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The Large Bowel and the Anal Canal
Published in E. George Elias, CRC Handbook of Surgical Oncology, 2020
In group A (asymptomatic people), the susceptibility to colorectal cancer can be described in terms of risk factors. People begin to be at significant risk from this disease between the ages of 40 to 50 years, and therefore annual digital rectal examination, fecal occult blood, and colonoscopy (or barium enema with air contrast and proctosigmoidoscopy) every 3 to 5 years are sufficient. However, within this group lies another subgroup, those who are asymptomatic but are at high risk such as those with familial history of polyps or familial cancer. They should be followed the same as for early diagnosis, but the initial examination should be initiated earlier at age 20 to 30 years.
Approach To The Patient With Rectal Bleeding
Published in John P. Papp, Endoscopie Control of Gastrointestinal Hemorrhage, 2019
With the exception of a digital rectal examination, the general physical examination of patients with rectal bleeding may be of little benefit. Blood in the small bowel acts as a peristaltic stimulant. An increased bowel sound activity associated with passage of dark or bright blood per rectum is a diagnostic clue suggesting its origin in the upper intestinal tract. Physical examination of the abdomen must be meticulously performed; since further information may be gathered to assist in the location of the bleeding site. A mass in the abdomen may be associated with a carcinoma. Ascites and/or an enlarged liver may be evidence of cirrhosis. Intestinal ischemia with the left colon characteristically involved will have tenderness with or without rebound in the left upper and midabdomen.
Anorectal Abscess and Fistula
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Intersphincteric abscess presents with anal pain and constitutional disturbance. Rectal examination is excruciatingly painful. The diagnosis is often missed unless MR examination or EUA is undertaken. The worry is that inadequate early intersphincteric drainage may result in a supralevator abscess. Furthermore, competent anal sphincters often prevent adequate drainage, hence follow-up is essential.
Evaluation and management of endometriosis
Published in Climacteric, 2023
The diagnostic investigation for endometriosis starts with a physical examination consisting of a speculum examination (direct visualization of the cervix and vaginal fornices) and a bimanual pelvic examination. Mobility, fixation and/or tenderness of the uterus should be evaluated carefully. Site-specific tenderness in the pelvis should also be evaluated [10]. The vaginal examination can facilitate the detection of infiltration or nodules of the vagina, uterosacral ligaments or pouch of Douglas. The rectovaginal digital examination may allow the detection of infiltration or mass involving the rectosigmoid or adnexal masses. Rectal examination is highly recommended to assess the lateral and dorsal extension of the disease allowing detection of the patients who are at risk of hypogastric vessel injury and/or hypogastric plexus damage. It also allows the surgeon to evaluate the mobility of the nodule of the dorsal cul-de-sac and thus to predict how difficult the surgery may be [14].
Diagnostic outcomes from transrectal and transperineal prostate biopsies – experiences from a Swedish tertiary care Centre
Published in Scandinavian Journal of Urology, 2021
Henrik Ugge, Sebastian Jarl, Petros Georgouleas, Sven-Olof Andersson, Pernilla Sundqvist, Janusz Frey
Tumor characteristics are displayed in Table 2. The distribution of ISUP and Gleason sum gravitated slightly towards higher scores in the TR group, but with no statistically significant difference (Chi-squared test p = 0.51 and p = 0.76, respectively). The proportion of reported ≥ cT2 was likewise higher in the TR group (n = 12, 24.0%) compared to the TP group (n = 3, 13.0%), but rectal examination at the time of biopsies was more often not performed in the TP group (17.4% compared to 2.0%). The reported reason in several of these cases was abstinence from rectal examination in order to avoid faecal perineal contamination. Positive finding of cancer in biopsies from the anterior part of the prostate did not differ between groups (TR, n = 18, 25.0% vs. TP, n = 8, 24.3%, Chi-squared Test, p = 0.93, data not shown), neither did the proportion with anteriorly located MRI lesions (n = 27, 37.5% vs. n = 11, 33.3%, Chi-squared test, p = 0.68, data not shown).
Testosterone therapy may reduce prostate cancer risk due to testosterone deficiency at a young age via stabilizing serum testosterone levels
Published in The Aging Male, 2020
Xiao Zhang, Yan Zhong, Farid Saad, Karim Sultan Haider, Ahmad Haider, Angela G. Clendenin, Xiaohui Xu
Patients in the TRT group were seen and followed up four times a year which are the times when they returned for their next injection. Each time throughout the observation time, PSA and T levels were measured. Digital rectal examination and transrectal ultrasound were performed each time during the first year of treatment, thereafter at least two times a year. In the non-TRT group, PCa screening was performed routinely once or twice each year as part of a general health assessment. PCa diagnosis was confirmed through biopsy. If PSA increased to 4 ng/mL and above or increased by more than 0.75 ng/mL within 12 months, or if there were suspicious findings on digital rectal examination or trans-rectal ultrasound, a biopsy was performed to determine if PCa was present. The diagnosis procedures followed the European Association of Urology guidelines on PCa [15].