Chapter 23 Scrotum First 1/2 PPT

Helpfulness: +1
Set Details Share
created 3 years ago by Brittanydms
57 views
show moreless
Page to share:
Embed this setcancel
COPY
code changes based on your size selection
Size:
X
Show:
1

...

Anatomy:

  • Scrotum
  • Testicles
  • Seminal Vesicles
  • Prostate
  • Penis
2

Identical

Kidneys

16

Embryology:

  • Gender determined by Y chromosome
  • Male/female embryo _____ until __ th week
  • Testicles arise in fetal upper abdomen near ____
  • Testes descend to urinary bladder by ___ weeks
3

8th; genital tubercle

Empty

Penis

Embryology:

  • Prior to ___ week, all embryos have region called the ___ ____
    • elevated area between coccyx and umbilical cord
      • Mesonephric and paramesonephric ducts ____
  • In males, genital tubercle elongates to form the ____
4

inguinal canal; 7th

3rd; prostatic urethra

Prostate gland

Prenatal Development:

  • Testes descend through _____ into scrotum after __ month
  • Prostate develops during ___ month
  • ____ of urinary bladder narrows to form the ____ _____
  • These buds develop into tubules, which elongate & multiply to form lobes of ____ ____
5

Testicles, epididymis, ductus deferens

Raphe

Dartos; tunica dartos

Scrotum:

  • Skin and superficial fascia of scrotum are continuous with the abdomen
  • Contains the ____, _____, and proximal portion of ____ ____
  • Scrotum divided into lateral portions by a median ridge called the ____
  • Internally the scrotum is divided into sacs by a septum consisting of the ____, or ____ ____
6

Dartos; small vessels

Posterior

Cremaster Muscle

Temperature

Scrotum:

  • ____ contains superficial fascia and contractile tissue; abundantly supplied by ____ ____
  • ____ to dartos lies the external spermatic fascia (continuation of the external oblique fascia of the abdominal wall)
  • ____ ____ surrounds each testicle and extends into the abdomen over the spermatic cord
    • regulates the _____ of the testes
7

Tunica vaginalis

Infundibuliform fascia

Tunica vaginalis

Scrotum:

  • Deep surrounds the covering layers of the testes, the ____ _____
  • Deep to cremaster muscle is the innermost fascial layer of the scrotum, the internal spermatic fascia or _____ ______
    • surrounds the covering layers of the testes, the ____ _____
8

Exocrine

Endocrine

Testes:

  • Male gonads (endocrine and exocrine glands).
  • _____ function – produce sperm, which are transported through ducts that store and transport the sperm.
  • _____ – produce testosterone
9

Ovoid

3-5

2-3

2-4

Decreases

Testis Size:

  • Adult testicle
  • ____ shape
    • __-__ cm length
    • __-__ cm A-P dimension
    • __-__ cm width
    • Size _____ with age
10

Tunica albuginea

Mediastinum, rete

Mediastinum

Testis:

  • Each testis covered by dense fibrous tissue called ____ ____ testis
  • Thickened portion of tunica albuginea is the ______ testis at region of ____ testes.
  • The _____ testis supports testicular vessels and ducts.
11

Mediastinum

Seminal fluid; epididymis

Testis:

  • Rete testis located within the ______ testis
    • Carries ____ ____ from testis to _____ through efferent ductules
    • Superior aspect of testicle
12

250

Leydig

Testoserone; androgens

Rete

Testis:

  • ____ lobules, each contain one to three convoluted seminiferous tubules, which produce sperm (spermatozoa)via spermatogenesis
    • ____ cells located between tubules
      • Responsible for prodcuing _____ and _____
  • Tubules empty into the straight tubules, which converge with the ____ testis
13

Testicular

Right; IVC

Left; LRV

Vascular Anatomy:

  • Blood supply is via the internal ______ artery (internal spermatic arteries) – arise from the anterior aspect of the aorta just inferior to the renal vessels
  • ____ testicular vein drains in to the ____ near the renal veins
  • ____ testicular vein drains into the ___
14

Testicular; Centripedal

____ artery >Capsular artery>_____ artery>Recurrent rami

15

6-7

Superior; posterior

Ductus deferens

Epididymis:

  • __-__ cm tubular structure
  • EPIDIDYMIS connected to ____ portion of testis and runs along the ____ aspect to the base of the testis
  • Drains into the ____ ____ at base of testis
16

Head; 6-15

Ductus epididymis

Tail; ductus deferens

Epididymis:

