NR509 Final Chapter 20 and 21 Male and Female Gent.pdf

o Ascic uid normally shis o dependen side, changing he margin o dullness. o Resuls o uid wave ess are no specic. o To palpae an organ or mass in an ascic abdomen place your sened and sraighened ngers on he abdomen and briey jab...

o Ascic uid normally shis o dependen side, changing he margin o dullness. o Resuls o uid wave ess are no specic. o To palpae an organ or mass in an ascic abdomen place your sened and sraighened ngers on he abdomen and briey jab hem oward he srucure and ry o ouch is surace. Your hand will quicky displace he uid and sops abruply as i ouches a solid surace. Colon cancer and screening recommendaons o Screening ▪ Aduls aged 50-75 years - opons ▪ Sool based ess ▪ Fecal immunochemical es (FIT) annually ▪ High sensiviy guaiac based ecal occul blood esng annually ▪ FIT-DNA esng every 1-3 years ▪ Direc visualizaon ess ▪ Colonoscopy every 10 years ▪ Sigmoidoscopy every 5 years ▪ Flexible sigmoidoscopy every 10 years wih FIT every 3 years ▪ CT colonography every 5 years ▪ Aduls aged 76-85 ▪ individualized decision making, decisions should ake ino consideraon lie expecancy and pervious screening. Previously unscreened aduls migh bene rom screening. ▪ Aduls over 85 ▪ do no screen because risks do no ouweigh benes. o Screening and removing precancerous adenomaous polyps are he mos eecve way o screen or colon cancer o Physical acviy, aspirin, and oher NSAIDs and posmenopausal hormone replacemen herapy proec agains colorecal cancer o Sool ess and colonoscopy can screen or colon cancer Chapter 20 Male Genitalia Techniques o examinaon o Look or scroal swelling in mumps, orchis, scroal edema, and escular cancer ▪ Fever and dysuria in a man suggess acue prosas, acue pyelonephris, disseminaed gonococcal inecon, syphilis, or pos obsrucve UTI o The paen may be sanding or sing o Inspec he skin, prepuce, and glans ▪ Phimosis is a gh prepuce ha canno be reraced over he glans ▪ Paraphimosis is a gh prepuce ha once reraced canno be reurned ▪ Hypospadias is venral displacemen o he meaus on he penis while epispadias is dorsal displacemen o Inspec he urehral meaus and i indicaed, srip or “milk” he penile sha ▪ Urehral sricures mos commonly occur in he proximal urehra, bu induraon or rmness along he venral surace o he penis suggess a urehral sricure or possibly a carcinoma o Palpae he sha o he penis  o Inspec he scroum including skin, hair, and conour ▪ A poorly developed scroum on one or boh sides sugges cryporchidism (an undescended escle) o Palpae each ess including he epididymis and spermac cord ▪ Tender painul scroal swelling is presen in acue epididymis, acue orchis, escular orsion, and srangulaed inguinal hernia ▪ Any painless nodule on he ess raises he possibiliy o escular cancer ▪ The vas deerens, i chronically ineced, may eel hickened or beaded, a cysc srucure in he srucure in he spermac cord suggess a hydrocele o he cord Anaomy o Screening or sexually ransmied inecons (STIs) o Penile discharge or lesions and scroal or escular pain, swelling, or lesions STIs o Look or yellow penile discharge in gonorrhea Whie discharge is rom chlamydia o Suspec scabies or lice in a paen complaining o inense pruris wih evidence o penile or pubic excoriaons. o Epididymis ▪ Acue ▪ Inamed epididymis is induraed, swollen, and noably ender, making i dicul o disnguish rom he ess. The scroum may be reddened and he vas deerens inamed. o Syphilis ▪ Secondary (Condyloma lanum) ▪ Large raised, round or oval, a opped grey or whie lesions poin o condylomaa laa. These are conagious and, along wih rash and mucus membrane sores in mouh, Vagina, or anus are maniesaons. ▪ Female ▪ Syphilic chancre (genial ulcer)- rm painless ulcer orm primary syphilis, orms approximaely 21 days aer exposure o reponema pallidum. I may remain hidden and undeeced in he vagina and heals regardless o reamen in 3-6 weeks. ▪ Male ▪ Primary syphilis, small red papule ha becomes a chancre, a painless erosion up o 2 cm in diameer. Base o chancre is clean, red, smooh, and glisening, boarders are raised and induraed. Chancre heals wihin 3-8 weeks. o Genial Wars (condylamaa acuminaa) ▪ Papules or plaques o variable shapes Caused by HPV, usually srains 6 and 11 ▪ Takes weeks o monhs or i o visible ▪ Can arise on penis, scroum, groin, highs, and anus ▪ Can cause iching and pain ▪ May disappear wihou reamen ▪ Ineced conacs may have no visible wars ▪ Small red papule ha becomes a chancre May develop inguinal lymphadenopahy ▪ 20-30% develop secondary syphilis which suggess coinecon wih HIV o Genial Herpes  ▪ Small scaered or grouped vesicles ▪ Primary episode may be asympomac ▪ Associaed wih ever, malaise, headache, arhralgias, local pain, edema, and lymphadenopahy ▪ Red papule or pusule inially hen orms a painul deep ulcer wih ragged noninduraed margins ▪ Conain necroc exudae Tescular disorders and cancer o Abnormalies o he eses ▪ Cryporchidism ▪ Teses are arophy and may lie in inguinal canal or he abdomen, resulng in an unlled scroum. There is no palpable le ese or epididymis. This raises he risk or escular cancer. ▪ Small eses ▪ in aduls, escular lengh is usually greaer han 3.5 cenmeers. Small, rm eses are seen in Kleineler syndrome, usually less han wo cenmeers. Small, so eses suggesng arophy seen in cirrhosis, myoonic dysrophy, use o esrogens, and hypopiuiarism; May also ollow or orchis. ▪ Acue orchis ▪ he eses is acuely inamed, painul, ender, and swollen. I may be dicul o disnguish rom ha epididymis. The scroum maybe red end. Seen in mumps and oher viral inecon; Usually unilaeral. ▪ umor o he eses (early)-mos commonly diagnosed cancer in whie men ages o 20 o 34 years. ▪ usually appears as a painless nodule. Any nodule wihin he eses warrans invesgaon or malignancy. ▪ Risk acors o escular cancer. ▪ Whie ehniciy, amily hisory, HIV, and hisory o cryporchidism. ▪ Tumor o he eses (lae) ▪ as a escular neoplasm grows and spreads, i may seem o replace he enre organ. The escle characeriscally eels heavier han normal. ▪ Acue epididymis ▪ An acuely inamed epididymis is Tinder and swollen and may be dicul o disnguish rom he eses. The scroum maybe red and in he vas deerence inamed. I occurs chiey in aduls. Coexisng urinary rac inecon or prosas suppors he diagnosis. ▪ spermaocele and cys o he epididymis ▪ a painless, movable cys mass jus above he eses sugges a spermaocele or epididymal cys. Boh ransilluminae. The ormer conains sperm, and laer does no, bu hey are clinically indisnguishable. ▪ Variceal o he spermac cord ▪ heir seal reers o varicose veins o he spermac cord, usually ound on he le. I eels like a so” bag o worms” separae rom he eses, and slowly collapses when he scroum is elevaed in he supine paen. ▪ orsion o he spermac cord  ▪ wisng o he escle on is spermac cord produces an acuely painul and swollen organ ha is reraced upwards in he scroum, which becomes red and edema. There is no associaed urinary inecon. I is a surgical emergency because o he obsruced circulaon. Hernias o I he perioneal lining remains an open channel o he scroum, i can give rise o an indirec inguinal hernia o The parieal and visceral layers orm a poenal space or he abnormal uid accumulaon o a hydrocele o Femoral hernias prorude in he groin and can presen as an emergency wih bowel incarceraon or srangulaon o When loops o bowel orce heir way hrough he inguinal canal, hey produce inguinal hernias o Srangulaed hernia requires promp surgical evaluaon Human papillomavirus (HPV) (including vaccinaon recommendaons) o Chapter 21 Female Genitalia Techniques o examinaon o Inspec he mons pubis, labia, perineum ▪ Excoriaons or ichy, small red maculopapular sugges pediculosis pubis ▪ An enlarged clioris is seen in masculinizing endocrine disorders ▪ The Barholin glands are no visible ▪ A Barholin gland may become acuely or chronically ineced resulng in swelling. ▪ Acue ▪ The gland appears ense, ho, very ender abscess. Possible labial swelling. ▪ Look or pus emerging orm he duc or eryhema around he duc opening. ▪ Chronic ▪ A nonender cys is el ha may be large or small. o Inspec cervix ▪ A yellowish discharge on he endocervical swab commonly represens mucopurulen cervicis rom chlamydia, gonorrhea, or herpes simplex ▪ Raised, riable, or lobed war-like lesions are seen wih condylomaa or cervical cancer o Inspec vagina ▪ Vaginal discharge oen accompanies inecon rom candida, richomonas vaginalis, and BV ▪ Use he lower blade as a reracor during bearing down helps expose