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MIDS 137 > Ch 5b (normal scrotum) > Flashcards

Ch 5b (normal scrotum) Flashcards

1
Q

Where do the testes develop?

A

B/w posterior abdominal wall + peritoneum

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2
Q

When do the testes pass through the inguinal ring + lie in the scrotum?

A

7th month: inguinal ring
8th month: in scrotum

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3
Q

What is the gubernaculum testis?

A

The caudal genital ligament is continuous with a band of mesenchyme which connects the fetal testis to the developing scrotum

(seen during testicular descent in inguinal region)

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4
Q

When is the gubernaculum present?

A

Only during development of urinary + reproductive organs

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5
Q

What does the gubernaculum attach to?

A

Caudal end of testis

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6
Q

What does the gubernaculum do?

A

Anchors fetal testis to inguinal region to prevent upward movement

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7
Q

What is the name of the remnant that forms once the gubernaculum testis shrinks/disappears?

A

Scrotal ligament

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8
Q

Location of scrotal lig?

A

-Extends from inferior pole of testis
+
-From tail of epididymis to skin of scrotal wall

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9
Q

What does the scrotal lig do?

A

Secures the testis by keeping it in place + limiting the amount it can move around within the scrotum

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10
Q

What forms the tunica vaginalis?

A

When the testes descend into the scrotum, the peritoneal lining called the processus vaginalis fuses around the testis to form the tunica vaginalis

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11
Q

When does the communication b/w the tunica vaginalis + peritoneal cavity obliterate?

A

After birth

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12
Q

What 2 layers compose the tunica vaginalis?

A

Peritoneal sac with a visceral + parietal layer

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13
Q

What structures does the tunica vaginalis surround?

A

Covers + surrounds majority of testis + epididymis

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14
Q

What structures does the visceral + parietal layers of tunica vaginalis cover?

A

Visceral: testis + epididymis
Parietal: inner lining of scrotal wall

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15
Q

What are the visceral + parietal layers of the tunica vaginalis separated by?

A

A potential space that normally has some fluid in it

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16
Q

Is a small amount of fluid seen within the scrotum normal?

A

Yes

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17
Q

What is the tunica albuginea?

A

Fibrous sheath that covers the testis

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18
Q

SF of the tunica albuginea?

A

Thin echogenic line

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19
Q

What is the scrotum?

A

Fibromuscular sac that holds the testis

(it is composed of several layers of fascia + muscle)

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20
Q

What are the 6 layers of the scrotum?

A

-tunica dartos
-external spermatic fascia
-middle spermatic fascia
-cremasteric muscle
-internal spermatic fascia
-tunica vaginalis

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21
Q

Normal scrotal wall thickness?

A

2-8 mm

(depends on the state of contraction of the cremasteric muscle)

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22
Q

SF of normal scrotum?

A

-homogeneous
-slightly echogenic when compared to testis

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23
Q

The scrotum is divided into 2 parts by what structure?

A

Median raphe (midline septum)

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24
Q

What is the median raphe?

A

Fibrous band of tissue

-Runs ventral to under surface of penis
-Runs dorsal along middle of perineum to anus

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25
Q

3 major structures contained in the scrotum?

A

-spermatic cord
-epididymis (head, body, tail)
-testes

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26
Q

What do the testes look like + where are they?

A

Bilateral, symmetrical, ovoid glands in the scrotum

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27
Q

Normal testicle measurements?

A

3-5 cm x 2-3 cm x 2-3 cm

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28
Q

How much does each adult testicle weigh?

A

B/w 10-19 grams

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29
Q

Do the testes ever change in size?

A

Yes they change with age

(increases in size up to puberty then decreases later in life)

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30
Q

SF of testicles in adults?

A

-homogenous
-medium level echos (similar to thyroid gland)
-smooth contour

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31
Q

SF of testicles in children?

A

Hypoechoic + small

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32
Q

Testis are surrounded by a fibrous capsule called what?

A

Tunica albuginea

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33
Q

The tunica albuginea is covered by what?

A

Tunica vaginalis

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34
Q

What are the 2 layers of the tunica vaginalis that are separated by small amount of fluid?

A

-Parietal (outer)
-Visceral (inner)

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35
Q

What is the mediastinum testis?

