Chapter 13: Colon Procedures and Male Reproductive Health
A. Definitions
1. C
2. J
3. A
4. F
5. I
6.
7.
8.
9.
10.
E
B
G
H
D
B. Word Parts
Directions: Indicate the meaning of each word part in the space provided. List as many medical
terms as possible that incorporate the word part in the space provided.
Word Part
Meaning of Word Part
1. bi/o
life
2. -opsy
to view
3. colon/o
colon
4. -scopy
visual examination
5. -scope
instrument used for
visual examination
6. endo-
within
7. -oxia
oxygen
Medical Terms That Incorporate
Word Part
Copyright © 2012, 2008, 2004, 2000, 1995, 1990, 1984, 1979 by Saunders, an imprint of Elsevier Inc.
Instructor’s Resource Manual
8. -ase
enzyme
9. ox/i
oxygen
10. sigmoid/o
sigmoid (colon)
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EVALUATION OF LEARNING
1. What are the three parts of the large intestine?
Cecum, colon, rectum.
2. What are the functions of the large intestine?
Absorption of water and the preparation of the fecal material for elimination.
3. What is the function of the anal sphincter muscles?
Expel waste from the body.
4. What is the function of the mucus secreted by the large intestine?
To bind the fecal material together and protect the wall of the large intestine from the
irritating effect of substances moving through it.
5. List five causes of blood in the stool.
Hemorrhoids, diverticulitis, polyps, colitis, upper gastrointestinal ulcers, colorectal cancer.
6. Define the term melena, and explain what causes it.
Black and tarlike stool caused by the oxidation of the iron in the blood by intestinal and
bacterial enzymes.
7. What is the primary reason for screening patients for the presence of fecal occult blood?
Early diagnosis and treatment of colorectal cancer, which increases a patient’s survival rate.
8. Why must three stool specimens be obtained for the fecal occult guaiac slide test?
Provides for the detection of blood from gastrointestinal lesions that do not bleed every day.
9. List two reasons for placing a patient on a high-fiber diet when testing for fecal occult blood.
To encourage bleeding from lesions that bleed only occasionally and to add bulk to promote
bowel elimination to ensure adequate specimen collection.
10. What medications and vitamin supplements must be discontinued before guaiac slide testing?
Ibuprofen (Motrin, Advil), naproxen (Aleve), more than one adult aspirin per day, iron
supplement, vitamin C supplement greater than 250 mg per day.
11. List two factors that could cause false-positive test results on a guaiac slide test.
Taking an iron supplement, eating foods containing peroxidase, eating red or rare meat,
performing the test during a menstrual period, and taking medications that irritate the
gastrointestinal tract such as NSAIDs and aspirin.
12. List three examples of diagnostic tests that may be performed if the guaiac slide test result is
positive.
Colonoscopy, sigmoidoscopy, a double-contrast barium enema radiographic study, and CT
colonoscopy.
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13. Why is it important to perform quality-control methods when developing the guaiac slide
test?
To ensure reliable and valid results.
14. How should the guaiac slide test be stored?
At room temperature; protected from heat, sunlight, and strong fluorescent light; should not
be stored in close proximity to volatile chemicals.
15. What factors can cause a failure of the expected control results to occur on a guaiac slide
test?
Use of outdated slides or developing solution; an error in technique; subjection of the slides
to heat, sunlight, strong fluorescent light, or volatile chemicals.
16. List the advantages of the fecal immunochemical test (FIT) compared with the guaiac slide
test.
FIT is more sensitive to the presence of lower gastrointestinal bleeding; FIT is not affected
by drugs or food and therefore does not require medication and dietary restrictions; FIT has
fewer false-positive test results.
17. How does a fecal DNA test function to detect colorectal cancer?
Uses DNA technology to detect abnormal cells that are shed into the stool from cancerous
growths or colorectal polyps.
