Breast and Genitourinary Ax Flashcards
The breast lies anterior to what muscles?
pectoralis major and serratus anterior muscle
3 types of tissue breasts are made up of
adipose, fibrous, grandular - varies depending on age,. menstruation, lactation,e tc
Montgomery’s gland
small elevated sebaceous glands on the areola that secretes the protective lipid during lactation
Explain the internal anatomy of breasts
- 15-20 Lobes that radiate from nippe composed of Lobules
- clusters of Alveoli (produce milk) are in each Lobule,
- 15-20 Lactiferous Ducts form a collection system that converges at the nipple.
- Behind the nipple, Lactiferous Sinuses, which is a reservoir for storing milk
Why does dimpling occur in Breast Ca
Cooper’s ligament is a fibrous band that support the breasts. Ca causes it to become contracted, causing pits or dimpling of the overlying skin
Landmarks: Quadrants for breasts
Upper inner quadrant Upper out quadrant Axillary tail of spence Lower outer quadrant Lower left quadrant
Axillary Lymph nodes:
- central axillary
- lateral axillary
- subscapular (posterior axillary)
- pectorial (anterior axillary)
Developmental Considerations for the breast: infancy
- breast structures are present, but only lactiferous ducts within nipple. No alveoli
- little change until puberty
Developmental considerations: breast and genitalia adolescence female
- estrogen stimulates breast changes
(from hypothalmus releasing GnRH –> pituitary releases LH an FSH –> ovaries release estrogen)
-Tanners staging (2-5 yrs ave)
1. Thelarche (breast development) - starts at puberty
2. Andrenarche/Pubarche (axillary, pubic hair)
3. Height spurt
4. Menarche (first period)
(boobs, pubs, grow, flow)
Developmental considerations for breasts in pregnancy
- early sign of pregnancy is nostalgia (sore and incr. size)
- may see veins, stretch marks, darker more erect nipples, colostrum in 3rd trimester
Post-Menopausal women: breasts developmental changes
- glandular tissue atrophies and replaced with fibrous tissues (decr. estrogen and progesterone)
- fat atrophies
- breast size and elasticity decrease (droop and sag)
- lactiferous duct fibrosis and calcification
- lumps may be more palpable
Supernumerary Nipple
extra nipple
Gynecomastia
breast tissues enlarges. Can happen in men during puberty or hormone therapy. Can be unilateral
How do you perform an objective breast exam?
unexpected findings?
LACE
- Look (inspect)
- Arms position (x3) (retraction, dimpling, fixation)
- Check lymph nodes (observe axillary and supraclavical regions for bulging, discoloration, edema. Not usually palpable
4.. Examine breast tissue (1 or 3 ways)
unexpected findings:
- hard, painful, fixed lumps
- peau d’orange
- changes
- dimpling, fixations
- thickening
Urethra in males
a tube that carries urine form the bladder to the outside of the body. when erect, the flow of urine is blocked, allowing semen to travel.
Scrotum and cremaster muscle
Scrotum: loose protective sac that was a continuation of the abdomen. Hold the testes
Cremaster muscle: controls the size of scrotum in response to temperature. Testes best produce sperm 3 degrees less than abdominal, When cold cremaster contracts to be closer to body
Testes
a septum separates the scrotum sac into 2 halves, each scrotal half is a testis
- solid oval structure
- suspended by spermatic cords
- function is to produce sperm
(left can be lower due to longer sprematic cord)
Epididymiss:
a coiled duct system and main storage site of sperm. On top of testis inside scrotum
- continuous with vase deferens
Vas Deferens
a muscular duc that approximates with other vessels to form sprematic cord.
carries sperm from epididymis to ejaculatory duct
sprematic cord
ascends along the posterior border of the uterus and runs throguh the tunnel of the inguinial canal of the abdomen
-supplies blood to testes, continuous w/ vas deferens
Ejaculatory duct
vas deferens joins seminal vesicle to form the ejaculatory duct. empties into urethra
Prostate gland
- Walnut-size gland located between the bladder and penis, just in front of the rectum.
- The urethra runs through the center of the prostate from the bladder → penis
- Secretes an alkaline fluid that nourishes and protects sperms viability. During ejaculation, the prostate squeezes this fluid into the urethra, and it’s expelled with sperm as semen
- Seminal vesicles: contribute fluid to the semen during ejaculation
- Bulbourethral gland: two pea-shaped glands located underneath the prostate gland. Adds fluid to the semen during ejaculation
Male genitalia exam:
- inspect and palpate penis
- inspect and palpate scrotum
- if mass exists, transilluminate
- palpate inguinal hernia
- palpate inguinal lymph nodes
Vulva
Mons Pubis
- external genitalia
- round, firm pad of adipose tissue covering the symphysis pubis
Labia Majora and Minora
Majora: two rounded folds of adipose tissue from the mons pubis to perineum
Minora: inside majora, two smaller, darker, skin folds joines at clitoris (hood) to the fremulum
Skene’s gland
surround the urethral meatus
Bartholin’s gland:
two opening on either side, posterior to vaginal orifice
- secretes lubricating mucus during intercourse
Female genitalia considerations for infants:
engorgement of external genitalia (from mother’s estrogen)
Female genitalia considerations for Adolescents
Tanner staging
Female genitalia considerations Pregnancy considerations
- Godell’s sign (softening of cervix)
- Chadwicks sign: vaginal mucosa and cervix looking cyanotic
- Hegar’s sign: (sometimes) uterus softens
Female genitalia considerations Aging Adult
Menses - becomes irregular then ceases
- ovulation becomes sporadic
- uterus and cervix shrink, ovaries atrophy
- pelvic muscle weakens
- vagina shortens, narrows, epithelium atrophies
- less moisture = painful sex, itchiness, dryness, infection risk, burning)
Female Genitalia Exam summary
- inspect and palpate external genitalia
- palpate labia, skene’s and bartholin’s gland
- use vaginal speculum and inspect cervix and vagina (pt and Lithotomy poisiton)
- Optain specimens for cytological study
- perform bimanual exam (cervix, uterus and adnexa)