A

It is an incomplete septum due to the tunica albuginea projecting posteriorly into the testis

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36
Q

The testicular parenchyma is made up of what?

A

Numerous seminiferous tubules

(which goes towards the mediastinum testis, opens into the rete testis, then drains into epi head)

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37
Q

What are rete testis?

A

Anastomosing network of delicate tubules located in the mediastium testis

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38
Q

SF of mediastinum testis?

A

Hyperechoic + linear

(image on slide looks like hyperechoic line going through the middle of the testis)

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39
Q

Are the small tubules of the rete testis normally seen?

A

No, unless they are dilated (aka tubular ectasia)

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40
Q

What is the path of the spermatic cords?

A

Pass from abdominal cavity through inguinal canal + down into the scrotum

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41
Q

Location of each spermatic cord?

A

Lies above/parallel to inguinal ligament

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42
Q

Function of the spermatic cord?

A

To suspend the testis in the scrotum

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43
Q

What is the spermatic cord composed of?

A

-Arteries (testicular, cremasteric + deferential)
-Veins of the pampiniform plexus
-Nerves
-Lymphatics
-Vas deferens
-Connective tissue

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44
Q

SF of spermatic cord in SAG + TRV?

A

SAG:
-Numerous hypoechoic, slightly tortuous, linear structures
-Measures up to 2mm

TRV:
-Numerous hypoechoic ovoid structures with echogenic borders (representing vascular walls + connective tissue)

45
Q

Path of the vas deferens?

A

Runs in the spermatic cord, through the scrotum, inguinal canal + into the abdomen

46
Q

Are the vas deferens a continuation of the epi?

A

Yes!

47
Q

What are the vas deferens?

A

Thick paired muscular ducts

(transports sperm to urethra before ejaculation - think of them as the “sperm ducts”)

48
Q

How long are the vas deferens?

A

About 45 cm in length

49
Q

SF of vas deferens?

A

SAG: Linear hypoechoic structure superior to epi

TRV: ovoid structure (target / doughnut look)

50
Q

Measurement of vas deferens in TRV?

A

Less than 0.5mm

51
Q

Does a normal spermatic cord show blood flow within the arteries + veins of the pampiniform plexus at rest?

A

Minimal flow seen

52
Q

Normal veins of pampiniform plexus measure what?

A

Less than 2mm

53
Q

What does a valsalva look like on a normal pt?

A

Slightly increases venous flow

54
Q

Should we do a valsalva on every scrotal exam?

A

Yes!

55
Q

Measurement for a varicocele?

A

3mm or larger

56
Q

Why are valsalva’s performed?

A

To check for dilation of scrotal veins

(use dual screen + CD for it)

57
Q

Function of epididymis?

A

Stores small quantities of sperm prior to ejaculation

58
Q

3 parts of epi?

A

-Head (globus major)
-Body (corpus)
-Tail (globus minor)

59
Q

Location of epi head, body + tail?

A

Head: superolaterally to testis

Body: adjacent to posterolateral part of testis

Tail: inferolateral surface of testis + continues to become vas deferens

60
Q

Which part of epi continues to become vas deferens?

A

Epi tail

61
Q

SF of epi head?

A

-Homogeneous
-Isoechoic/slightly more echogenic than testis
-Triangular/tear drop shaped
-Located superior to testis

62
Q

SF of epi body/tail?

A

-Isoechoic to hypoechoic compared to testis
-Narrow body + curved tail
-Smaller + more variable in position than head
-Usually located posterior + inferior to testis
-Best seen in SAG

63
Q

What is an appendix testis?

A

-Ovoid or elongated protuberance
-5 mm in length
-Attached to upper pole testis

64
Q

What is an appendix epididymis?

A

Approx. same size as the appendix testis (5mm)

65
Q

What is the echogenicity of appendages of the testis + epi?

A

Isoechoic - echogenic

(found superior to testis + epi)

66
Q

Appendix testis + epi’s are what type of remnant?

A

Embryologic remnants

67
Q

Should we document an appendix testis or epi?

A

Yes always, they are not always seen on u/s

68
Q

What is a vasectomy?

A

When the vas deferens get cut+ sealed in order to stop sperm from getting into the semen

69
Q

Do we ask all pt’s if they have had a vasectomy for a scrotal exam?

A

Yes!

70
Q

Types of changes to the epi after a vasectomy?

