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Repro med test 2 > Male pathophys aka Penises and stuff > Flashcards

Male pathophys aka Penises and stuff Flashcards

1
Q

What is the guideline that draws the testis into the scrotum?

A

the gubernaculum

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2
Q

the external oblique essential continues into the scrotum as what muscle?

A

cremaster

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3
Q

layers of the spermatic cord:

A

Skin, Dartos, External spermatic fascia, cremaster, internal; spermatic fascia, tunica vaginalis, testis

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4
Q

Testicular torsion:

A

-twisting of spermatic cord, compressing its blood supply

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5
Q

most common cause of testicular torsion?

A

-bell clappers deformity

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6
Q

what is bell clappers deformity?

A

-weakness or absence of scrotal ligament, which means testis not held in position well

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7
Q

this ligament is a remnant of the gubernaculum:

A

scrotal ligament

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8
Q

what can in-utero torsion result in?

A

-Monorchism or vanishing testis- born with only one visible testis

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9
Q

how is monarchism distinguished from cryptorchidism?

A

US

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10
Q

symptoms of torsion:

A
  • significant acute pain
  • cremasteric reflex is absent
  • testis is swollen, tender, and high in scrotum with transverse lie
  • look for absence of blood flow on ultrasound
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11
Q

Orchitis:

A
  • Testicular inflammation
  • usually caused by infection
  • often in combination with epididymal inflammation
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12
Q

paths of infection causing orchitis?

A
  • blood stream

- retrograde: vas deferens-> epididymis-> testis

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13
Q

Organisms that cause orchitis:

A

Bacterial and non-sexually transmitted: Staph, Strep, E. Coli (increased risk with surgical manipulation or frequent catheterization)

Sexually transmitted: Gonorrhea (GC), Chlamydia (Cz), Syphilis

Viral: usually mumps, sometimes coxsackie or parvovirus

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14
Q

orchitis symptoms:

A

rapid onset of pain in one or both testicles that usually begins locally but over several days may spread to the groin.
One or both testicles may appear tender, swollen, red or purple.
Patient may have a “heavy feeling” in the swollen testicle.
Blood may appear in ejaculate; urethral discharge may occur (but not always!)
pain/burning with urination, or pain with increased abdominal pressure (e.g. with bowel movement), groin pain, pain with intercourse.
Systemic symptoms: high fever,nausea,vomiting, malaise

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15
Q

Tx of orchitis:

A
  • Antiobiotics- po x 10day
  • STD counseling
  • Fertility counseling
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16
Q

fertility and orchitis-epididymitis:

A

If both testes are affected, fertility can be affected
Damage to Leydig cells– testosterone
Damage to seminiferous tubules
Especially concerning with mumps orchitis
Should ask about hx of orchitis during any infertility visit, or with finding of hypogonadism or low testesterone.

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17
Q

Where do testicular tumors arise from:

A
  • Germ cells: Seminoma or embryonal: may make and release tumor markers
  • Non-germ cells: Sertoli or leading cells: may release testosterone
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18
Q

Testicular ca info:

A

Disease of young people*
Most common = seminoma
Half of all cases diagnosed between 20 and 34 years of age
High cure rate* – 90% survival at 5 years

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19
Q

80% of people with testicular ca have an extra copy of a portion of what chromosome?

A

12
-Most cancer cells are triploid or tetraploid– so the genetic defect seems to affect proofreading of chromosomes at the pre-mitotic checkpoint.

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20
Q

If the cancer arises from germ cells, testicular cancers can secrete embryonic proteins, like…

A

B-HCG, AFP, or LDH

If a tumor has one of these markers (and not all do), the marker can be followed to monitor treatment.

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21
Q

Varicocele:

A

Dilation of veins in the pampinoform plexus

A “varicose vein of the spermatic cord”

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22
Q

Causes of varicoceles:

A

Most common cause is poor blood return from pampinoform plexus testicular vein  central circulation.

I think left gets more because it has it crosses over with the left renal vein

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23
Q

treating varicoceles:

A

-embolize veins

24
Q

Hydrocele:

A

A fluid collection within the scrotum.
Can occur in adults or infants.
Can be communicating or non-communicating.

25
Q

Communicating hydrocele:

A

Occurs when there is a patent funicular process (processus vaginalis from embryology) allowing fluid to descend from the peritoneal cavity into the scrotal sac.

the tunica vaginalis remains open to the peritoneal cavity (normally it closes by 3 weeks postpartum)– called a funicular process.

26
Q

All hydroceles are caused by fluid accumulation within what structure?

A

-tunica vaginalis

the peritoneum-like remnant of the processus vaginalis

27
Q

patent funicular process may increase risk of what in men?

A

indirect hernia

28
Q

what intra-abdominal disease processes could cause this person to have scrotal swelling?

A

Intraperitoneal bleeding
Ascites
Abdominal cancer

29
Q

Non-communicating hydrocele:

A

Hydrocele that occurs even when the processus vaginalis has closed, and is now a tunica vaginalis.

30
Q

2 ways non-communicating hydroceles can happen:

A

Fluid accumulates in the tunica vaginalis before birth, and just doesn’t get reabsorbed.

A process inside the scrotum (infection, cancer, or fluid production by the tunica itself) causes fluid to build up there.

31
Q

differentiating hydrocele and cancer?

A

shine a light if you can see through it its probably a hydrocele

If you’re examining a child, It still could be a loop of bowel in the scrotum from an inguinal hernia!!
Most likely it’s a hydrocele… but look at other symptoms as well…

32
Q

BPH=

A

increased number of cells, not just larger cells.

Gland (secretory) and muscle cells are both increased in number.

33
Q

Are there other causes for urinary symptoms with BPH?

A

Some think that these symptoms are age-related; the increased prostate size may increase risk of nerve dysfunction in the bladder.