18. What is the purpose of performing a sigmoidoscopy?
Following a positive fecal occult blood test to determine the source and cause of the
bleeding; to evaluate patient symptoms related to the colon such as lower abdominal pain,
diarrhea, or constipation; to detect the presence of lesions, polyps, hemorrhoids, fissures,
infection, and inflammation.
19. Describe the following patient preparation required for a sigmoidoscopy:
a. The day before the procedure and continuing until the examination is completed:
Do not consume any solid food or milk products; consume only gelatin (Jell-O) or popsicles
(except purple or red, which could be mistaken for blood in the colon); drink only clear
liquids (water, apple juice, sport drinks [e.g., Gatorade], soft drinks, clear broth); do not
drink alcohol; coffee or tea is permitted with no milk or cream.
b. The evening before the procedure:
Drink the following laxative between 5 p.m. and 7 p.m.: one 10-ounce bottle of Magnesium
Citrate; continue drinking plenty of clear liquids throughout the evening.
c. The day of the procedure:
You may continue drinking clear liquids until 4 hours before the procedure; 2 hours before the
examination: Insert one Fleet’s enema rectally following the package instructions; 1 hour before
the procedure: Insert another Fleet’s enema.
20. What is the purpose of the digital rectal examination (DRE)?
To palpate the rectum for the presence of tenderness, hemorrhoids, polyps, or tumors; also to
relax the sphincter muscles and to prepare the patient for the insertion of the endoscope.
21. What is the purpose of insufflating air into the colon during a sigmoidoscopy?
To distend the lumen of the colon for better visualization.
22. What is the purpose of suctioning during sigmoidoscopy?
To remove secretions such as mucus, blood, and liquid feces, which interfere with proper
visualization of the intestinal mucosa.
23. What is the recommended position of the patient during flexible fiberoptic sigmoidoscopy?
Sims’ position.
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24. How can the medical assistant help the patient relax during the sigmoidoscopy?
By telling the patient to breathe slowly and deeply through the mouth.
25. What parts of the colon are viewed during a colonoscopy?
Sigmoid colon, descending colon, transverse colon, and ascending colon.
26. What is the purpose of a full bowel preparation before a colonoscopy?
To empty the colon of fecal material that can interfere with good visualization of the wall of
the colon, making it difficult to detect abnormalities.
27. How should a patient consume the liquid laxative solution when preparing the bowel for a
colonoscopy?
Drink one 8-ounce glass of the liquid laxative solution every 10 to 15 minutes until 2 quarts
(eight 8-ounce glasses) have been consumed.
28. Where is the prostate gland located?
The prostate gland surrounds the urethra and is located just below the bladder and in front
of the rectum.
29. What are the symptoms of prostate cancer?
Difficulty in urinating; weak or interrupted urinary flow; pain or burning during urination;
frequent urination; blood in the urine; pain in the lower back, pelvis, or upper thighs.
30. How is the digital rectal examination used for the early detection of prostate cancer?
Normally, the prostate gland should feel soft, whereas malignant tissue is firm and hard.
31. What conditions can cause an elevated PSA level?
Prostate cancer, benign prostatic hyperplasia, and prostatitis.
32. What is the PSA level for each of the following:
a. Normal range 0 to 4 ng/ml.
b. Slightly elevated range 4 to 10 ng/ml.
c. Moderately elevated range 10 to 20 ng/ml.
d. Highly elevated Greater than 20 ng/ml.
33. What patient preparation is required for a PSA test?
Engage in normal activity for 2 days before the test (avoid vigorous exercise); do not have
sexual intercourse for 2 days before the test.
34. What tests may be ordered by the physician if the patient has positive prostate screening
results?
Transrectal ultrasound, biopsy of the prostate gland, bone scan, and CT scan.
35. What is the definition of the term screening?
The process of testing an individual to detect a disease in that individual who is not yet
experiencing symptoms of that disease.