A

-enlargement of epi
-heterogeneous epi
-spermatoceles
-dilation of rete testis
-sperm granulomas

(40% of pt’s experience changes after procedure)

71
Q

What 3 arteries supply scrotal blood flow?

A

Bilateral testicular, cremasteric + deferential arteries

72
Q

Which artery provides major blood supply to testis?

A

Testicular arteries

73
Q

What does the deferential artery supply?

A

Epi + vas deferens

74
Q

What does the cremasteric artery supply?

A

Peritesticular tissues

75
Q

Where do testicular arteries arise from?

A

From anterior aspect of aorta, below the renal arteries, which then enter the spermatic cord at the internal inguinal ring with the other cord structures

76
Q

The venous drainage from the scrotum travels through what structure?

A

Pampiniform plexus - then empties into the testicular veins

77
Q

Right testicular vein drains into what?

A

IVC

78
Q

Left testicular vein drains into what?

A

Left renal vein

(think left for left)

79
Q

Would we be more worried for right or left side testicular dilatation?

A

Right side - it is more serious as it goes into the IVC

80
Q

Do the testis have high or low vascular resistance?

A

Low - it is always receiving + wanting blood

81
Q

What does low resistance mean?

A

When an organ wants blood (is not resisting flow) because it is vital for human existence

82
Q

What does high resistance mean?

A

When an organ resists blood flow because its function is not essential for human existence (like muscles)

83
Q

Does the testicular, intratesticular + epi arteries have high or low resistance?

A

Low resistance + high blood flow

84
Q

Does the cremasteric + deferential arteries have high or low resistance?

A

High resistance + low blood flow

85
Q

What is the primary function of the testes?

A

Production of sperm + testosterone

86
Q

What is spermatogenesis?

A

Development of sperm cells

87
Q

Where does spermatogenesis occur?

A

In seminiferous tubules

88
Q

What cells secrete testosterone?

A

Cells of Leydig

89
Q

What does testosterone do?

A

-Stimulates production of sperm
-Primary sex hormone responsible for development of male reproductive tissues + maintenance of male secondary sex characteristics

90
Q

Where does sperm production occur in the testes?

A

Coiled structures called the seminiferous tubules

91
Q

The epi is on the top or bottom of each testicle?

A

Top

92
Q

A cord like structure where sperm mature + are stored is called the?

A

Epididymis

93
Q

How does the sperm travel from the epi to the vas deferens?

A

It moves forward with smooth muscle contractions

94
Q

The sperm arrives first where?

A

At the ampulla just above the prostate gland

(secretions from the seminal vesicle beside the ampulla then get added)

95
Q

The seminal fluid gets propelled forward through which ducts towards the urethra?

A

The ejaculatory ducts

96
Q

As the seminal fluid passes the prostate gland, what gets added to make semen?

A

A milky fluid

97
Q

The semen gets ejaculated from the penis through which structure?

A

Urethra

98
Q

What is the gold standard for evaluating pt’s with scrotal issues?

A

High frequency grayscale sonography with spectral, color + power doppler

99
Q

Which transducer is best for scrotal exam?

A

12-18 MHz linear probe

(with spectral, color + power doppler capabilities)

100
Q

Could we use a curvilinear probe?

A

Yes, for an increase FOV

101
Q

What surgical history should we ask our pt?

A

-Vasectomy
-Hernia repair
-Orchiopexy (moves an undescended testis into the scrotum)
-Hydrocelectomy (surgery to remove hydrocele)

102
Q

Should we ask our pt if they are currently being treated by antibiotics?

A

Yes, get them to locate the area of pain, swelling or palpable mass too

103
Q

What are we comparing b/w both testicles during an exam?

A

Compare size, echogenicity + vascularity

104
Q

CD is used to evaluate what in the testis?

A

Intratesticular arteries

105
Q

Spectral doppler is used to document what?

A

The intratesticular arterial + venous waveforms

106
Q

Are veins easy to see with CD?

A

No, hard to see

107
Q

If no blood flow within the testis, what might this indicate?

A

Testicular torsion

108
Q

Should we include the epi in SAG when imaging the middle + lower parts of testis?

A

Include the body/tail

109
Q

Which plane is the spermatic cord, epi + skin thickness evaluated in?

A

Both SAG + TRV

MIDS 137 (14 decks)

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