  • Subdivided into:
    • ____ (globus major) larger (__-__ mm), superior portion
    • Body runs along posterior aspect of testis and contains ____ _____, harder to see
    • ____ (globus minor) smaller, inferior portion, where ductus epididymis empties into _____ _____
17

10-15; rete

Single

Spermatic cord

Epididymis:

  • Contains __-__ efferent tubules from ____ testes
  • Converge to form ____ duct-ductus epididymis
    • Becomes vas deferens and continues into ____ ____
18

Thicker

Ampulla of the deferens

Ejaculatory duct

Verumontanum

Ductus Deferens:

  • _____, less convoluted continuation of ductus epididymis
  • At terminal end, near seminal vesicles, the ductus dilates; known as ____ _____
  • Joins duct of seminal vesicles to form the ____ ____
    • Empties into urethra at ______
19

Two; scrotum; pelvis

Ductus deferens; testicular; pampiniform plexus; cremaster

Spermatic Cord:

  • ____ cords extend from _____ through the inguinal canals and internal inguinal rings into the ____
  • Each cord contains the ____ ____, _____ arteries, venous _____ _____, lymphatics, autonomic nerves, and fibers of the _____ muscle
20

Posterior; superior

medially; apex; ureters

Ejaculatory duct; prostatic urethra

Seminal Vesicles:

  • Paired glands that lie _____ to bladder & _____ to prostate
  • Each vesicle angles _____ toward the ____ of the bladder and lies medial to the _____
  • Joins with ductus deferens to form _____ ____; ducts course through PG & empty into ____ ____
21

Convoluted; ejaculatory ducts

5; 1

Seminal Vesicles:

  • ____ pouch-like structures emptying into the distal portion of the ductus deferens to form the ____ ____
  • Each measures __ cm in length and less than __ cm in diameter
22

Size; texture; vascularity

Masses

Peritesticular

What to look for:

  • Testicular ___, ____ and _____
  • Inflammatory process
  • Presence and composition of _____
  • Detection of _____ fluid collections
23

Scrotal trauma

Pain

Undescended testicles

Scrotum:

  • Evaluation of ____ ____
  • Doppler: R/O torsion
  • Evaluation of scrotal ____
  • Location of _____ _____
24

Homo

Medium

Echogenic; mediastinum testis

Tunica vaginalis

Sono appearance: Scrotum

  • ____geneous
  • ____ level echoes
  • _____ line along the long axis: _____ _____
  • Small amt. fluid between layers of ____ ____
25

Chaperone

High

Prior

Scrotum:

  • Be fully aware of the facility’s protocol regarding a _____ in the examining room. When in doubt, GET a hospital employee TO WITNESS THE ENTIRE EXAM.
  • Choose a ____ frequency linear probe; have pt. cart lowered and neat
  • Note: children and young men are sometimes more self-conscious so a thorough patient history and detailed explanation of the exam are a must ____ to the start of the exam.
26

Injury

Pain

Lump

Indications for Scrotal Scan:

  • Recent ____ - when?
  • ____, use scale 1-10
  • was pain sudden or just worse over time
  • pt feels a “____”- can they find the area?
  • clinician felt an abnormalities on examination- side? Can the patient feel the area in question?
27

Enlargement

Dysuria

Blood

Indications for Scrotal Scan:

  • _____ of the scrotum, bilateral R, or L
  • Fertility work-up (are there palpable areas in the groin (Lt especially)
  • Chlamydia, orchitis, mumps, syphilitic orchitis, trauma
  • _____
  • ____ in urine
28

Intravaginal; spermatic

More; spermatic cord; tunica vaginalis

Pediatric:

  • With _____ torsion only the _____ cord is involved
  • Newborns are ____ likely to experience an extravaginal torsion when the _____ ____ and the ____ _____ are invoved.
29

Testicles

Superior; posterior

Coarse

Spermatic cord

Scrotum:

  • _____ are surrounded by a white, dense, fibrous capsule – tunica albuginea
  • Head of epididymis seen _____ and ____ to testicle
  • Texture of epididymis more ____
  • _____ ____ seen as it courses through inguinal canal
30

Longitudinal; transverse

Valsalva’s

NORMAL

Scrotum:

  • Images of both testes are obtained in the _____ and _____ projections
  • A transverse scan with both testes for comparison is taken
  • Upright views or ____ maneuver when necessary
  • Color flow and Power mode Doppler is obtained; if one testicle contains pathology or is painful (torsion) set the color on the ____ testicle and do not change the color dial.
31

CRYPTORCHIDISM; failure

Cancer; 35

Klinefelter’s; pseudohermaphrodism; microcalcifications

Congenital Variants:

