Scrotum

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created 5 years ago by Annabelle
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updated 5 years ago by Annabelle
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1

What is the length of the testis?

3-5 cm

2

What is the width of the testis?

2-3 cm

3

What is the volume of the testis

25 ml

4

Which gene determines sex?

Y

5

What what age do embryos look the same?

up to 8 weeks

6

what drives structural changes?

hormones

boys get a testosterone bath

7

Where do the testes develop?

near the kidneys

8

At what time do the testes descend?

7 months (28 weeks)

9

where do the testis drop?

through the inguinal canal into the scrotum

10

Name the 2 parts of the testis

outer sac
internal contents

11

Name the external genitalia

scrotum
penis

12

name the internal genitalia

prostate
seminal vesicles
Bulbourethral gland
vas deferens
testes

13

Explain the layers of the scrotum from out to in

card image

skin
tunica dartos
external spermatic fascia
cremaster muscle
internal spermatic fascia
tunica vaginalis X2
tunica albuginea

14

what does the external spermatic fascia cover?

the cremaster muscle

15

explain the significance of the tunica vaginalis

it is an double walled covering with a visceral and parietal layer

16

What type of gland is the testi?

endocrine - testosterone
exocrine - sperm

17

what is the outer coat of the testis

card image

tunica albuginea

18

what does the tunica albuginea form?

extends into the testi to form the mediastinum

19

What is the mediastinum testis?

formed from the extension of the tunica albuginea the mediastinum testis radiates into the testi to form 200-300 lobules containing seminiferous tubules

20

what is the function of seminiferous tubules

card image

spermatogenesis

21

explain the path of sperm after leaving the seminiferous tubules

straight tubules
Rete testis
efferent ducts - head epididymis

22

What arteries supply the testis?

testicular arteries off the aorta

23

what veins drain the testis?

card image

pampiniform plexus
testicular veins
Rt - IVC
Lt - Lt renal vein

24

Describe the shape of the epididymis

card image

comma shape

single long convoluted tube

25

How long is the epididymis tube?

20 feet
6 meters

26

Which part of the epididymis is the largest?

head

27

Where does the head lie

card image

most superior

28

where does the body of the epididymis lie?

card image

extends along the posterior aspect

29

Where is the tail of the epididymis

card image

thinnest most inferior part

30

What is problematic of the inguinal canal?

card image

tends to be weak
common place for hernia

31

What is the spermatic cord composed of?

vas deferens
arteries
veins
nerves
lymphatics
cremaster muscle

32

What is the function of the cremaster muscle?

temperature regulation

33

Seminal vesicles VS seminiferous tubules

seminiferous tubules - spermatogenous
Seminal vesicles -

34

What is the function of the vas deferens?

connect the tail of the epididymis to the prostate

35

How long is the vas deferens?

18 inches

36

Explain the route of the vas deferens.

card image

travels through the inguinal canal
travels over the top of the pubic bone
swings around to the back side of the bladder

dilates distally to form the ampulla of deferens

joins the seminal vesicles
into the superior section of the prostate

37

What does the epididymis consist of?

3 smooth muscles

38

what is the ampulla of deferens

card image

dilation of the vas deferens just before it enters the prostate

39

What is the ejactlatory duct?

card image

vas deferens joins the seminal vesicles

40

What is the function of the seminal vesicles?

secretes 60% of seminal fluid

41

What is the function of the prostate?

produces 30 % of seminal fluid

42

what is the shape of the prostate?

cone shaped

base and apex

43

What does the Prostate consist of?

various regions and zones

44

levator ani muscles

card image

pelvic floor muscles

45

What is the prostate urethra?

part of the urethra that runs through the prostate

46

bulbourethral gland

card image

5% of seminal fluid

clear and thick lubricant;
flushing agent that washes out the urethra

47

What is the Cowper’s Gland?

another name for bulbourethral gland

48

Seminal Fluid

60% seminal vesicles
30% prostate
5% bulbourethral gland

49

Appearance of the prostate

hetergenous

50

What are the regions of the prostate?

card image

veramontanum - prostatic portion of the urethra where the seminal ducts enter

Peripheral zone (PZ)

Central zone (CZ)

Transition zone (TZ)

fibromuscular zone (or stroma)

periurethral zone

51

What is the penis consist of?

3 cylinder masses

2 corpus cavernosum
1 corpus spongiosum

52

Where does the urethra run through the penis?

within the posterior spongiosum

53

what bounds and divided the the three cylinder masses of the penis

card image

tunica albuginea
buck's fascia - fibrous envelope

54

What type of blood engorges penis during erection

venous blood

55

Explain the flow of penile arteries

internal iliacs

internal pudendal

- deep artery of the penis
- corpus cavernosum

- bulbourethral artery
- corpus spongiosum , glans penis

56

Explain venous flow of the penis

superficial and deep dorsal vein
pudendal venous plexus
internal pudendal vein
internal iliac vein

57
card image

...

58

What do Reproduction organs begin from?

2 urogenital folds

59

What does the urogenital folds consist of?

  • gonad
  • mesonephros
60

What does the mesonephos develop into

  • metanephos
  • urogential sinus
61

What does the gonad develop into

  • mesonephric duct
  • paramesonephric duct
62

What does the paramesonephric duct develop into?

female genitalia

  • vagina
  • uterus
  • fallopian tubes
63

What does the mesonephric duct develop into?

male genitalia

  • testis
  • penis
64

What is the wolfian duct

mesonephric duct

65

What is the mullerian duct

paramesonephric duct

66

Which gender has mullerian and wolfian ducts?

both

67

What is the sonographic appearance of the scrotum & testes?

homogeneous

medium level echoes

bilaterally equal in size

echogenic midline

epididymis superior posteriorly to the testicle

slightly more echogenic

more course texture

Blood flow is evident on color Doppler

through out the parenchyma

68

What transducer should be used on a scrotal exam?