anerior vaginal wall deecs such as cysoceles o Palpae he cervix  ▪Cervical moon enderness and adnexal enderness are hallmarks o PID, ecopic pregnancy, and appendicis ▪ Nodulariy, immobiliy, and enderness in he ornices may resul rom endomeriosis ▪ Nodules on he uerine suraces sugges myomas Palpae he uerus o Palpae he ovaries ▪ Wihin 3-5 years aer menopause, he ovaries become arophic and usually nonpalpable ▪ In posmenopausal women, invesgae a palpable ovary or possible ovarian cys or ovarian cancer ▪ Pelvic pain, bloang, increased abdominal size and UTI sympoms are more common in women wih ovarian cancer o Assess he pelvic oor muscles ▪ Weakness o he pelvic oor muscles may cause pain, urinary inconnence, ecal inconnence, and prolapse o he pelvic organs o Perorm a recovaginal examinaon i indicaed ▪ Sool in he recum may smulae a recovaginal mass bu unlike a malignan mass i can be dened by digial Anaomy o Screening or sexually ransmied inecons (STIs) o Bacerial vaginosis o Trichomonal vaginis: a proozoan, oen bu no always acquired sexually. ▪ Discharge: yellowish, green, gray, possibly rohy, may be malodorous o Oher s/s: prurius, pain on urinaon, dyspareunia ▪ Vulva and vaginal mucosa: vesbule and labia minora may be eryhemaous, he vaginal mucosa may be diusely reddened, wih small red granular spos or peechiae in he poserior ornix. Mild cases he mucosa looks normal. o Lab eval: scan saline wen moun or richomonads sni or shy odor aer applying whi es. Candidiasis o candida albicans, a yeas, normal overgrowh o vaginal ora, many acors may predispose, including anbioc herapy. ▪ Discharge: whie and curdy, may be hin bu ypically hick, no as prouse as in richomonal inecon, no malodorous o Oher s/s: pruris, vaginal soreness, pain on urinaon, dyspareunia ▪ Vulva and vaginal mucosa: he vulva and surrounding skin are oen inamed and swollen o a variable exen. Paches o discharge, mucosa may bleed when hese paches are scraped o, in mild cases he mucosa looks normal. o Lab eval: scan poassium hydroxide preparaon or he branching hyphae o candida. GYN/pelvic examinaon (including Pap smear esng) o Esrogen is recommended or paens who have had a hyserecomy or combined use o esrogen and progesn or prevenng chronic condions in posmenopausal women Pelvic inammaory disease (PID) o Cervical disorders  o Uerine umors o Cervical cancer (including screening and risk acors) o Human papillomavirus (HPV) (including vaccinaon recommendaons) o HPV oers he opporuniy o preven cervical cancer and pre-cancers o Pap-smears can also ideny high-risk precancerous changes or early cancers o Prevens inecon rom HPV subypes 16,18, 6, and 11, which cause 90% o genial wars. o The bivalen vaccine prevens inecon rom subypes 16 and 18 o Recommended or prevenon o cervical, vulvar, and vaginal cancers and precancers emales as well as anal cancer, and genial wars in boh emale and males. o Vaccinaed women should sll ge cervical screening because vaccines do no preven all HPV subypes. o Condoms does no eliminae he risk o cervical HPC inecon o Recommended or hose wih compromised immune sysems including HIV Chapter 22 Anus, Rectum, and Prostate Techniques o examinaon o Pu p. in a side lying posion ▪ Inspec he sacrococcygeal and perianal areas Inspec he anus ▪ A ender purulen reddened mass wih ever or chills suggess an anal abscess. Abscesses unneling o he skin surace rom he anus or recum may orm a clogged or draining ano-recal sula. Fisulas may ooze blood, pus, or eculen mucus. Consider anoscope or sigmoidoscopy or beer visualizaon. ▪ Sphincer ghness may occur wih anxiey, inammaon or scaring ▪ Sphincer laxiy occurs in neurologic disease such as S2-S4 cord lesions and signals possible changes in he urinary sphincer and derusor muscle o Perorm a digial recal examinaon ▪ Assess he anal sphincer one ▪ Palpae he anal canal and recal surace ▪ I a mass is noed wih irregular borders, suspicious o recal cancer ▪ In persons wih prosaes palpae he prosae gland Common concerns o Change in bowel habis ▪ Pencil hin sools may warn o colon cancer o Blood in sool ▪ Dark arry sools i polyps, carcinoma, GI bleeding, mucus in villas adenomas, IBD, or IBS o Pain wih deicaon, recal enderness ▪ Hemorrhoids, procs rom STIs o Anal wars or ssures