Abnormal findings

Haemorrhoids are not palpable unless thrombosed: similarly, normal seminal vesicles cannot be felt. In patients with chronic constipation the rectum is often loaded with faeces. Carcinoma of the lower rectum is palpable as a mucosal irregularity. An obstructing carcinoma of the upper rectum may produce ballooning of the empty rectal cavity below. Faecal masses are commonly palpable; they should be movable and can he indented. Metastases or colonic tumours within the pelvis may be mistaken for faeces and vice versa. Lateraliscd tenderness suggests pelvic peritonitis, e.g. right-sided tenderness in an appendix abscess.

In women, the normal cervix and the retroverted uterus are often palpable on the anterior wall; cervical carcinoma may be palpated. The presence of a vaginal tampon may confuse the inexperienced examiner. Acute salpingitis will cause lateralised tenderness. A 'frozen pelvis' from extensive peritoneal dissemination of tumour, e.g. ovarian cancer produces a hard, rigid feel to the pgivic organs.

In men, prostatic hyperplasia often produces a palpable symmetrical enlargement, but may not do so if the hyperplasia is confined to the median lobe. A hard, irregular gland suggests prostatic carcinoma, 'file median groove is often undetectable; in the presence of extracapsular spread

Rigid Proctoscope
Ihe female [E and the prostate in the male d].

there may be tethering of the rcctal mucosa. The prostate is abnormally small in hypogonadism. Tenderness accompanied by a change in the consistency of the gland may be due to prostatitis or a prostatic abscess.

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Essentials of Human Physiology

Essentials of Human Physiology

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