COLON PROCEDURES AND MALE REPRODUCTIVE HEALTH

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CHAPTER 13

• COLON PROCEDURES AND MALE REPRODUCTIVE HEALTH

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PRETEST
True or False

• Hemorrhoids can cause visible red blood to appear
  on the outside of the stool.
• Nonvisible blood in the stool is termed occult
  blood.
• Colorectal cancer is a common form of cancer in
  individuals over 40 years of age.
• A blue color appearing on a Hemoccult test result
  is interpreted as a negative reaction.
• If a Hemoccult test is positive, the physician
  may order a colonoscopy.

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PRETEST, CONT.
True or False

1. The patient is placed in the prone position for a
   flexible sigmoidoscopy.
2. The function of the prostate gland is to produce
   sperm.
3. Prostate screening is recommended once a year for
   men over the age of 50.
4. A normal prostate gland feels firm and hard.
5. The most common sign of testicular cancer is a
   small, hard, painless lump on the testicle.

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Content Outline
Introduction to Colon Procedures

• Colon procedures performed in medical office
• Fecal occult blood test (FOBT)
• Flexible sigmoidoscopic examination

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Introduction to ColonProcedures, cont.

• Some patients reluctant to perform FOBT at home
• MA should explain purpose of test
• If patient understands beneficial results
• Will be more likely to participate as required
• MA assists physician during the sigmoidoscopy

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Fecal Occult Blood Testing

• Blood in stool can indicate
• Hemorrhoids
• Diverticulosis
• Polyps
• Colitis
• Upper gastrointestinal ulcers
• Colorectal cancer

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Fecal Occult Blood Testing, cont.

• Some conditions produce visible red blood on
  outside of stool
• Makes it easy to detect
• Example hemorrhoids

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Fecal Occult Blood Testing, cont.

• Melena black, tarlike stool
• If blood enters stool
• From upper gastrointestinal (GI) tract
• In an amount of 50 ml or more
• Causes melena
• Dark color result of oxidation of iron in blood
• By intestinal and bacterial enzymes

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Fecal Occult Blood Testing, cont.

• Occult blood Blood in such a small amount that
  it is not detectable by the unaided eye
• Invisible or hidden blood
• Can only be detected through chemical or
  microscopic analysis

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Fecal Occult Blood Testing, cont.

• Colorectal cancer (CRC)
• Most common form of cancer in individuals over 40
• During early asymptomatic stages
• Almost all neoplasms of colon and rectum bleed
  small amount on intermittent basis
• Takes form of occult blood
• Important to detect leads to early diagnosis
  and treatment
• Increases patient's survival rate

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Fecal Occult Blood Testing, cont.

• When more pronounced symptoms start appearing
• Usually indicates advanced stage of CRC
• Symptoms of CRC
• Visible bleeding
• Change in bowel habits
• Abdominal pain

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The Guaiac Slide Test

• Most often used to screen for occult blood in the
  stool
• Brand names
• Hemoccult
• ColoScreen

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The Guaiac Slide Test, cont.

• Fecal blood loss in excess of 5 ml/day results
  in positive reaction
• Patients normally lose up to 3 ml/day
• From minor abrasions of nasopharynx and GI tract
• Test does not show positive reaction until blood
  loss reaches 5 ml (or more) per day
• Specimen collected from three consecutive bowel
  movements
• Purpose to detect blood from GI lesions that
  exhibit intermittent bleeding

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The Guaiac Slide Test, cont.

• Patient collects specimens at home
• Returns prepared slides to office for developing

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The Guaiac Slide Test, cont.

• MA responsible for providing patient with
  instructions
• Preparation for test
• Collection of specimens
• Care and storage of slides

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The Guaiac Slide Test, cont.

• Purpose of FOBT
• Screen for occult blood to detect
• Colorectal cancer (primary use)
• Upper GI ulcer
• Disorders causing gastric and intestinal
  irritation

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The Guaiac Slide Test, cont.

1. Positive result indicates blood in stool

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The Guaiac Slide Test, cont.

• Cause of bleeding must be determined to make
  diagnosis
• Further diagnostic procedures are performed
• Flexible sigmoidoscopy
• Colonoscopy
• Double-contrast barium enema

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Patient Preparation

• Patient Preparation and Guidelines
• To ensure accurate test results

• Special diet begin 3 days before test
• Continue until all three slides prepared

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Patient Preparation, cont.

• Dietary guidelines
• High-fiber diet
• Encourages bleeding from lesions that only bleed
  occasionally
• Fiber adds bulk promotes elimination for
  specimen collection

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Patient Preparation, cont.

• Examples of fiber to include in diet

1. Lettuce
2. Spinach
3. Corn
4. Celery
5. Apples
6. Bananas
7. Oranges
8. Peaches
9. Whole-grain breads and cereals

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Patient Preparation, cont.

