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

2. 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.

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

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

5. Introduction to Colon Procedures, 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

6. Fecal Occult Blood Testing
Blood in stool can indicate:
Hemorrhoids
Diverticulosis
Polyps
Colitis
Upper gastrointestinal ulcers
Colorectal cancer
Define the conditions listed on the slide. 6

7. Fecal Occult Blood Testing, cont.
Some conditions produce visible red blood on outside of stool
Makes it easy to detect
Example: hemorrhoids
What would you say to a patient who has discovered blood in the stool and is showing anxiety? 7

8. 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
Patients who take iron supplements may have a dark-colored stool. 8

9. 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
What symptoms may the patient be showing if there is no blood seen in the stool, but tests show occult blood is present? 9

10. 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
What factors contribute to the occurrence of colorectal cancer? 10

11. 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
What steps can a person take to reduce the chances of having colorectal cancer? 11

12. The Guaiac Slide Test
Most often used to screen for occult blood in the stool
Brand names:
Hemoccult
ColoScreen 12

13. 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? 13

14. The Guaiac Slide Test, cont.
Patient collects specimens at home
Returns prepared slides to office for developing
What are some patient teaching points you can cover with the patient about collection and hand hygiene?

15. The Guaiac Slide Test, cont.
MA responsible for providing patient with instructions:
Preparation for test
Collection of specimens
Care and storage of slides
Written and verbal instructions should be given to the patient. 15

16. 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
What disorders can cause gastric and intestinal irritation? 16

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

18. 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. 18

19. Patient Preparation Patient Preparation and Guidelines
To ensure accurate test results
Special diet: begin 3 days before test
Continue until all three slides prepared 19

20. Patient Preparation, cont.
Dietary guidelines:
High-fiber diet
Encourages bleeding from lesions that only bleed occasionally
Fiber adds bulk: promotes elimination for specimen collection
What foods are high in fiber? 20

21. Patient Preparation, cont.
Examples of fiber to include in diet:
Lettuce
Spinach
Corn
Celery
Apples
Bananas
Oranges
Peaches
Whole-grain breads and cereals 21

22. 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:
Beef
Lamb
Processed meats
Liver
What would the MA tell a patient about the importance of refraining from red meat? 22

23. Patient Preparation, cont.
Small amounts of following are acceptable:
Well-cooked pork
Poultry
Fish
Some patients will only eat red meat. Give some suggestions of meals they may eat. 23

24. 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
Peroxidase is an enzyme that may cause false-positive results. 24

25. Patient Preparation, cont.
Certain meds:
Irritate GI tract
May cause bleeding
May cause a false-positive test result
Vitamin C and aspirin should be avoided. 25

26. Patient Preparation, cont.
Discontinue: starting 3 days before the test
Indomethacin
Phenylbutazone
Corticosteroids
Indomethacin is used for pain. 26

27. Patient Preparation, cont.
Discontinue: starting 7 days before the test
Aspirin
Nonsteroid antiinflammatory meds:
Ibuprofen
Naproxen
What is the difference between aspirin and nonsteroidal antiinflammatory medication?
Why is it suggested to take an aspirin if you are having a heart attack? 27

28. 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
If a patient states he or she does not take vitamin C, but takes a multi-vitamin, how would you respond? 28

29. 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
Why would this be important? 29

30. Patient Preparation, cont.
If using a toilet-bowel cleaner
Before initiating first bowel movement:
Remove cleaner device from toilet
Flush twice
Why would the patient need to remove bowel cleaner? 30

31. The Guaiac Slide Test Store slides at room temperature Protect from:
Heat
Sunlight
Fluorescent light
Prevents deterioration of slides
What are some suggestions as to where to store the slides? 31

32. Quality Control 10. Quality Control Ensures reliable and valid results
Performed after patient's slide has been developed, read, and interpreted
Notice the orange box on the slide. This is where the MA performs quality control.

