Gyne activity questions 7 - 10 Flashcards
can the identification of the testes during an 18-20 week fetal scan be used reliably for gender determination?
No. However a penis and scrotum will be present.
the testicular descent into the scrotum occurs well after 20 weeks gestation.
Testicular descent occurs in combination with….
the enlargement of the testes, atrophy of the mesonephric kidneys and paramesonephric ducts.
At 26 weeks where have the testes descended to?
the posterior inguinal rings
The next stage is the journey through the inguinal canal
What is the process of testicular descent controlled by?
androgens and increasing intraabdominal pressure.
How long does it take the testes to pass through the inguinal canal and into the scrotum?
This takes two to three days as the testes pass external to the peritoneum and processus vaginalis.
What happens to the canal once the testes pass through the canal?
In most fetuses, the canal then contracts.
At what fetal age does the testis descend down the inguinal canal?
36 weeks
What is the increased incidence of malignant change in an undescended testis?
48 times
In what ways will an undescended testis vary on ultrasound from a typically located testis?
Smaller and more hypoechoic
What happens to the pars infravaginalis gubenaculi (PIG) and the gubernaculum after testicular descent?
Both of these structure atrophy and thus are not evident on ultrasound
What is the sensitivity of ultrasound in detecting an undescended testis?
70-91% sensitivity. MRI is able to improve on this percentage.
What are the two layers of tunica vaginalis?
Visceral and parietal
Is fluid between the tunica vaginalis normal?
In small amount, yes.
Large amounts are called a hydrocele
How does a hydrocele impact upon the testis?
The important thing to note is that a hydrocele does not distort the shape of the testis but surrounds it.
If a collection of fluid compressed the testis, what is it likely to be?
A collection of fluid that distorts or compresses the testis is likely to be a large epididymal cyst.
What causes a congenital hydrocele?
persistence of a communication between the peritoneal cavity and the tunica vaginalis through a patent processus vaginalis.
What causes an acquired hydrocele?
may occur at any age
due to a number of pathological conditions.
Examples include: inflammation of the tunica vaginalis and injury/inflammation of the epididymis.
What are the clinical similarities and differences between orchitis and tortion?
The torsion heads off to theatre urgently to get the vascularity back into the testis.
The orchitis will require antibiotics and have an excellent outcome. Surgery is not required.
In this context, it is a very difficult diagnosis and thus ultrasound is used as the primary imaging modality. Both have pain !
What are the similarity and differences in b mode ultrasound appearances of orchitis and tortion?
In both orchitis and torsion, the testis can undergo similar change.
The testis becomes slightly oedematous and thus becomes slightly hypoechoic and heterogenous.
There can be prominent vessels in both.
In the case of torsion, these will be congested veins becoming prominent
in orchitis, this will be an increase in calibre due to hyperaemia.
What are the similarity and differences in colour ultrasound appearances of orchitis and tortion?
Distinctly different. The orchitis will show a flood of vascularity, greater than the contralateral side. The torsion will show no vascularity.
What are the similarity and differences in epididymis ultrasound appearances of orchitis and tortion?
In epididymo-orchitis, the epididymis becomes enlarged and hyperaemic. There is significant focal tenderness.
In torsion, there is often no change to the appearance of the epididymis.
What are the similarity and differences in hemiscrotum ultrasound appearances of orchitis and tortion?
Both pathologies may have a reactive hydrocele and thus this is not discriminatory.
