1. COLON PROCEDURES AND MALE REPRODUCTIVE HEALTH
CHAPTER 13
COLON PROCEDURES AND MALE REPRODUCTIVE HEALTH

2. Introduction to Colon Procedures
Colon procedures performed in medical office:
Fecal occult blood test (FOBT)
Flexible sigmoidoscopic examination
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

3. Fecal Occult Blood Testing
Blood in stool can indicate:
Hemorrhoids
Diverticulosis
Polyps
Colitis
Upper gastrointestinal ulcers
Colorectal cancer
Some conditions produce visible red blood on outside of stool
Makes it easy to detect
Example: hemorrhoids
Define the conditions listed on the slide. 3

4. 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
Occult blood: Blood in such a small amount that it is not detectable by the unaided eye
Invisible or hidden blood that can only be detected through chemical or microscopic analysis
Patients who take iron supplements may have a dark-colored stool. 4

5. 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
Early detection = early diagnosis and treatment = increases patient's survival rate
When more pronounced symptoms start appearing:
Usually indicates advanced stage of CRC
Symptoms of CRC:Visible bleeding, change in bowel habits, abdominal pain
What factors contribute to the occurrence of colorectal cancer? 5

6. The Guaiac Slide Test
Most often used to screen for occult blood in the stool
Brand names:
Hemoccult
ColoScreen 6

7. 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
The primary purpose of the guaiac slide test is to screen for colorectal cancer, but what are other important uses for the test results? 7

8. The Guaiac Slide Test, cont.
Patient collects specimens at home
Returns prepared slides to office for developing
MA responsible for providing patient with instructions:
Preparation for test
Collection of specimens
Care and storage of slides
What are some patient teaching points you can cover with the patient about collection and hand hygiene?

9. The Guaiac Slide Test, cont.
7. Positive result: indicates blood in stool
What would you say to a patient whose test is positive?

10. 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
Describe these diagnostic tests. 10

11. Patient Preparation 8. Patient Preparation and Guidelines:
To ensure accurate test results
Special diet: begin 3 days before test
Continue until all three slides prepared
Dietary guidelines:
High-fiber diet
Encourages bleeding from lesions that only bleed occasionally
Fiber adds bulk: promotes elimination for specimen collection 11

12. Patient Preparation, cont.
Examples of fiber to include in diet:
Lettuce
Spinach
Corn
Celery
Apples
Bananas
Oranges
Peaches
Whole-grain breads and cereals 12

13. Patient Preparation, cont.
Meat-free diet: No red or rare meat
Meat contains animal blood: may cause false-positive test result
Small amounts of well-cooked pork, poultry or fish are acceptable.
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
What would the MA tell a patient about the importance of refraining from red meat? 13

14. Patient Preparation, cont.
Certain meds irritate GI tract
May cause bleeding
May cause a false-positive test result
Discontinue meds starting 3 days before the test as instructed by a physician
Do not initiate test:
During a menstrual period
When there is bleeding from hemorrhoids
If using a toilet-bowel cleaner
Before initiating first bowel movement remove cleaner device from toilet and flush twice
Vitamin C and aspirin should be avoided. 14

15. Quality Control Store slides at room temperature Quality Control
Protect from heat, sunlight, fluorescent light
Quality Control
Ensures reliable and valid results
One drop of developing solution: applied between positive and negative monitor areas
Positive area: should turn blue
Negative area: should not change color
What are some suggestions as to where to store the slides? 15

16. Flexible Sigmoidoscopy
Visual examination of mucosa of rectum and lower third of colon using a flexible sigmoidoscope
Sigmoidoscopy can detect:
Lesions
Polyps
Hemorrhoids
Fissures
Infection
Inflammation
Cause of rectal bleeding
Symptomatic and asymptomatic colorectal cancer
What are the signs that could indicate the presence of colorectal cancer? 16

17. Flexible Sigmoidoscopy, cont.
If abnormal area detected: biopsy taken
If an abnormal area is detected, a biopsy is taken for histologic examination.

18. Sigmoidoscope

19. 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
Preventive examinations and tests, particularly prostate screening and testicular self-examination, can detect prostate and testicular cancer early, when the patient is asymptomatic. 19

20. 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 20

21. Prostate Cancer Screening, cont.
Prostate gland
Surrounds urethra
Located just below bladder and in front of rectum
Size and shape of a walnut
Function: secretes fluid that transports sperm
How would you relay information to a patient who wants to know about prostate cancer? 21

22. 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
Frequent urination (especially at night)
Blood in urine
Pain in lower back, pelvis, or upper thighs
What other conditions may have these symptoms? 22

23. Prostate Cancer Screening, cont.
Primary screening tests for prostate cancer
Digital rectal examination (DRE)
Physician inserts lubricated gloved finger into rectum; Prostate gland palpated through rectal wall
Prostate-specific antigen test (PSA)
Measures amount of prostate-specific antigen (PSA) in blood (protein normally produced by membrane that covering prostate gland)
A PSA test in obtained by drawing the patient’s blood. 23

24. Digital Rectal Examination

25. Testicular Self-Examination (TSE)
Purpose: early detection of testicular cancer
Testicular cancer
Most common between ages 15 and 34
Most cases detected by men: By accident or during TSE
c. Factors that increase risk
History of cryptorchidism (undescended testicles)
Family history of testicular cancer
Cancer of other testicle
Caucasian male
Patient handouts on performing TSE are usually given to the patient. 25

26. Testicular Self-Examination (TSE), cont.
Perform TSE monthly: starting at age 15
Choose easy to remember date
Best time to perform: after taking warm bath or shower
Heat: allows scrotal skin to relax and become easier to palpate
Most common sign of testicular cancer:
Small, hard painless lump (pea-sized)
Instruct patient to report any abnormalities to physician immediately
What genetic and environmental factors could contribute to the occurrence of prostate cancer? 26