36. What is the American Cancer Society recommendation for the PSA test and the DRE?
Health care providers discuss the potential benefits and limitations of prostate screening with
men older than 50 years of age; following this discussion, the PSA test and the DRE should
be offered annually to men 50 years and older who are at average risk for prostate cancer
and have at least a 20-year life expectancy. Those men who indicate a preference for testing
should be tested.
37. When does testicular cancer most commonly occur?
Between the ages of 15 and 34.
38. When is the best time for a male to perform a testicular self-examination (TSE) and why?
After taking a warm bath or shower. Heat allows the scrotal skin to relax and become soft,
making it easier to palpate the underlying testicular tissues.
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Instructor’s Resource Manual
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39. What are the risk factors for testicular cancer?
History of undescended testicles, family history of testicular cancer, cancer of the other
testicle, Caucasian race.
40. What is the most common sign of testicular cancer?
A small, hard, painless lump located on the front or side of the testicle.
CRITICAL THINKING ACTIVITIES
A. FOBT Patient Preparation
Frank Morrison has been given a Hemoccult slide kit for fecal occult blood testing (FOBT). In the
space provided, plan breakfast, lunch, and dinner for him following the FOBT patient preparation
guidelines on page 553 of your textbook.
Answers vary according to individual student responses.
C. Capsule Endoscopy
Perform an Internet search for capsule endoscopy. Search for textual information and videos of
this procedure. Based upon your research, answer the following questions regarding this
procedure.
1. What is capsule endoscopy?
2. What conditions can be diagnosed using capsule endoscopy?
3. What patient preparation is required for this procedure?
4. What are the advantages of capsule endoscopy?
5. What are the disadvantages of capsule endoscopy?
APPLY YOUR KNOWLEDGE
Choose the best answer to each of the following questions.
1. Tess Terrell, a 52-year-old woman, comes to the medical office for a complete physical
examination. As part of the examination, she is given a Hemoccult test to perform at home.
Tess asks Megan Baer, CMA (AAMA), why she has to do this test. Megan explains to her that
the purpose of a Hemoccult test is to
A. Screen for the presence of blood in the stool
B. Detect the presence of parasites in the stool
C. Detect the presence of polyps in the large intestine
D. Diagnose colorectal cancer
2. Megan instructs Tess on how to prepare for the Hemoccult test. Megan relays all of the
following information to her except
A. Discontinue taking vitamin supplements that contain iron.
B. Eat moderate amounts of broccoli and melon.
C. Start the diet modifications 3 days before collecting the first stool specimen.
D. Do not eat any red meat.
3. Tess asks Megan why she must consume a high-fiber diet during the testing period. Megan
explains that a high-fiber diet
A. Prevents the occurrence of a false-negative test result
B. Prevents gastrointestinal irritation during the test
C. Encourages bleeding from intestinal lesions
D. Flushes toxins out of the colon that could affect the test results
E. All of the above
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Instructor’s Resource Manual
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4. Tess completes the Hemoccult test and returns it to the medical office. Megan develops the
slides. After applying the developing solution to the first slide, Megan observes a trace of blue
at the edge of the slide. Megan records this as
A. Slide 1: Positive
B. Slide 1: Negative
C. Slide 1: No reaction
D. Slide 1: Invalid
5. Dr. Polyp instructs Megan to schedule Tess for a sigmoidoscopy and to instruct Tess in
proper bowel preparation. Megan instructs Tess to perform all of the following except
