the external inguinal ring, which is palpable. The internal ring and canal are nt palpable. Inguinal hernias are the result when bwels prtrude thrugh weak areas. The femral canal, which lies belw the inguinal ligament, is anther area f weakness fr develping a herniated mass. The femral canal is lcated just medial t the femral vein. Frequency, Age, & Sex Inguinal Hernia Inguinal Hernia Femral Hernia Indirect Direct Mst cmmn, all ages, bth sexes. Often in children; may be in adults Less cmmn, usually in men >40 Rare in wmen Least cmmn. Mre cmmn in wmen than men. Pint f Origin Abve inguinal ligament, near its midpint (the internal inguinal ring) Abve inguinal ligament, clse t the pubic tubercle (near the external inguinal ring) Belw the inguinal ligament; appears mre lateral than an inguinal hernia. Can be hard t differentiate frm lymph ndes Curse Often int the scrtum Rarely int the scrtum Never int the scrtum Examining finger in inguinal canal during straining The hernia cmes dwn the inguinal canal and tuches the fingertip The hernia bulges anterirly and pushes the side f the finger frward. The inguinal canal is empty. Signs and symptms Sexual respnse Penile discharge r lesins Scrtal pain, swelling r lesins 2

4 Signs and Symptms (cn t) Penile discharge r lesins Functinal Medicine University s Functinal Diagnstic Medicine Training Prgram Mdule 1 * Lessn 6: Part IX: Male Genitalia, Hernias & Rectum Physical Exam & Assciated Pathlgy By Wayne L. Sdan, D.C., D.A.B.C.I., & Rn Grisanti, D.C., D.A.B.C.O., M.S. Discharges frm the penis related t sexually transmitted diseases (STDs) are presented as dripping r staining f underwear. The amunt f discharge, its clr and cnsistency, alng with any fever, chills r rash shuld be cnsidered an STD and cnfirmed. A yellw discharge usually indicates a gncccal infectin, while a clear r white discharge usually indicates a nngncccal urethritis. Scrtal pain, swelling, r lesins Scrtal pain can indicate infectin f the cntents, testicular trsin, hernia, and epididymitis. The Penis Inspectin The skin The prepuce (freskin) Glans Exam the skin fr inflammatin, lesin, r infestatins (lice, scabies). Retractin f the freskin is essential in examinatin. The Scrtum and Its Cntents Inspectin The skin Lift the scrtum s that the psterir surface is visible. Examine fr any rashes, epidermid cysts, r skin cancer Nte any swelling, lumps r veins. A prly develped scrtum n ne r bth sides suggests cryptrchidism (an undescended testicle). Cmmn scrtal swellings include indirect inguinal hernias, hydrceles, and scrtal edema. Palpatin f the penis and scrtum Palpate the penis between the thumb and first tw fingers, nting any abnrmalities f tenderness r induratin, which wuld suggest urethral stricture r a pssible cancer. Palpate the scrtum between the thumb and first tw fingers, nting any pain r swelling. Tenderness r pain indicates acute epididymitis, trsin r hernia. Any painless ndule may indicate testicular cancer, especially in the yung adult. 3

5 Functinal Medicine University s Functinal Diagnstic Medicine Training Prgram Mdule 1 * Lessn 6: Part IX: Male Genitalia, Hernias & Rectum Physical Exam & Assciated Pathlgy By Wayne L. Sdan, D.C., D.A.B.C.I., & Rn Grisanti, D.C., D.A.B.C.O., M.S. Palpatin f the penis and scrtum (cn t) Palpate each spermatic crd, including the vas deferens, between yur thumb and fingers, frm the epididymis t the superficial inguinal ring. Multiple trtuus veins in this area may be palpable and visible, which indicate a variccele. If the vas deferens is infected, it may feel thickened. A hydrcele f the crd is suspected if a cystic structure is present. Patients shuld be encuraged t perfrm self-examinatin n a regular basis. Palpatin f the Rectum and Assciated Structures The prstate The prstate has three lbes, tw f which are palpable thrugh the rectum. Between the lbes is a shallw grve that is als palpable. The size f the prstate is apprximately 2.5 cm lng. The uterine cervix The uterine cervix usually is palpable thrugh the anterir wall f the rectum. The valves f Hustn, cntained within three inward fldings f the rectum, may smetimes be felt. Signs and symptms Change in bwel habits Bld in the stl Pain with defecatin; rectal bleeding r tenderness Anal warts r fissures Weak stream f urine Burning with urinatin Change in bwel habits and bld in the stl may be an early warning sign f cancer. Any change in bwel habits, including change in size f stl, shuld be investigated. Frequency f urinatin may indicate diabetes and/r acute chrnic infectin. Hesitatin f urine flw r dribbling may indicate an enlarged prstate Prctitis includes anal itching, anrectal pain, tenesmus, discharge r bleeding frm infectin, r rectal abscess. Causes include intestinal parasites, diet, bacterial and viral infectins, anal intercurse. 4

6 Functinal Medicine University s Functinal Diagnstic Medicine Training Prgram Mdule 1 * Lessn 6: Part IX: Male Genitalia, Hernias & Rectum Physical Exam & Assciated Pathlgy By Wayne L. Sdan, D.C., D.A.B.C.I., & Rn Grisanti, D.C., D.A.B.C.O., M.S. Examinatin Please visit On Line Library On Line Vide Tutrials Male Urlgical Exam (includes urgenital, rectal, & prstate exams) Fecal Occult Bld Testing A new clrectal cancer screening test is available: Fecal Glbin by Immunchemistry (InSure) Offers imprved clinical sensitivity and specificity that leads t a higher detectin rate f bleeding due t early-stage cancers and significant adenmas Benefits ver traditinal guaiac-based fecal ccult bld tests Only lwer gastrintestinal bleeding frm the clrectum is detected because it utilizes mnclnal antibdies specific fr human glbin Desn t require any dietary r medicinal restrictins Better patient hme testing cmpliance References Lessn 6 Parts 1-IX: 1. Bates Guide t Physical Examinatin and Histry Taking; 8 th editin; 10 th editin; Lynn S. Bickley, MD, Peter G. Szilagyi, MD, MPH Current Medical Diagnsis & Treatment; Stephen J. McPhee, MD; Maxine A. Papadakis, MD 5. Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 guidelines fr the management f patients with peripheral arterial disease 6. The Merck Manual f Diagnsis and Therapy, 18 th ed 7. Internal Medicine n Call; 2002; Steven A Haist, MD, MS, FACP; Jhn B. Rbbins, 8. Principals f Nutritinal Assessment, 2 nd ed, Rsalind S. Gibsn 9. Fd, Nutritin, & Diet Therapy, 5 th ed, Krause & Mahan 10. Labratry Evaluatins fr Integrative and Functinal Medicine, 2 nd ed, Richard Lrd, PhD, J.P. Alexander Bralley 5