These nerves are part of the pelvic plexus (hypogastric plexus)– a matrix of sympathetic and parasympathetic nerves that supply the pelvic organs, including bladder and prostate.

Prostate enlargement can compress the plexus branches to the bladder, or cause retrograde dysfunction of those nerves.

34
Q

How does testosterone affect the prostate?

A

Testosterone is at a high concentration in the blood vessels traveling near the prostate.

Both testosterone and its metabolite, DHT, can increase cell division in the prostate

As men age, their serum testosterone goes down– but their DHT levels in the region of the prostate stay higher, causing a a paracrine effect.

So as men age, DHT is the main hormonal actor in BPH.
DHT is produced even when testosterone levels go down.

35
Q

How does testosterone affect the prostate?

A

DHT also seems to cause prostate growth by increasing production of growth factors, particularly in prostate cells—
In other words, it activates proto-oncogenes in the prostate.

36
Q

is BPH a risk factor for cancer?

A

nope

37
Q

What are some risk factors for cancer?

A

History of multiple sexual partners, history of HSV or HPV, and positive serology for HPV 16 and 18 are all risk factors for prostate cancer.

38
Q

oncological thinking of prostate cancer.

A
  • eliminates apoptosis

- androgens that increases cell turnover

39
Q

Phimosis

A

inability to completely retract foreskin that covers the head of the penis

40
Q

physiologic phimosis:

A

Children are born with tight foreskin at birth, and separation occurs naturally over time.

At birth, the glans is exposable in less than 4% of boys
At three years of age, 10% of boys still don’t have a retractable foreskin.
Typically resolved by age 7

41
Q

pathologic phimosis:

A

A secondary phimotic condition

Glans either cannot be exposed at all or can only be exposed partially

Adhesions and scar tissue prevent full exposure

Usually caused by recurrent balanitis (infection below the foreskin) or improper hygeine

42
Q

Paraphimosis:

A

Foreskin is partially retracted but “stuck” at that position
Cannot return to covering the glans
Since it’s usually a bit tight in this position, venous congestion can happen distal to the ring of foreskin
This congestion causes compression of underlying penile tissue
Can become a medical emergency if blood flow is too hindered.

43
Q

phimosis tx:

A

Good hygeine (also prevention)
Gentle manipulation of the foreskin from the glans
Never traumatize a child with overzealous manipulation
If needed emergently: circumcision

44
Q

Penis tumors :(

A

Papillomas
HPV :
-Some are dangerous serotypes.
-Cause unregulated epithelial growth

45
Q

Squamous carcinoma of penis:

A 
In situ
Invasive
Ulcerative
HPV
Regional lymph nodes.
Metatasizes widely.
46
Q

Peyronies disease:

A

An acquired inflammatory condition of the penis.

Principal manifestation of Peyronie’s disease = the formation of a plaque (a segment of flat scar tissue) within the connective tissue of the penis.

This plaque can usually be felt through the penile skin. This plaque may lead to serious problems such as curved and/or painful erections.

47
Q

symptoms of peyronies:

A

Plaques reduce the elasticity of the penile connective tissue, causing bend towards the plaque region during erection.

Although Peyronie’s plaques are most commonly located on the top of the penis, they may also occur on the bottom (ventral) or side (lateral) of the penis.
Some men have more than one plaque, which may cause complex curvatures.
Occasionally an extensive circumferential plaque develops. These plaques typically do not cause curvature but may cause a “wasting” or “bottleneck” deformity of the penile shaft.

In other severe cases, the plaque may accumulate calcium and become very hard, almost like a bone.
In addition to penile curvature, many patients also report shrinkage or shortening of their penis.

48
Q

causes of peyronies:

A

Not known for sure
Probably secondary to mild penile trauma Most experts believe that Peyronie’s disease is likely the consequence of a minor penile trauma.
vigorous sexual activity? (e.g., bending of the penis during penetration, pressure from a partner’s pubic bone, etc.)
injuries from sports or accidents?
Increased risk with diabetes, tobacco use, or a history of pelvic trauma
Poor wound healing
More traumatized tissue than normal

49
Q

Diagnosing Peyronies:

A

Symptoms = pain with erection, abnormal appearing erection
Hard plaques palpated on exam
It may be necessary to induce an erection in the clinic for proper evaluation of penile curvature
In some cases an ultrasound or x-ray examination of the penis is used to characterize the plaque and check for the presence of calcification.

50
Q

Priapism:

A

Painful Erection lasting >4 hours
Uncommon, usually not due to sexual stimulation
Has to do with increased flow into penis vs. decreased flow out

51
Q

Priapism is mediated by nitric oxide and paracrine signaling causing what 2 mechanisms?

A
  • compression

- stretching

52
Q

2 types of priapism:

A

High-flow (non-ischemic):
-Result of overabundance of arterial flow
Low Flow (ischemic):
-Result of decreased venous drainage, usually due to vaso-occlusion

53
Q

Metabolic demands within penile tissue are…

A

low

  • Average temperature 4 degrees lower than the body
  • Probably why erection can be tolerated for up to 4 hours
  • In low-flow priapism, however, metabolic needs cannot be met:
  • -Elevated pCO2, low pO2
  • -Acidic pH
54
Q

risks for priapism?

A 
People with viscous or occlusive blood disorders:
-Sickle cell
-Leukemia
-Polycythemia
Those on certain Rx meds:
-Viagra, cialis
-Zyprexa, wellbutrin, coumadin
Penile/ genital injury
Spinal cord injury, blood clots, spider venoms
55
Q

priapism tx:

A

Inhibitors of parasympathetic muscle relaxation
Intracavernous injections of vasoconstrictors
Shunting of venous blood

Repro med test 2 (7 decks)

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