• Meat-free diet No red or rare meat
• Meat contains animal blood may cause
  false-positive test result
• Examples of meat to avoid

1. Beef
2. Lamb
3. Processed meats
4. Liver

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Patient Preparation, cont.

• Small amounts of following are acceptable

1. Well-cooked pork
2. Poultry
3. Fish

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Patient Preparation, cont.

• Do not consume foods that contain peroxidase
• Could cause a false-positive test result
• Examples of foods containing peroxidase
• Horseradish
• Turnips
• Broccoli
• Cauliflower
• Radishes
• Melons

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Patient Preparation, cont.

• Certain meds
• Irritate GI tract
• May cause bleeding
• May cause a false-positive test result

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Patient Preparation, cont.

• Discontinue starting 3 days before the test
• Indomethacin
• Phenylbutazone
• Corticosteroids

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Patient Preparation, cont.

• Discontinue starting 7 days before the test
• Aspirin
• Nonsteroid antiinflammatory meds
• Ibuprofen
• Naproxen

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Patient Preparation, cont.

• Also discontinue starting 3 days before the
  test
• Iron supplement may cause false-positive test
  result
• Vitamin C (in excess of 250 mg/day) may cause
  false-negative test result

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Patient Preparation, cont.

• Do not initiate test (to prevent a false-positive
  test result)
• During a menstrual period
• Or in first 3 days after a menstrual period
• When there is bleeding from hemorrhoids

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Patient Preparation, cont.

• If using a toilet-bowel cleaner
• Before initiating first bowel movement
• Remove cleaner device from toilet
• Flush twice

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The Guaiac Slide Test

• Store slides at room temperature
• Protect from
• Heat
• Sunlight
• Fluorescent light
• Prevents deterioration of slides

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Quality Control

• 10. Quality Control
• Ensures reliable and valid results
• Performed after patient's slide has been
  developed, read, and interpreted

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Quality Control, cont.

• Slides contain a performance monitor
• One drop of developing solution applied between
  positive and negative monitor areas
• Positive area should turn blue
• Negative area should not change color

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Quality Control, cont.

• Failure of expected control results test results
  are invalid
• Cause
• Outdated cards or developing solution
• Error in technique
• Slides were subjected to
• Heat
• Sunlight
• Strong fluorescent light

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What Would You Do?What Would You Not Do?
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What Would You Do?What Would You Not Do?
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Flexible Sigmoidoscopy

• Visual examination of mucosa of rectum and lower
  third of colon using
• Flexible fiberoptic sigmoidoscope an endoscope
  that is designed for passage through the anus to
  permit visualization of the rectum and sigmoid
  colon

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Flexible Sigmoidoscopy, cont.

• Sigmoidoscopy can detect
• Lesions
• Polyps
• Hemorrhoids
• Fissures

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Flexible Sigmoidoscopy, cont.

• Infection
• Inflammation
• Cause of rectal bleeding
• Symptomatic and asymptomatic colorectal cancer

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Flexible Sigmoidoscopy, cont.

1. If abnormal area detected biopsy taken

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Flexible Sigmoidoscopy, cont.

• Early detection of CRC leads to early diagnosis
  and treatment
• Increases chance of survival

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Patient Preparation for Sigmoidoscopy

• Purpose of preparation remove fecal material for
  visualization of colon
• Preparation
• Light, low-residue meal evening before
  examination
• Avoid
• Raw fruits/vegetables
• Whole-grain breads and cereals

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Patient Preparation for Sigmoidoscopy

• Laxative and enema on evening before examination
• On morning of examination
• Light breakfast
• Another enema until returns are clear

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Patient Preparation for Sigmoidoscopy, cont.

• Some physicians prefer no preparation
• May change appearance of mucosa of colon
• Patient examined after normal defecation

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Digital Rectal Examination

• Performed before sigmoidoscopy
• Physician uses well-lubricated gloved index
  finger
• Palpates rectum for presence of
• Tenderness
• Hemorrhoids
• Polyps
• Tumors

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Digital Rectal Examination

• Any abnormality viewed directly when
  sigmoidoscope inserted
• Also relaxes sphincter muscles
• Prepares patient for endoscope insertion

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Flexible Sigmoidoscope

• Composed of thin fibers of bendable glass that
  transmit light and images
• Image magnified 10 times
• Viewed through eye lens located on handle
• Videoscope allows for viewing images on a
  screen

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Flexible Sigmoidoscope, cont.

• Sigmoidoscope consists of
• Control head
• Long flexible insertion tube attached to a light
  source
• ½ inch in diameter
• 65 cm long
• Allows physician to view one third of colon

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Sigmoidoscope
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Flexible Sigmoidoscope, cont.

• To perform procedure
• Distal end of sigmoidoscope lubricated

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Flexible Sigmoidoscope, cont.

