Write Up: Rectal Cancer, Part 2 (Physical)

General Examination (all post-operatively):

Patient was alert, conscious and comfortable. He is cachexic, with good hydration, not dyspneic, not in distress or pain. There is an intravenous cannulation access line on his right forearm and it is unattached to anything.

He appeared anemic, with slight conjunctival pallor noted.

There was no cyanosis.

He has scleral jaundice, but no other signs of chronic liver disease, e.g. Palmar erythema, Dupuytren’s contracture, spider naevi, hepatic flap and leukonychia. 

He did however, have bilateral pitting edema up to the sacrum.

There was no sternal tenderness.

His vital signs are generally stable.

PR = 90 bpm

BP = 140/90, borderline hypertensive

RR = 14 cycles per minute

T = 37 

Abdominal Examination:

The abdomen was non-distended, moving freely and symmetrically with respiration. The umbilicus was centrally located, inverted. There were no striae, no dilated veins, no visible peristalsis.

There was a vertical midline laparotomy scar, measuring about 13 cm in length. It has healed with minimal scarring, dry, and not infected.

There was a colostomy attached at the left iliac fossa, with no spouting, clean with no leakage, contains air and fecal remnants brownish in color, no blood, 

The abdomen was soft and non-tender. Surgical scar was also non-tender.

There is a single mass felt at the suprapubic region, measuring about 8 x 8 in size, spherical in shape, solid, firm, smooth, nonmobile, non-tender, with an indiscriminate border. The lower border could not be felt, the mass not enhanced by tensing the abdominal muscles, not warm, and without overlying skin changes.

There was hepatomegaly with a 17 cm liver span, about 4 finger breadths below the costal margin in the midclavicular line. The liver was non-tender, with a blunt edge, smooth surface, firm consistency.

There was no splenomegaly, the kidneys were not ballotable, there was no shifting dullness or fluid thrill. Bowel sounds were present and normal. No renal bruits.

No spine tenderness.

Per Rectal Examination:

No abnormalities detected on inspection.

There was normal anal tone. 

Finger could not get above 5 cm from the anal verge. There was a mass, which could not be circumscribed as it occupied the whole rectum. The mass was fixed, smooth, size could not be determined, non-tender. The prostate was not enlarged, firm in consistency, smooth in surface.

There was no blood, only brownish residue. No melenic odor.

Cardiovascular Examination:

Apex beat was located at the 6^th intercostal space in the left anterior axillary line. No gallop rhythm, no murmurs, including ejection systolic murmur

Jugular venous pressure not present.

Respiratory Examination:

Air entry was adequate bilaterally and equal. No basal crepitations.

Lymph Node Examination:

No cervical, supraclavicular, or inguinal nodes palpable.