A. Do not take aspirin or iron starting 5 days before the procedure.
B. Do not consume solid food starting the day before the procedure.
C. Consume only milk and milk products starting the day before the procedure.
D. Take a laxative the evening before the procedure.
6. Tess arrives at the medical office for the sigmoidoscopy. Megan prepares Tess for the procedure
by positioning her in
A. Fowler’s position
B. Sims’ position
C. Knee-chest position
D. Prone position
7. During the sigmoidoscopy procedure, Megan assists Dr. Polyp by
A. Lubricating Dr. Polyp’s gloved finger for the digital rectal examination
B. Lubricating the distal end of the sigmoidoscope
C. Assisting with suction equipment
D. Holding a specimen container to accept a biopsy specimen
E. All of the above
8. After the sigmoidoscopy, Megan cleans up the examining room. She removes the flexible
sigmoidoscope to the back work area and cleans it by
A. Rinsing it with hot water
B. Sanitizing and disinfecting it
C. Sterilizing it in the autoclave
D. Soaking it in kerosene
9. Ted Wright, 50 years old, comes to the medical office for a physical examination. After
talking with the physician, Ted decides to have a DRE and a PSA test. Ted asks Megan Baer,
CMA (AAMA), to explain the purpose of this type of screening again. Megan responds by
telling Ted that it
A. Screens for the presence of colorectal cancer
B. Determines the cause of infertility
C. Assists in the diagnosis of colitis
D. Screens for the presence of prostate cancer
10. Megan draws a blood specimen from Ted for a PSA test. Ted asks Megan what the normal
range is for this test. What does Megan tell him
A. 0 to 4 ng/ml
B. 4 to 10 ng/ml
C. 10 to 20 ng/ml
D. More than 20 ng/ml
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Instructor’s Resource Manual
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11. Matt Coleman, 22 years old, comes to the medical office for an employment physical. Dr.
Polyp asks Megan Baer, CMA (AAMA), to instruct Matt in the procedure for a testicular
self-examination. All of the following instructions are included in Megan’s discussion except
A. Perform the examination once each month.
B. Refrain from sexual intercourse for 2 days before performing the examination.
C. Take a warm shower before performing the examination.
D. Palpate each testicle for lumps using both hands.
12. While taking Matt’s medical history, Megan obtains the following information. Which of the
following puts Matt at higher risk for testicular cancer?
A. Matt was born with undescended testicles.
B. Matt collects old coins.
C. Matt is a vegetarian.
D. Matt is of African-American heritage.
VIDEO EVALUATION FOR CHAPTER 13: COLON PROCEDURES AND MALE
REPRODUCTIVE HEALTH
Video: Procedures 13-1 and 13-2: Fecal Occult Blood Testing
____T___1. Colorectal cancer is one of the most common forms of cancer in individuals older
than 50 years.
____T___2. During the early asymptomatic stages, almost all neoplasms of the colon and
rectum bleed a small amount on an intermittent basis.
____F___3. Hidden blood in the stool is known as melena.
____T___4. The stool sample should not be collected if there is visible blood in the stool or
urine.
____F___5. The patient should be instructed to consume foods that are low in fiber starting 3
days before the collection period.
____T___6. Improper patient preparation for the FOBT can lead to inaccurate test results.
____T___7. The slides contain filter paper impregnated with guaiac, a chemical necessary for
detection of blood in the stool.
____F___8. The patient should be instructed to store the slides in the refrigerator.
____T___9. If the Hemoccult slides are exposed to heat, the active reagents impregnated on
the filter paper can deteriorate, leading to inaccurate test results.
____T___10. The patient should be instructed to collect a stool specimen from two different
parts of the stool.
____F___11. A thick smear of the stool specimen should be spread over the filter paper.
____F___12. The wooden applicators should be flushed down the toilet.
____F___13. A standard envelope can be used to mail the Hemoccult slides to the medical
office.
____T___14. An outdated solution should not be used to develop the slides because it can lead
to inaccurate test results.
____T___15. Two drops of developing solution should be applied to the guaiac test paper
underlying the back of each smear.
____T___16. The developing solution can cause irritation of the skin and eyes if contact occurs.
____T___17. Failure of the expected control results to occur indicates an error, and the test
results are not valid.
____F___18. The Hemoccult slides should be discarded in a biohazard waste container.
Copyright © 2012, 2008, 2004, 2000, 1995, 1990, 1984, 1979 by Saunders, an imprint of Elsevier Inc.