Male Genitalia and Hernias Flashcards Preview

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Flashcards in Male Genitalia and Hernias Deck (73):
1

Shaft of the penis is formed by what three columns of vascular erectile tissue?

Corpus spongiosum (contains urethra, ends in glans)

2 corpora cavernosa

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2

Smegma

  • Cheesy whitish material - a combination of exfoliated (shed) epithelial cells, transudated skin oils, and moisture. It occurs in both female and male mammalian genitalia.
  • collects under prepuce/foreskin
  • Normal

3

epididymis

on posterolateral surface of each testis

soft, comma shaped

consists of tightly coiled spermatic ducts that provide a reservoir for storage, maturation, and transport of sperm from testis to vas deferens

4

What happens during ejaculation?

  • the vas deferens transports sperm from tail of epididymis along a somewhat circular route to the urethra

 

5

path of the vas deferens

vas ascends scrotal sac into pelvic cavity through external inguinal ring, then loops over the ureter to the prostate behind the bladder. There it merges with the seminal vesicle to form the ejaculatory duct, which traverses the prostate and empties into the urethra

6

what structures contribute secretions to spermatic fluid?

vasa deferentia, seminal vesicles, prostate

(plus sperm stored in epididymis)

7

How does erection occur

  • venous engorgement of the corpora cavernosa.
  • Results from 2 types of stimuli
    1. visual, auitory, or erotic cues trigger sympathetic outflow from higher brain centers to the T11 through L2 levels of spinal cord
    2. Tactile stimulation initiates sensory impulses from the genitalia to Sto S4 reflex arcs and parasympathetic pathways through the pudendal nerve
    • both seem to increase levels of nitric oxide and cyclic GMP --> local vasodilation

 

8

Anatomy: inguinal ligament, inguinal canal, external inguinal ring, pubic tubercle

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9

Is the external inguinal ring palpable?

Yes. Triangular, slitlike structure palpable just above and lateral to the pubic tubercle

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10

Are the internal inguinal ring and inguinal canal palpable?

No.

11

How do inguinal hernias form?

When loops of bowel force their way through weak areas of the inguinal canal

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12

Indirect Inguinal Hernia

  • develops at interna inguinal ring, where spermatic cord exits abdomen
  • most common.
  • Occur across all ages, even kids.
  • Palpate: Above inguinal ligament near internal inginal ring, often in scrotum. Hernia comes down between inginal canal to touch finger.

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13

direct inguinal hernia

  • more medial than indirect
  • from weakness in the floor of the inguinal canal  
  • associated with straining and heavy lifting
  • less common
  • men >40yo, rare in women.
  • Palpate: Above inguinal ligament near external inguinal ring. Rare in scrotum. Hernia bulges anteriorly and pushes side of finger forward during exam

 

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14

Femoral hernia

  • in femoral canal below inguinal ligament
    • lateral, never in scrotum
  • Least common

  • More in women than men

  • more likely to present as emergencies with bowel incarceration or strangulation

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15

How to find femoral canal

  • can't see it, so estimate by placing right index finger, from below, on right femoral artery.
    • Your middle finger will then overlie the femoral vein
    • your ring finger,the femoral canal - where hernias protrude

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16

DDx for lack of libido

  • psychogenic causes, e.g., depression
  • endocrine dysfunction
  • side effects of meds (e.g., SSRIs)

17

DDx Erectile Dysfunction

  • psychogenic - esp if early morning erection is preserved
  • decreased testosterone
  • decreased blood flow in hypogastric arterial system
  • impaired neural innervation
  • diabetes

18

Premature ejaculation

common, esp in young men

19

reduced or absent ejaculation in middle-aged or older men

  • less common
  • ddx: meds, surgery, neurologic deficits, lack of androgen

20

lack of orgasm with ejaculation

usually psychogenic

21

yellow penile discharge suggests...

gonorrhea

22

White penile discharge suggests...

gonococcal urethritis from Chlamydia

23

Symptoms of disseminated gonorrhea

rash, tenosynovitis, monoarticular arthritis, meningitis

with or w/o urogenital symptoms

24

Chancre

ulcer seen in syphilis

25

warts seen in...

HPV

26

swelling of scrotum seen in...

mumps orchitis, scrotal edema, testicular cancer, indirect inguinal hernias, hydroceles

27

Scrotal pain seen in...

testicular cancer, epididymitis, orchitis

infexn, torsion, strangulated inguinal hernia

28

phimosis

tight prepuce that cannot be retracted over the glans

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29

paraphimosis

tight prepuce that, once retracted, cannot be returned - edema ensues

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30

balanitis

inflammation of the glans

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31

balanoposthitis

inflammation of glans and prepuce

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32

pubic or genital excoriations suggest...

lice (crabs), or, sometimes, scabies

33

Temperature and sperm production

  • Temp regulated by distance of testes from body, and by muscular contraction
  • Proper sperm production requires cool body temp, under 37 deg celcius

34

what is severed in a vasectomy?

vas deferens

35

function of spermatic cord

suspend testis & scrotum

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36

What to ask about discharge


•color, consistency, odor

37

Why ask about history of cardiac dz?


