SUGER Flashcards
The inguinal canal is a potential weakness in the anterior abdominal wall. What factors normally prevent herniation of the abdominal contents through the inguinal canal?
The deep inguinal ring and superficial inguinal ring are in different positions. The lower fibres of transversalis and internal oblique arch over the canal and close it off during contraction of the abdominal wall.
Where would you palpate the ductus deferens? By palpation alone, how would you identify the ductus deferens?
Although it arises at the lower pole of the testis it is attached to the back of the testis and is difficult to feel here. It is easy to feel in the spermatic cord and feels like a hard cord.
What is a varicocele?
High pressure of venous blood in the pampiniform plexus of veins in the scrotum cause the veins to enlarge.
Some indirect inguinal hernias are congenital (meaning “present at birth”) even though they may not appear until later in life. Explain the embryology of these hernias.
The testis develops in the posterior part of the abdomen and migrates down through the inguinal canal to lie in the scrotum. As it migrates it pulls a covering of peritoneum with it; this becomes the tunica vaginalis. Normally the connection between the peritoneal cavity and the tunica vaginalis obliterates but in some cases it remains as a fine tube. This fine tube may then stretch up to form a hernia.
Where would you try to palpate lymph nodes to assess the spread of testicular cancer?
The lymph drainage of any organ follows the arteries (but flow in the opposite direction). Cancer of the testis will spread to lymph nodes around the aorta where the testicular arteries arise.
Where might you look for an undescended testis? Is it worth surgically correcting this anomaly?
Anywhere along its normal (embryological) path on the posterior abdominal wall. Spermatogenesis does not occur correctly at body temperature so the testis migrates into the scrotum where the temperature is lower. In undescended testis correction is essential to ensure future fertility.
What anatomical structure in the glans penis might impede the progress of a catheter?
The navicular fossa
Which nerves provide sensory innervation to the scrotal skin?
The anterior 1/3 is through the ilio-inguinal nerve (Lumbar 1 nerve root) and the posterior 2/3 the peudendal nerve (Sacral 2, 3 and 4 nerve roots).
Renal tumours can become very large before they invade adjacent structures. What anatomical features explain this?
Fibrous capsule (inner layer) closely applied to the renal substance, perirenal fat, renal fascia (encloses the kidney and adrenal glands together), pararenal fat. So the tumor has to grow through multiple tough layers before invading adjacent structures.
Describe two common variations in the anatomy of the renal pelvis and ureter.
Duplex system, pelvoureteric junction obstruction.
What veins do the right and left gonadal veins drain into?
Right – directly into the inferior vena cava, left into the left renal vein.
What is a polar artery? Why do polar arteries exist?
When the kidneys develop (embryology) they have a segmental pattern with a separate artery to each part. Usually these arteries join to form a single renal artery. However, about ¼ of people have two renal arteries to one kidney, usually a large renal artery and a smaller one to the inferior pole of the kidney; a polar artery. A polar artery can compress the ureter and stop urine flow.
Where would you palpate an abdominal aortic aneurysm?
The aorta finishes just above the umbilicus so can only be felt in the upper abdomen.
What are the narrow parts of the ureter where a stone may get stuck?
The ureter has three narrowing’s which may be too small for a stone to pass through; where the pelvis of the kidney becomes the ureter, at the pelvic brim and where the ureter passes through the bladder wall.
Describe the relationship of the ureter to bony landmarks of the abdomen and pelvis (useful for finding the ureter on an X-ray).
The pelvis of the left kidney is about the level of the Lumbar 2-3 disc and the right pelvis at the Lumbar 3 body. The ureter commences at the lower part of the pelvis and runs down the tips of the transverse processes of the lumbar vertebrae. It runs just medial to the sacroiliac joint but usually directly over it inferiorly. It runs across the tip of the spinous process of the pelvis and medially into the bladder.