  • _______– _____ of testicles to descend into scrotum
    • Common locations: abdomen, inguinal canal, external inguinal ring
  • An undescended testicle places the patient’s chance for _____ up to ____ times higher than normal
  • ______ syndrome, male _______, and testicular neoplasms will have more ____
32

Hermaphroditism

Pseudohermaphroditism

Mosby's:

  • _____– testicular and ovarian tissue in same person
  • ______– person has either male or female gonads, but external genitalia of the opposite sex, or both
33

Varicocele; veins; epididymis; spermatic cord

Extratesticular Pathology:

  • Hydrocele, hematocele, pyoceles
  • _____-collection of abnormally dilated, tortuous, and elongated ____ of the pampiniform plexus (posterior to testes, accompanying _____ and vas deferens within the _____ ____).
  • Hernia, Tumors, Epididymal lesions, and Epididymitis
34

Doughnut

2

Denonciller’s fascia

Obturator internus; levator ani

Prostate Location:

  • _____-like gland:
  • Anterior surface __ cm. posterior to the symphysis pubis, posterior surface is the rectum.
  • Rectum is separated from prostate by ____ _____
  • Laterally prostate is supported by the _____ _____ & ____ ____ muscles
35

Secretions

Distal urethra; external urethral orifice

Prostate:

  • Prostatic _____ are conveyed through numerous prostatic ducts to prostatic urethra (located at central core of the prostate)
  • Fluids are carried outside body through the penis via the ___ ____ and ____ ____ ____
36

20

4

3

3.8

Age

Prostate:

  • Weighs ___ g
  • Measurement:
    • __ cm transversely
    • ___ cm A-P
    • ___ cm in cephalocaudal dimension
    • May enlarge with ___ secondary to benign hypertrophy (BPH), malignancy, or other causes
37

function

4.0

2.5

Prostate Lab Values:

  • Serum Prostatic Specific Antigen (PSA): used to evaluate ____ of the prostate
    • All glandular tissues of the prostate produce PSA.
  • Normal values:
    • 2 tests
      • 1. monoclonal assay nml = __ ng/ml
      • 2. polyclonal assay = 0.2 to ___ng/ml
38

0.75

Masses

Transurethral resection of the prostate

Prostate Lab Values:

  • Also check for an annual increase ___ng/ml = risk for prostate cancer
  • Infection (prostatitis)
  • Detection of ____
  • Evaluation of BPH
  • Staging of cancer spread
  • Evaluate TURP-____ _____ ____ ___
  • Biopsy guidance
39

Peripheral; central; glandular

Zonal Anatomy:

  • The prostate is divided into zonal anatomy. These can be divided by an outer gland: ____ zone and an inner gland: ____ zone, transition zone and periurethral ____ zones
40

Hetero; medium

Glandular; fibromuscular

Symmetrical

Sono Appearance: Prostate

  • ___ogeneous with ____ level echoes
  • Contains ____ and _____ tissue
  • Should appear _____
41

Prostatic urethra

APEX

BASE

Prostate:

  • Shaped like cone with central core – ____ ____
  • Tip of cone – ____– is inferior margin of prostate, provides exit for urethra
  • ____ is superior – in contact with bladder
42

Posterior; obliquely; anteriorly; verumontanum

FIBROMUSCULAR STROMA

Prostate:

  • Ejaculatory ducts enter prostate at ____ margin and course _____ and _____ to join the prostatic urethra near the _____(close to center of gland)
  • ______ _____- anterior to prostatic urethra
43

Largest; 70; malignancy

20

5

1

Posterior glandular portion – ZONES:

  • Peripheral zone: ____ (__%); lat. & post. To distal prostatic urethra- Most common location of _____
  • Central zone: (__%); at prostatic base; the ducts of vas deferens and SV enter central zone
  • Transition zone: (__%); 2 lobes on lateral aspects of prox. Urethra sup. to verumontanum- Area where BPH occurs
  • Periurethral zone (< _%)
44

Semilunar

Rounded

Hyperechoic

periurethral tissue; fibromuscular stroma

Prostate:

  • Appears ____ near base (superiorly)
  • Becomes ____ near the apex (inferiorly)
  • _____ to normal seminal vesicles
  • Low level echoes anterior & midline represents ____ _____ and ____ ____
45

Central; transition

Peripheral; echogenic; homogeneous

Posterior; lateral

Prostate:

  • ____ zone and _____ zone not distinguished individually
  • _____ zone appears more _____ and ______
  • Peripheral zone occupies ____ and ____ portions