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Submitted By colleencayasa
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Evaluate the body of the uterus for:
a. Position
b. Architecture, size, shape, symmetry, tumor
c. Consistency
d. Tenderness
e. Mobility
3. Continue bimanual palpation and evaluate the cervix for position architecture, consistency and tenderness especial on the mobility of the cervix, then explore the anterior, posterior and lateral fornices
4. Place the “vaginal” fingers in the right lateral fornix anf the “abdominal” hand on the right lower fornices a. outline the adnexa b.normal tube- not palpable c. normal ovary (4x2x3 cm) often not palpable d. adnexal mass
5. Palpate the left adnexa region, repeating technique described above
6. Follow the bimanual examination with a rectovaginal abdominal examination
7. In virgins – rectal- abdominal technique

E. Rectal Examination 1. Inspect the perineal and anal area, the pilonidal (sacrococcygeal) region and perineum for color and lesion 2. Instruct the patient to “strain down” 3. Palpate the pilonidal and anal area, ischiorectal fossa, perineum and the region before inserting the gloved finger into the ana canal 4. Palpate the anal canal and the rectum with well lubricated gloved index finger 5. Evaluate the anal canal for: a. tonus 1.external sphincter muscle 2. anorectal ring b. tenderness 1. tight sphincter 2. anal fissure 3. painful hemorrhoids c. tumor or irregularities, specially the pectinate line d. superior aspect examine the finger
1. Blood
2. Pus
3. Other alteration, smear, stool
e. Evaluate the rectum
a. Anterior wall
b. Right lateral wall, left lateral, posterior wall, superior aspect, test for the occult blood

Supine position Relaxed position Pillow under the head
Inspect for signs of intraabdominal mass, organomegaly or distention
Initial Palpation Liver Spleen Other abdominal contents, mass effect…...

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