Male GU, Rectal and Prostate Exam Flashcards
Anatomy of the Male GU
Shaft of Penis
testes & scrotum
Shaft : 3 parts
1 = urethra
- open in a vertical slit meatus in teh tip/glans penis
2 = corpus spongiosum
- extends from the blub of the penis to the glans: exanded base = corona
3 = corpus cavernosa
- main erectile body
Testes
- paired glands: made of seminiferous tubutles and interstitial tissue
- 4-5 cm post puberty
Scrotum
- loose wrinkle skin pouch with Tunica dartos: dartos muscle underneath
- two compartments: housing each testicle
- tunica vaginalis: covers the testicles on al sides except posteriorly
Anatomy of the Male GU
Epididymis
Vas Deferences
Seminal Fluid made of
Epididmyis
- sitting atop each testicle
- a resivoir for storage, maturation and transportation of sperm
Vas Deferens
- cord-like structure to transport sperm from teh tail of epididymis to the urthera
Sperm Travel
- vas deferens travel from behind the scrotal sac –> to the inguinal canal –> over the urter –> prostate –> perges with seminal vesicles –> forms common ejaculatory duct –> empties into urethra
Seminal Fluid
- vas deferens + seminal vesciles + prostate = fluid
Define the Landmarks of the Groin
ASIS: the illiac bone: boarder here
Pubic Tubercle: medial boarder on superior rami of pubis
Inguinal Ligament
- between the ASIS and pubic tubercile
Inguinal Canal
- medial to and parallel to teh inguinal ligamner; created tunnel for vas deferens to pass through teh abd. muscles
Femoral Canal
- below the inguinal ligmanet
Lymphatic Drainage of the Male GU
Lymph Drainge
horzontal and vertical group of nodes
- from the penis: passes to the Deep and External Inguinal nodes
- from the scrotum drain into superfiscial inguinal nodes
- from the testes to their parrellel venous drainge
Male Sexual Development
hormonal influence
Hormones
GnRH from the hypothalmus –> to the pituitary
triggers release of LH and FSH from teh pituitary to the gonads
LH –> leydig cells: to promote testosterone, which at its target tissue is converted to 5-DHT
- male gentalia growth: promste, seminal vesicles, secondary sex characteritics
FSH –> Sartoli cells: sperm prodcution in the semiinferous tubules
male sexual function requires
- normal testosterone levels
- arterial blood flow
- neurovascualr innervation: alpha adrenergic and cholinergic
Penial Discharge & Assocaited Diseases
History
-discharge: amount, color
- associated systematic symptoms
- pain/sores or growths
- itching
- scrotal swelling/pain
Symptoms
- Yellow = gonorrhea
- white = chalymida
- rash and tendo/join = disseminated gonrrhea (rash is hemorrhagic vesiculopustuale
- ulcer: herpres (multiple: scattered vesicles, gropued) or syphilis (shiny base painless ulcer)
- warts: HPV (warts are single/multiple, raised and cauliflower like)
- itch: lice/scabies
- mass/swelling in testicles (redness, swelling) : orchitisi, mumps(systemic sx.), testicual torison
History for Considering the possible STIs
STI History to Consider
- mutiple sex partners
- use of protection
- illict drug use
- hx. of STi
- types of sex
Symptoms
- sre throat: think/ask oral sex
- diarrhea or rectal bleed : think/ask anal sex
- anal itching/pain
- systemic: fever, dysuria, rashes, joint pain or conjuntivits (reactive arthritis)
PE: Male GU Exam
Inspection & Palpation of Penis
Chaparone for this and wear gloves always
Inspection : penis
- skin: look at all surfaces of the penis
- foreskin: if there: retract; look for rashes or carcinomas
- phimosis: cannot retract
- paraphimosis: once retracted, cannot return to normal
- glans: ulcers, scare, inflammation
- balanitis: inflammation of the glans
- urethral meatus: index and thumb to assess opening
- document any dicharge and color
- note hypospadis (ventral or belwo) or epispadius (dorals or above)
Palpation : penis
- with thumb and first two fingers
- palapte shaft: induration or tenderness
PE: Male GU Exam
Inspection and Palaption: Scrotum and Scrotal Contents
Inspection: scrotum
- skin: lift scrotum and inspect ahir
- scrotum contous: for swelling, lumps, veins, masses or asymmetry between the two
- cryptochrism: undeceded testicle
- bening scrtocal epidermoid cysts: white/yllow keratin follice domes
- inguinal area: note any itching, redness
- fungal infections can live here
Palpate: scrotum
- one hand: palpate the testis and epididymis between thumb and first two fingers
- two hand: cradle testis at both poles with thumb and finger tip or both hands : position them back and forth
Normal scrotum: firm, not hard, decended symmetric with nontender and no masses
- palpate and note the testis and epididmyis size and shape and consistency
- palpate and notice the spermatic cord from the external inguinal ring
Hernial Evaluation: direct and indirect inguinal hernias
Inspection
Palpation
Postion
- standing (or laying but standing is easier)
- inguinal hernias are most common, indirect is most common inguinal
Inspection
- inspect the area for any buldging or asymmetry
Palpation
- palpate for the hernia: tip of index finger at anteroir inferior margin of scrotum
- move hand upward into the inguinal canal & follow the spermatic cord up to the inguinal ligmanet
- ask pt. to cough
- palpate for buldge, mass during cough
Hernia Specifics
indirect v direct
strangulated v incarcerated
Indirect
- pass through the inguinal canal (most common)
- buldge near internal inguinal ring
Direct
- buldge near the external inguinal ring
these need surgery if incaracerated or symptomatic
Incarcerated: cannot reduce back
Stragulated: loss of blood flow now
hydrocele v varicocele
how to palpate and distinguuish
Hydrocele
- collection of fluid in tunica vaginalis
Varicocele
- varicosed veins of the testicular venous supply
Palpate the mass
- place fingers Above mass
- palpate the spermatic dorde 2 cm above testis: have pt. beardown to palpate the spermatic cord: increased diamter if hydro/varico
Transillumination
- shine light from the back
- light shines through as red: hydrocele
- light does not shine through: mass
Self Testicular Exams: Recommendations
USPSTF : does NOT recommend screening for testcualr cancer in asymptomtic pt.
ACS: does not recommend routine self testicular exams or screening
but be aware that if therese a lump: see provider
Rectal and Anal Anatomy
Rectum & anal opening are posterior to the urethra and bladder
- from the rectum: can feel the prostate
- the seminal vesicles are above the prostate: “rabbit ear shape”
- Sigmoid colon ends at the rectum
- Rectum separates from the anus at the rectoanal junction: dentate line
- dentate line: change from skin to mucosal membrane: from anus to rectum
anal canal: internal and external sphincter
external sphincter: skeletal muscle voluntary control
internal sphincter: smooth muscle involuntary control
ROS for Rectal/Anal Complains
ROS
- change in bowel habits (blood in stool)
- pain with defication, blood in rectum or tender rectum
- anal warts/fissures
- weak streatm: change in urinary habits (prostate)
- dysuria or hematuria