• Inserted into anus and rectum
• Slowly advanced into colon
• Small amount of air blown (insufflated) into
  colon
• Distends lumen of colon for better visualization
• Suction equipment removes secretions
• Secretions interfere with visualization of
  mucosa
• Examples mucus, blood, liquid feces

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Flexible Sigmoidoscope, cont.

• Visual examination of intestinal mucosa
  performed
• As scope is inserted
• As it is withdrawn

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What Would You Do?What Would You Not Do?
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What Would You Do?What Would You Not Do?
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Introduction to Male Reproductive Health

• Important to male reproductive health
• Prostate screening
• Testicular self-examination
• Can detect cancer early
• Early treatment often results in a cure

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Prostate Cancer Screening

• Prostate cancer second most common cause of
  cancer deaths in males (lung cancer most common)
• Increases after age 50
• Found more often in
• African Americans
• Men with family history of prostate cancer

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Prostate Cancer Screening, cont.

• Prostate gland
• Surrounds urethra
• Located just below bladder and in front of rectum
  (see Figure 13-3)
• Size and shape of a walnut
• Function secretes fluid that transports sperm

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Prostate Cancer Screening, cont.

• Early stages of prostate cancer
• Often no symptoms
• Symptoms when prostate cancer more developed
• Difficulty urinating
• Weak or interrupted urinary flow
• Pain or burning during urination

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Prostate Cancer Screening, cont.

1. Frequent urination (especially at night)
2. Blood in urine
3. Pain in lower back, pelvis, or upper thighs

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Prostate Cancer Screening, cont.

• When prostate cancer diagnosis early chance for
  cure very good
• American Cancer Society recommends
• Men over 50 undergo annual prostate screening

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Prostate Cancer Screening, cont.

• Primary screening tests for prostate cancer
• Digital rectal examination (DRE)
• Prostate-specific antigen test (PSA)

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Digital Rectal Examination

• Quick and simple procedure
• Causes only momentary discomfort

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Digital Rectal Examination, cont.

• To perform DRE
• Physician inserts lubricated gloved finger into
  rectum
• Prostate gland palpated through rectal wall
• To determine if enlarged or has abnormal
  consistency
• Normal prostate gland feels soft
• Malignant tissue feels firm and hard

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Digital Rectal Examination
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PSA Test

• Measures amount of prostate-specific antigen
  (PSA) in blood
• PSA
• Protein normally produced by
• Membrane that covers cells of prostate gland
• Normal range 0 to 4 ng/ml

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PSA Test, cont.

• Elevated results may indicate benign or
  malignant growth
• Slightly elevated 4 to 10 ng/ml
• Moderately elevated 10 to 20 ng/ml
• Highly elevated Above 20 ng/ml
• The higher the PSA level the more likely that
  cancer is present

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PSA Test, cont.

• Patient preparation
• Engage in normal activity for 2 days before test
• Levels may normally increase after vigorous
  exercise
• Do not have sexual intercourse 2 days before test
• Changes PSA level

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PSA Test, cont.

• Further testing performed if likelihood of
  cancer is present
• Transrectal ultrasound (TRUS)
• Biopsy of prostate gland
• Bone scan
• Computed tomographic (CT) scan

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Testicular Self-Examination (TSE)

• Purpose early detection of testicular cancer
• Testicular cancer
• Most common between ages 15 and 34
• If detected early very high cure rate
• Most cases detected by men
• By accident
• During TSE

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Testicular Self-Examination (TSE), cont.

• Factors that increase risk
• History of cryptorchidism (undescended testicles)
• Family history of testicular cancer
• Cancer of other testicle
• Caucasian male

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Testicular Self-Examination (TSE), cont.

• Perform TSE monthly starting at age 15
• Choose easy to remember date (e.g., first day of
  month)
• Best time to perform after taking warm bath or
  shower
• Heat allows scrotal skin to relax and become
  soft
• Easier to palpate

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Testicular Self-Examination (TSE), cont.

• Most common sign of testicular cancer
• Small, hard painless lump (pea-sized)
• Located on front or side of testicle
• Instruct patient
• Report any abnormalities to physician
  immediately

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Testicular Self-Examination (TSE)
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POSTTEST
True or False

1. Melena means that the stool appears hard and dry.
2. Consuming red meat may cause a false-positive
   result on a Hemoccult test.
3. Aspirin should be avoided for 7 days before
   beginning a fecal occult blood test.
4. The Hemoccult test should be stored in the
   refrigerator after applying a stool specimen to
   it.
5. Patient preparation for a sigmoidoscopy includes
   a high fiber diet.

75
POSTTEST, CONT.
True or False

1. A flexible sigmoidoscopy can be used to diagnose
   colorectal cancer.
2. After use, a sigmoidoscope must be autoclaved for
   20 minutes.
3. There are often no symptoms in the early stages
   of prostate cancer.
4. A PSA level of 20 is within normal range.
5. Testicular cancer occurs most commonly between
   the ages of 15 and 34.