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Rectal Palpation



SYNONYMS


Digital palpation, rectal exam, transrectal palpation



OVERVIEW AND GOALS


Tactile assessment of the urethra, caudal aspect of the trigone of the urinary bladder, bony pelvic canal, aortic trifurcation, pelvic diaphragm, anal sacs, rectal mucosa, and either the prostate gland (males) or vagina (females)



INDICATIONS


Part of any complete routine physical exam in adult dogs; generally not feasible in puppies or cats



CONTRAINDICATIONS



• Animals weighing <5 kg

• Relative contraindication: anal/rectal pain. Requires that the rectal exam be performed under sedation or general anesthesia.


EQUIPMENT, ANESTHESIA



• Sedation or anesthesia only if required for patient comfort

• Latex or other clean, nonsterile exam glove

• Lubricant (e.g., K-Y Jelly or Vaseline)

• Cotton wool or other absorbent material to receive contents expressed from anal sacs

• Microscope slide with drop of saline


ANTICIPATED TIME


About 30-60 seconds



PREPARATION: IMPORTANT CHECKPOINTS


Review elements of animal’s history (dysuria, hematuria, tenesmus, hind limb lameness, etc.), remainder of physical exam, and any diagnostic findings (e.g., hypercalcemia) that could be pertinent to rectal examination findings.



POSSIBLE COMPLICATIONS AND COMMON ERRORS TO AVOID



• Rectal perforation: extremely uncommon when gentle technique is used.

• Anal sac rupture: also uncommon; however, impacted, infected/abscessed sacs may be more fragile. If anal sacs are large and/or painful, and gentle pressure is unrewarding or distressing to the patient, anesthesia is recommended, and anal sac cannulation may then be performed.

• Perianal fistulae may make it difficult to assess the exact location of the anal opening; time and caution are warranted to avoid exacerbating a fistula through blunt probing.

• Rectal peristalsis may be confused with perineal hernia or rectal stricture. If uncertainty exists, the rectal exam can be prolonged by 1-2 minutes; a wave of peristalsis will pass, but a stricture will not.


PROCEDURE



• Animal is restrained in a standing position by technician holding the head and neck.

• The right-handed examiner puts a glove on his or her right hand; the right index finger is lubricated.

• The examiner stands behind the animal and lifts its tail with the left hand to expose the anus.

• The right index finger is placed on the anus, and then after a few seconds of accommodation by the animal, the finger is gently introduced through the external anal sphincter.

• The tail may be released; most dogs will hold the tail elevated during the rectal exam.

• The left hand, no longer holding the tail, reaches under to the animal’s caudal abdomen and cups the ventrocaudal abdomen.

• In addition to this cupping motion, the examiner draws the hand caudally toward his or her body to elevate the viscera of the caudal abdomen toward the right index (palpating) finger. With sufficient upward pressure, and without discomfort to the animal, it is possible to palpate the prostate of even giant-breed dogs this way.

• The palpation reaches to the maximal depth allowed by the examiner’s finger and the animal’s comfort; the examiner can also turn the finger circumferentially to assess both left and right walls of the pelvic canal and the roof of the pelvic canal.

• Once the exam is completed, the examiner withdraws the index finger, ensuring to first palpate the integrity of the pelvic diaphragm (assess for perineal hernia) and, if necessary, to express the anal sacs located at the 4 and 8 o’clock positions if the anus is pictured as a clockface.

• Finally, the feces coating the glove are examined grossly for blood or other abnormalities and smeared on a microscope slide for cytologic examination.


ALTERNATIVES AND THEIR RELATIVE MERITS



• Fecal flotation and fecal occult blood test: identifies microscopic abnormalities (parasites, blood) but is of little use regarding structural malformations of the rectum and perirectal area.

• Abdominal ultrasound: excellent visualization of many organs of caudal abdomen and cranial pelvic canal; however, the bony pelvis and colon severely narrow the acoustic window and compromise ultrasound assessment of urethra, distal colon, and much of the pelvic canal, which is the area that a rectal examination accesses best.

AUTHOR: ETIENNE CÔTÉ



Rectal Scraping



SYNONYMS


Rectal scrape, rectal cytologic analysis



OVERVIEW AND GOAL


The goal of rectal scraping is to obtain samples of mucosal tissue for cytologic examination.



INDICATIONS


Animals with signs of disease of the rectum or distal colon, such as hematochezia and tenesmus, especially when rectal mucosa has a diffusely thickened or cobblestone feel per rectal palpation. Most commonly indicated for the diagnosis of rectal histoplasmosis, protothecosis, pythiosis, or neoplasia.



CONTRAINDICATIONS


Suspicion of rectal perforation or deep ulceration



EQUIPMENT, ANESTHESIA



• Often performed without anesthesia or sedation. Sedation may be required for animals with pain on rectal palpation or for animals with an uncooperative temperament.

• Wooden tongue depressor (alternatively, cotton tipped applicator or blunt-tipped metal spatula like those for pharmacy use)

• Exam glove
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Jul 24, 2016 | Posted by in SMALL ANIMAL | Comments Off on R

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