33. 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
Should gloves be worn when performing the quality control? 33

34. 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
What would you say to a patient if he or she needed to repeat the test? 34

35. What Would You Do? What Would You Not Do?

36. What Would You Do? What Would You Not Do?

37. 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
What are the signs that could indicate the presence of colorectal cancer? 37

38. Flexible Sigmoidoscopy, cont.
Sigmoidoscopy can detect:
Lesions
Polyps
Hemorrhoids
Fissures
What are polyps and fissures? 38

39. Flexible Sigmoidoscopy, cont.
Infection
Inflammation
Cause of rectal bleeding
Symptomatic and asymptomatic colorectal cancer
What does symptomatic and asymptomatic mean? 39

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

41. Flexible Sigmoidoscopy, cont.
Early detection of CRC: leads to early diagnosis and treatment
Increases chance of survival 41

42. 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
What factors that make a diagnosis difficult can be removed by proper patient preparation for a sigmoidoscopy? 42

43. Patient Preparation for Sigmoidoscopy
Laxative and enema on evening before examination
On morning of examination:
Light breakfast
Another enema until returns are clear
Prep kits are available for the patient at the hospital or physician’s office. 43

44. Patient Preparation for Sigmoidoscopy, cont.
Some physicians prefer no preparation
May change appearance of mucosa of colon
Patient examined after normal defecation
Preparation may also be waived if the patient is experiencing diarrhea. 44

45. Digital Rectal Examination
Performed before sigmoidoscopy
Physician uses well-lubricated gloved index finger
Palpates rectum for presence of:
Tenderness
Hemorrhoids
Polyps
Tumors
What might the physician use to lubricate the gloved finger?
How might the MA assist in this? 45

46. Digital Rectal Examination
Any abnormality viewed directly when sigmoidoscope inserted
Also relaxes sphincter muscles
Prepares patient for endoscope insertion
The MA needs to instruct and comfort the patient during this procedure. 46

47. 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
What might be the responsibility of the MA when assisting the physician? 47

48. 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
The sigmoidoscope is cleaned with a disinfectant such as Cidex. Why couldn’t we autoclave this equipment? 48

49. Sigmoidoscope

50. Flexible Sigmoidoscope, cont.
To perform procedure:
Distal end of sigmoidoscope lubricated
Why would we lubricate the tubing?

51. 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
Air blown into the patient may be uncomfortable. What would be the responsibility of the MA? 51

52. Flexible Sigmoidoscope, cont.
Visual examination of intestinal mucosa performed:
As scope is inserted
As it is withdrawn
Patient instructions after the sigmoidoscope are usually relayed to the patient by the MA.
The patient may experience some cramping and bloating which will disappear after gas is passed. 52

53. What Would You Do? What Would You Not Do?

54. What Would You Do? What Would You Not Do?

55. 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. 55

56. 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 56

57. 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
How would you relay information to a patient who wants to know about prostate cancer? 57

58. 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
What other conditions may have these symptoms? 58

59. Prostate Cancer Screening, cont.
Frequent urination (especially at night)
Blood in urine
Pain in lower back, pelvis, or upper thighs
The medical term for frequent urination at night is nocturia. 59

60. 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
What would an MA say to a 50-year-old patient who refuses to have his prostate checked? 60

61. Prostate Cancer Screening, cont.
Primary screening tests for prostate cancer
Digital rectal examination (DRE)
Prostate-specific antigen test (PSA)
A PSA test in obtained by drawing the patient’s blood. 61

62. Digital Rectal Examination
Quick and simple procedure
Causes only momentary discomfort 62

63. 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
Further testing is required if the DRE is abnormal. 63

64. Digital Rectal Examination

65. PSA Test Measures amount of prostate-specific antigen (PSA) in blood
Protein normally produced by:
Membrane that covers cells of prostate gland
Normal range: 0 to 4 ng/ml
Physicians who specialize in diseases of the urinary tract also treat prostate problems. 65

66. 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
Acute prostatitis is an infection of the prostate caused by bacteria. What category of drugs do you think are prescribed to treat this problem? 66

67. 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
Benign prostatic hyperplasia (BPH) is the term used to describe an enlarged prostate. BPH is common in older men. 67

68. 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
The MA is responsible for scheduling these procedures for the patient and giving preparation orders. 68

69. 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
Patient handouts on performing TSE are usually given to the patient. 69

70. 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
Every year, more than 189,000 people are diagnosed with prostate cancer, and approximately 30,000 die from the disease. 70

71. 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
What genetic and environmental factors could contribute to the occurrence of prostate cancer? 71

72. 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
A dull ache in the lower abdomen, back, or groin may also be signs of prostate problems. 72

73. Testicular Self-Examination (TSE)

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

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