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AB&SS 3 > M1: Scrotum > Flashcards

M1: Scrotum Flashcards

1
Q

What structure externally divides the scrotum into 2 compartments

A

Raphe or median raphe

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2
Q

What structure internally divides the scrotum into 2 compartments and forms the scrotal septum

A

Dartos tunica

Dartos sounds like dark, its dark inside a testicle

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3
Q

Normal thick ness of the scrotal wall

A

2-8 mm

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4
Q

Which strucutre lines the scrotum and what are its layers

A

Tunica vaginalis - parietal and visceral (1- 2 mm of fluid between these is normal)

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5
Q

What 2 things do the testicles produce

A

Sperm and testosterone

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6
Q

Normal size of testicles

A

L: 3-5 cm
W: 2-4 cm
AP: 3 cm

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7
Q

What is the tunica albuginea

What does it form posterioly

A

Fibrous layer surrounding each testicle

Medistinum

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8
Q

What strucutrre forms the lobules

A

Invagination of the tunica albuginea

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9
Q

What does lobules contain and what happens there

A

Contain seminiferous tubules which is the site of spermatogenesis

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10
Q

Describe the medistinum

Functtion?

A

Area on the posterior side of the testicle formed by the joining of the septations of the tunica albuginea

Provides support for the testicular vessels and ducts

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11
Q

What do the seminiferour tubules converge to form

A

Straight tubules

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12
Q

Describe the rete teste

What are they called when they exit the mediastinum

A

Convergence of the seminiferous tubules, located inside the mediastinum

Efferent ducts

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13
Q

Function of Efferent ducts

A

Carry seminal fluid to the epididymis

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14
Q

What is the bare area of the testicle

Why is it called “bare”

A

Area of the testicle and epi posteriorly where the testicles are connected to the scrotal wall by the visceral tunica vaginalis

Area is not covered by peritoneum

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15
Q

What is an appendix testis

A

Small appendage found on the upper pole of the testicle - remnant of the mullerian duct

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16
Q

Another name for mullerian duct

A

Paramesonephric duct

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17
Q

Location of epi compared to testicle

A

Superior and posterolateral

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18
Q

Where does the epi head empty

A

Vas deferens

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19
Q

Normal length for epi

A

6-7 cm

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20
Q

What is the epi formed by

A

The convergence of the efferent ducts from the rete testes

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21
Q

Another name for epi head

A

Globus major

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22
Q

Normal measurments for epi parts

A

H: 10-12 mm
B:2-4 mm
T: 2-5 mm

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23
Q

Function of the epi

A

Conveys sperm to the seminal vesicles, also for storage and maturation of sperm

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24
Q

What is an appendix epi

A

Remnant of the mesonephric (wolffian duct)