anti-hypertensives can affect sexual functioning
 

38


•Hypospadias
 

-congential displacement of urethral meatus, often inferior to penis (ventral displacement); groove from normal location to the tip of glans (primary); shaft of penis (secondary); base of penis (tertiary)

39


•Epispadias
 

-orifice of urethral meatus on dorsal aspect of penis

40


•Carcinoma of penis
 

indurated nodule often nontender; or persistent penile sore; almost exclusively in uncircumcised males; masked by the prepuce 

41

Epidermoid cyst


•common; dome shaped white or yellow papules; origin is occluded follicles filled with keratin debris and desquamated follicular epithelium; multiple; benign
 

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42

How to palpate the scrotum


•Palpate each testis and epididymis between your thumb and two fingers
•Locate the epididymis (nodular, cordlike)
•Note size, consistency, shape, tenderness, presence of nodules
•Palpate the spermatic cord; include the vas deferens between thumb and fingers from epididymis to superficial inguinal ring
 

43


•Scrotal edema -  causes

-often due to dependent edema; seen in CHF or nephrotic syndrome
 

44

Scrotal edema: relief inpatient and outpatient

Outpatient: Scrotal swings

inpatient – soft towels to lift + diuresis

45


•Hydrocele
 

-nontender, fluid-filled, smooth mass within the tunica vaginalis
•Usually confined to scrotum
 

46

confirming hydrocele

•Fingers can move above mass in scrotum
•Transilluminates + (b/c fluid filled) + f/u w/US

47


•Cryptorchidism
 

  • atrophied testis which may be in the inguinal canal or abdomen; scrotum is unfilled
    • “undescended left testicle”; no palpable left testis
    • > risk for testicular cancer

48


•Small testis

  • ≤ 3.5 cm in length;
  • small, firm with Klinefelter’s syndrome (≤2cm) or small soft, atrophied;
  • seen with use of cirrhosis, estrogen, or hypopituitarism
     

49


•Tumor of testis
 

  • early may be painless; late may feel heavy;
  • irregular, fixed;
  • transillumination negative
  • confirm with U/S

50


•Acute orchitis-
 

inflamed, painful testis
•Unilateral, often associated with a viral condition
•May be difficult to differentiate from epididymitis

51

abnormality of epididymis: 
•Spermatocele vs cyst

painless mobile cyst above the testis;

spermatocele contains sperm; cyst has no sperm; both transilluminate +

52


•Acute epididymitis
 

  • acutely inflamed 
  • tender
  • + scrotal edema
  • +erythema
  • +urethral discharge
  • +fever
  • coexisting UTI, prostatitis, STI
  • urine with WBC and bacteria

53


•Tuberculous epididymis

  • chronic inflammation of TB
  • firm enlargement of epididymis
  • tender, thickened, beading of vas deferens
     

54


•Varicocele of spermatic cord
 

  • “varicose vein” often found on left spermatic cord
  • soft “bag of worms”
  • separate from testis
  • supine position when scrotum is elevated, the bag collapses 
  • +infertility

55


•Torsion of spermatic cord
 

 torsion or twisting of the testicle on its spermatic cord

  • Acute pain, edematous; scrotal discoloration; testis is retracted up into scrotum
  • Absence of cremasteric reflex on side of acute swelling
  • No UTI associated
  • Surgical emergency-obstructs circulation; needs to be resolved within 6 hours

56

Prostate gland

  • chestnut shaped. Similar size to testis.
  • Ejaculatory fluid and enzyme that liquefies coagulated sperm.
  • Seminal vesicles extend from prostate onto superior portion of bladder

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57

Tanner Staging: Stage 1

prepubescent – no pubic hair

58

Tanner Stage 2

sparse hair or at base of penis. Slight enlargement of penis, testes slightly larger w/altered texture

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59

Tanner Stage 3

darker coarser curlier hair. Penis larger and longer. Scrotum further enlarged.

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60

Tanner Stage 4

coarse curly hair. Penis is enlarged in width and length. Scrotum is enlarged, skin very dark

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61

Tanner Stage 5

hair spread to medial surfaces of thighs. Penis, testes, scrotum to full maturity

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62

Diagnosis of gonorrhea or nongonococcal urethritis

gram stain and cuture

63

induration along ventral surface of penis suggests

urethral stricture or possibly carcinoma

64

induration along ventral surface of penis + tenderness suggest

periurethral inflammation secondary to a urethral stricture

65

Peak ages of testicular cancer

15-34yo - watch out for painless nodules on testis!

66

multiple tortuous veins in area of spermatic cord indicate

varicocele

67

why happens to a chronically infected vas deferens?

may feel thickened or beaded

68

What is suggested by a cystic structure in spermatic cord?

hydrocele of the cord

69

Scrotal Swelling & transillumination

+ indicates serous fluid such as hydrocele

- indicates blood or tissue, e.g., normal testis, tumor, most hernias

70

Distinguishing between hydrocele & hernia in scrotum

transillumination

auscultation - bowel sounds over hernia

71

hernias: incarcerated vs strangulated

incarcerated: annot be returned to abdominal cavity

strangulated: blood supply to entrapped contents is compromised

72

Signs of a strangulated hernia

tenderness, N/V

consider surgical intervention

73

Best time to perform testicular self exam

after warm bath or shower