Male Genitalia and Hernias Flashcards Preview

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Flashcards in Male Genitalia and Hernias Deck (73)
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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

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

9

Is the external inguinal ring palpable?

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

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

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.

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

 

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

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

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

29

paraphimosis

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

30

balanitis

inflammation of the glans