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    Gastrointestinal System 4

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    Dian Angriany
    The rectal examination involves carefully examining the anal area for lesions or hemorrhoids. A lubricated finger is inserted anally to palpate the anal wall and rectum, checking for masses or abnormalities of the prostate. During examination of the inguinal region, the patient stands while the examiner inspects for masses along the spermatic cord or in the scrotum. The examiner then palpates the inguinal canal and internal ring, asking the patient to cough to check for a hernia impulse. Differentiating between direct and indirect hernias can sometimes be done by compressing over the internal ring.

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    Gastrointestinal System 4

    Uploaded by

    Dian Angriany
    24 views2 pages
    The rectal examination involves carefully examining the anal area for lesions or hemorrhoids. A lubricated finger is inserted anally to palpate the anal wall and rectum, checking for masses or abnormalities of the prostate. During examination of the inguinal region, the patient stands while the examiner inspects for masses along the spermatic cord or in the scrotum. The examiner then palpates the inguinal canal and internal ring, asking the patient to cough to check for a hernia impulse. Differentiating between direct and indirect hernias can sometimes be done by compressing over the internal ring.

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    Gastrointestinal System 4

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    The rectal examination involves carefully examining the anal area for lesions or hemorrhoids. A lubricated finger is inserted anally to palpate the anal wall and rectum, checking for masses or abnormalities of the prostate. During examination of the inguinal region, the patient stands while the examiner inspects for masses along the spermatic cord or in the scrotum. The examiner then palpates the inguinal canal and internal ring, asking the patient to cough to check for a hernia impulse. Differentiating between direct and indirect hernias can sometimes be done by compressing over the internal ring.

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    24 views2 pages

    Gastrointestinal System 4

    Uploaded by

    Dian Angriany
    The rectal examination involves carefully examining the anal area for lesions or hemorrhoids. A lubricated finger is inserted anally to palpate the anal wall and rectum, checking for masses or abnormalities of the prostate. During examination of the inguinal region, the patient stands while the examiner inspects for masses along the spermatic cord or in the scrotum. The examiner then palpates the inguinal canal and internal ring, asking the patient to cough to check for a hernia impulse. Differentiating between direct and indirect hernias can sometimes be done by compressing over the internal ring.

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    Rectal Examination

    The patient is next asked to turn to the left lateral decubitus position with the right hip and
    knee fully flexed and the left hip and knee slightly flexed. The gluteal region should be at the
    edge of the examining table. The anal area is then carefully examined for any skin lesions,
    scars, fistula tracts, or external hemorrhoids. The gloved right index finger is then well
    lubricated and inserted anally. Resistance at the anal ring is usually due to spasm caused by
    nervousness and may be overcome by asking the patient to strain as the finger is inserted. The
    anal wall is carefully palpated, taking note of any hypertrophic apaillae, inflamed crypts,
    strictures, and for sphincter tone. The fingertip then palpates the rectum to check for any
    rectal mass and for the condition of the prostate.

    Inguinal Region

    Examination of the inguinal region is best performed by having the patient stand erect facing
    the examiner who is seated on a stool. The examiner should inspect the inguinal region for
    evidence of abnormal protrusions or masses along the course of the spermatic cord into the
    scrotum (Figure 80.13). If a suspicious mass is detected on inspection, the patient should be
    asked to cough to see if any additional impulse occurs. He should be asked to attempt to
    reduce the mass himself if that is possible.

    Figure 80.13

    Normal inguinal anatomy.

    If no mass is evident, the examiner should palpate the inguinal regions. This is best done by
    inserting the index finger along the spermatic cord inverting the scrotal skin to the pubic
    tubercle and then sweeping laterally to identify the external ring (Figure 80.14). The subject
    is then instructed to cough, and if an indirect inguinal hernia is present, the examiner should
    detect an impulse as the sac proceeds along the inguinal canal to exit at the external ring. If a
    general bulge is detected in the medial inguinal region, differentiation between direct and
    indirect inguinal hernia occasionally can be made on physical examination by pressing
    directly over the internal ring and thereby arresting descent of the indirect hernia (Figure
    80.15). If the subject then coughs again and the same protrusion occurs with the internal ring
    occluded, one can assume that the hernia is a direct hernia through the lower abdominal wall.

    Figure 80.14
    Palpation of the inguinal region, (a) The examiner inverts scrotal skin to palpate the inguinal
    canal. (b) With the finger in the internal ring and inguinal canal, the patient is asked to cough,
    to check for herniation.

    Figure 80.15

    Direct compression of the inguinal region to determine site of herniation.

    One must keep in mind the possibility of femoral hernias in this region. They exit through the
    femoral canal and present as a bulge below the inguinal ligament. Occasionally a femoral
    hernia loops cephalad over the inguinal ligament, presenting as a direct or indirect inguinal
    hernia. Palpation over the femoral canal should confirm the femoral origination of the hernia.

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