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25
Function of SV
Reservoir for seminal fluid
26
Function of spermatic cord Where does it travel
Connected the testes to the pelvis and abdo Suspends the tests in scrotu In the inguinal canal
27
What does the spermatic cord contain
Vas deferens Testicular A and venous pampiniform plexus Lymphatics and nerves
28
Which arteries supple the testicles, which areas and where do they branch from
Testcular arteries - AO - supplies testicles Deferential arteries - inferior vesicular arteries - supply epi and vas deferens Cremasteric arteries - interior epigastric artery - peritesticular tissue
29
How does venous blood drain from testicles
Pampiniform plexus to the testicular veins RTV - drains into IVC LTV - drains into LRV
30
Normal vascular resistance for arteries supplying the testicles
Testicular - low resistance Cremasteric and deferential - high resistance
31
Why is the LRV more prone to developing varicoceles
Due to venous drainage into LRV Chceck LK and LRV for RCC invasion or other mass
32
Describe scanning protocol for testicles
SAG: medial, mid, lateral testicle and epi TRX: medial, mid, lateral testicle and epi Always measure at mid Assess blood flow, take buddy image Scrotal wall thickness
33
US appreance of mediastinum
echogenic band located medially that runs from superior to inferior
34
US appreance of rete testis
Hypo areas in the mediastinum/small cystic areas
35
Which modality is almost 100% sensitive at detecting intrascrotal masses
US
36
Rule of thumb for extra-testiccular and intratesticular masses
Extra: more likely benign Intra: more likely malignant
37
Describe cryptorchidism Where are they usually located When is there a higher incidence of this happeneing
Faliure of testicles or testis to descend to normal position Typically unilateral Inguinal canal Premature infants
38
Most common GU abnormality in children
Cryptorchidism
39
What is the gubernaculum
The structure that guides and anchors the testis during descent into the scrotal sac
40
Causes of cryptorchidism
Lack of gonadotropin hormonal stimulation Adhesions or anatomic maldevelopments that block descent Idiopathic
41
Complications of cryptorchidism
Infertility - sperm production depends on temperature and full descent is needed for testicles to mature Testicular cancer of both testicles - 48 x higher risk
42
Treatment for cryptorchidism
Orchiopexy - surgical repair for infants and children Orchioectomy -removal for older children and adults due to cancer risk
43
Orchiopexy done before what age will retain fertility
2 years
44
US appearance of cryp.
Oval mass thats smaller than normal testicle | Medistinum hard to identify
45
Which strucutre can be mistaken for undescended testicle
Enlarged inguinal lymph node
46
What is polyorchidism
Congenital condition of testicular duplication Typically unilateral and located in scrotum Rare
47
What is testicular ectopia
Ectopic Testicular tissue identified anywhere along the path of descent
48
Describe hydrocele Where is the fluid typically seen
> 2mm collection of fluid b/w the tunica vaginalis layers Anterolateral portion of the scrotum
49
Moat common cause of painless scrotal swelling
Hydrocele
50
2 causes for hydrocele Describe them
Congenital - due to patent processus vaginalis which allows fluid to flow from the abdo to the scrotum Acquired - idiopathic, or secondary to infection, inflammation, neoplasm trauma
51
What is the processus vaginalis
Pathway that forms when the testicle descends into the sac during fetal development, should close on its own at 18-24 months
52
Most common cause of acquired hydrocele Trauma accounts for what % of hydroceles
Idiopathic 25%
53
Are large hydroceles usually associate with neoplasms
No
54
Small hydroceles are seen in what % of patients with testicular tumors
60%
55
US apperance of hydroceles
Varies....: Anechoic, through transmission Septations debris +/- scrotal pearls
56
Whats a hematocele Cause
Blood in the scrotal sac Trauma, surgery, neoplasms or torsion
57
Clinical presentation of hematocele cna mimic what pathology
Epididymitis or torsion
58
US appearance of hematocele
Acutely - scrotal wall might be thick Chronic - septations, debris Variable
59
What is a pyocele Cause
Pus in the scrotal sac Abscesses from infection that rupture into the tunica vaginalis
60
US appearance of pyocele
Echogenic collection Septations/loculations Thick sctoal wall Mural calcifications
61
What are varicoceles What size do they need to be
Abnormal dilation on veins of the pampiniform plexus due to obstructed venous return > 2 mm in diameter
62
2 causes of varicoceles Describe them
Primary - idiopathic 15-25 yrs Due to incompetent valves in the internal spermatic vein Secondary - due to increase pressure on the spermatic vein
63
Most common cause or correctable infertility
Primary varicocele
64
What to look for with secondary varicoceles
Mass is pelvis or abdo or nutcracker syndrome - compression of LRV b/w AO and SMA
65
Describe how preimary and secondary varicocele will change with pressure
Primary - will change, use valsalva. Or scan patient standing to asses... thi should change the size of the veins, wont see them as well supine Secondary - will not change will pressure/patient position b/c mass always impinging blood flow
66
US appearance of varicolceles
Numerous anechoic strucutres > 2 mm is diameter often located superior to the upper pole of testicle and epi head Valsalva will demonstrate changes if primary

AB&SS 3 (1 decks)

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