5 - 7 MHz Linear transducer

69

What should the patient be dressed during a scrotal exam?

maintain patient dignity

70

What techniques should be used during a scrotal exam?

place towel under testis for support

71

What are the required images for a scrotal exam?

  • longitudinal

upper

mid

mid with measurement

lower

  • transverse

med

mid

mid with measurement

lateral

  • comparison
72

What are the reasons for a scrotal scan?

R?O torsion

trauma

pain

size change

nodularity on physical exam

possible varicocele

R/O Hernia

locate undescended testicle

F/U Hydrocele

inflamation

infection

73

At what age do the testicle descend into the sac?

28 weeks

74

What drives the descent of the testicles?

gonatrophins

75

What happens if the testicles do not descend?

orchiopexy

surgery to correct

76

What is the medical intervention for a hematoma on a testicle?

let it heal on its own

77

What happens if a testicle gets ruptured?

medical emergency

within 72 hours the testicle can be saved

78

What is the sonographic appearance of a epididymal cyst?

hypoechoic

79

What is a spermatic cyst?

AKA epididymal cyst

80

What is a spermatocele?

AKA epididymal cyst

81

What causes a epididymal cyst?

obstruction of efferent ductile

old sperm

82

How dangerous are the large epididymal cyst?

usually benign

83

How dangerous are the small rigid epididymal cyst?

cause a lot of pain

84

What is the normal epididymal A/P measurement?

8 mm

85

What is the normal skin measurement of the skin surrounding the testicle?

2 mm

86

What is epididymitis?

inflammation of the epididymis

87

What is the most common cause of acute scrotal pain and tenderness?

epididymitis

88

What is the treatment for epididymitis?

responds well to antibiotics

89

What is the presentation of epididymitis?

fever

painful urination

90

What is the sonographic appearance of epididymitis?

enlarged epididymis (more than 8 mm)

increased flow

91

What is orchitis?

inflammation of a testicle

complication of epididymitis

92

What is the sonographic appearance of orchitis?

heterogenius

hyperechoic

reactive hydrocele

93

What is the presentation of orchitis?

elevated WBC

enlarged

skin thickening

94

What is a bell clapper?

narrow or absent bare area of the testicle

tunica albuginea closes all the way around testicle

95

What is the problem with a bell clapper?

when tunica albuginea closes all the way or most of the way there is no bare area and no place for the testicle to attach to scrotal wall

96

What is the common age for testicular torsion?

12 - 18

97

What is the peak age for testicular torsion?

13

98

What is testicular torsion?

testicle twists blocks blood flow

congenital

99

What is the sonographic appearance of testicular torsion?

No flow

contralateral to normal

enlarged

hypoechoic

100

What happens when a patient has testicular torsion?

24 hours

emergency

will become necrotic after 24 hours

101

What is hydrocele?

accumulation of serous fluid between the tunica vaginalis

102

What is the most common cause of painless scrotal swelling?

hydrocele

103

What is congenital hydrocele?

vaginalis usually closes after testis descend

if open fluid can leak into scrotum

104

What is acquired hydrocele?

abdominal secretions leak through

105

What happens to congenital hydrocele?

by 24 months usually resides

106

What causes acquired hydrocele?

infection

infarction

neoplasm - 60%

trauma - 25%

107

What is Varicocele?

abnormal enlargement of the pampiniform venous plexus in the scrotum

108

What is the sonographic appearance of varicocele?

pampiniform plexus larger than 2 mm

pampiniform usually not seen in U/S

109

What side is a varicocele on?

left because left spermatic cord drains into the left renal vein and causes reverse flow when valves are not created

110

What causes 40% of infertility in men?

varicocele

111

What is the biggest problem with varicocele?

increased flow causes testis to get to HOT and cause infertility

112

What are techniques to prove varicocele?

ask the patient to take a deep breath

or stand and pampiniform should dilate

113

What is a scrotal hernia?

bowel comes through when older men get loose

114

What is the sonographic appearance of varicocele?

bowel in the scrotum

peristalsis

115

What is testicular microlithiasis?

tiny micro fications without shadow

116

What is the sonographic appearance of testicular microlithiasis?

tiny micro fications without shadow

117

What does testicular microlithiasis cause?

infertility

precursor for testicular cancer

118

Names the solid malignant masses.

seminoma

embryonal cell carcinoma

yolk sac tumors

teratomas

119

What make up 95% of all testicular tumors?

germ cell tumors

120

What is a germ cell tumor?

highly malignant tumor associated with

elevated AFP

elevated HGC

121

What is AFP?

alpha fetal proteins

122

What is HCG?

human chorionic gonadotropin

123

What is 40-50% of solid malignant testicular masses?

seminoma

124

What is 25% of solid malignant testicular masses?

embryonal cell carcinoma

125

What is 60% of solid malignant testicular masses in infants?

yolk sac tomors

126

What is 5-10% of solid malignant testicular masses?

teratomas

127

What is a seminoma?

Solid malignant mass

generally found in 30 - 40 year olds

128

What is embryonal cell carcinoma?

malignant testicular tumor

less common but more aggressive

129

What is the most common germ cell tumor in infants?

yolk sac tumors

130

What is a teratoma?

malignant testicular tumor in adults

*generally benign in children

131

What is the sonographic appearance of a seminoma?

hypoechoic

single mass

132

How sensitive is ultrasound in diagnosing testicular tumors?

100%

133

Where are most malignant testicular masses found?

intratesticular

134

Where are most benign testicular masses found?

extratesticular