rectal toucher
DESCRIPTION
skill lab rectal toucherTRANSCRIPT
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Rectal Touche
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Anal Canal
ANATOMICAL ANAL CANAL (FROM ANAL VERGE TO DENTATE LINE)
SURGICAL ANAL CANAL (FROM ANAL VERGE TO ANORECTAL JUNCTION
ANORECTAL JUNCTION
COLLUMNA MORGAGNI
DENTATE LINE
INTERSPHINCTERIC GROVE/ WHITE LINE OF
HOUSTON
ANAL VERGE
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Pre sacral space
Deep post-anal space
Superficial post-anal space
Iscio rectal space
Perianal space
Supralevator space
Transverse septum
S P A C E
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1. Left lateral (Sims) position.
Rutin digunakan untuk wanita atau prosedue standar laki-laki.
Memudahkan pemeriksaan inspeksi dan palpasi anal kanal dan rektum.
Pasien miring kekiri, dengan tungkai atas kanan fleksi, sedangkan tungkai bawah kiri semi ekstensi.
Panggul harus menungging dan sejajar dengan pinggir tempat tidur.
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2. Knee-elbow position (sujud/jack knife position) atau Knee-chest position (miring meringkuk)
Baik untuk perabaan prostat dan vesikula seminalis.
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3. Dorsal position.
Pasien tidur dengan posisi setengah duduk posisi lutut ditekukkan(fleksi).
Telunjuk tangan kanan masuk kedubur pasien dengan melintasi dibawah paha kanan pasien.
Untuk bimanual palpasi tangan kiri diatas suprapubis.
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4. Lithotomy position.
Posisi litotomi biasanya dilakukan pada pemeriksaan rutin yang tidak memerlukan pemeriksaan anus secara detail. Dianjurkan dalam pemeriksaan prostate dan vesika seminalis karena memudahkan akses pada cavum peritoneal.
Bimanual dengan telunjuk kanan pada rektum sedang tangan kiri pada supra pubis.
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Inspeksi
Pisahkan gluteus kemudian inspeksi sekitar anus
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Hemorrhoid/prolapses recti
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Hemorrhoid
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Hemorrhoids are not varicosities
2nd Edition, 1999
instead they are
vascular cushions that
slide down, prolapse,
become congested,
enlarged, and bleed
“Anal Cushion” Gordon PH & Nivatvongs S. Principles of and practice of surgery for the colon, rectum, and anus
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Anal Fissure
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INFECTION START AT ANAL GLAND & MAY SPREAD THROUGH THE LONGITUDINAL MUSCLE FIBRE
ABSCESS MAY DEVELOP IN INTERSPHINCTERIC, PERIANAL (DEEP/ SUPERFICIAL, PELVIC.
RUPTUR ABSCESS MAY DEVELOP FISTULA
TYPE OF FISTULA DEPEND ON THE ABSCESS LOCATION
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