Page 2338 - Cote clinical veterinary advisor dogs and cats 4th

1157.e2 Rectal Palpation

Rectal Palpation
VetBooks.ir Anticipated Time

Difficulty level: ♦
before beginning the digital exam.
1 minute or less • The perineal region is examined visually
Synonym • The index finger is then inserted into the
Rectal, rectal exam Preparation: Important anus, and the tail is immediately released.
Checkpoints • Anal tone should be noted; it is normal for
Overview and Goal May be easier if the animal has defecated before the anal sphincter to tighten.
Rectal exam is part of a complete physical exam. exam, but it is not necessary • The nondominant hand can be used to reach
Although often most useful in assessment of under the abdomen and gently lift and push
issues related to the distal gastrointestinal or Possible Complications and the caudal abdominal organs dorsally and
genitourinary tract, it can provide crucial data Common Errors to Avoid backward; this can help make the prostate
about systemic disease. For instance, hyper- • Complications are rare. The most important more easily palpable in large dogs.
calcemia can be explained by apocrine gland is bite injury if the animal is painful and • The finger is gently pushed forward as far
anal sac adenocarcinoma (p. 29) detected on not properly restrained for examination. If as it can go along the floor of the rectum.
rectal palpation. possible, use an experienced assistant to help • If the rectum is full of firm feces, the finger
with restraint rather than the pet owner. can be used to manually evacuate the feces
Indications • Severe perianal fistulas may be confused with before attempting examination again. Small
Rectal examination should be part of the routine the actual anal opening. Dogs with severe amounts of soft feces do not interfere with
physical exam for every adult dog. Although perianal fistulas are typically very painful on the examination and need not be removed.
not routine, it may also be warranted in cats, palpation, and anesthesia or heavy sedation • The finger should be turned over 180 °
especially if there is a history of difficult is indicated before a careful exam (p. 771). both ways so that the dorsal colon can be
defecation. • Rarely, anal sac rupture may occur during palpated; sublumbar lymphadenopathy may
expression of diseased anal sacs. If resistance is be identified in this way.
Contraindications encountered during expression or the animal • After assessing the prostate (male) and
Very small patient size or tight rectal stricture appears to be distressed during the procedure, the furthest reach of the finger, it should
that precludes introduction of finger sedation/anesthesia and cannulation of the be slowly retracted back toward the anus,
sacs may be warranted. assessing the palpable structures and mucosal
Equipment, Anesthesia • Do not mistake a strong peristaltic wave texture along the way.
• Generally easily accomplished on an alert in the rectum for a rectal stricture. Peri- • The urethra should be palpable under the
dog with minimal resistance. May require stalsis will pass, but a stricture will remain ventral surface of the colonic mucosa.
sedation or anesthesia if the animal seems static. • When the fingertip is just inside the anus,
painful on attempted exam or for some cats. the finger should be swept circumferentially
Good lighting can improve the chance of Procedure to palpate the entire anus, including the anal
seeing subtle visual changes in the perineal • The dog is restrained in a standing position sacs.
area. by a technician. • The anal sacs, found at the 4- and 8-o’clock
• Clean, nonsterile examination glove • Using the dominant hand, lubricant should positions on the ventral portion of the anus,
• Lubricant (e.g., K-Y Jelly) be applied to the examiner’s gloved index should be palpated. Expression of material is
• Disposable absorbent material (e.g., paper finger. not necessary for healthy pets, but if there
towel, gauze) in which to collect substances • The examiner lifts the tail with the non- are signs of scooting, licking, or the sacs are
expressed from anal sacs. dominant hand to expose the anus. enlarged, expression is warranted.

RECTAL PALPATION Gentle upward abdominal palpation conducted during
rectal exam will assist in palpation of caudal abdominal structures and will help RECTAL PALPATION Perianal fistula is recognized on visual inspection of the
the finger reach the prostate in larger male dogs. perineal region an important aspect of the exam performed before rectal palpation.

www.ExpertConsult.com