Week 11- Male Pelvis Flashcards
Reproductive duct that extends from the epididymis the the ejaculatory duct
Vas deferens
Superior portion of the prostate gland, which is located below the inferior margin of the urinary bladder
base
Inferior portion of the prostate gland, which is located superior to the urogenital diaphragm
apex
A longitudinal ridge within the prostatic urethral wall where the orifices of the ejaculatory ducts are located on either side.
verumontanum
Demarcation between the inner gland and the outer gland, which normally appears hypochoic.
surgical capsule
Duct that passes through the central zone and empties into the urethra; originates from the combination of the vas deferens and the seminal vesicle.
ejaculatory duct
Describe the transrectal sonographic technique used to evaluate the prostate gland, including patient preparation, positioning,, image orientation, and any contraindications to the study.
The most common approach is the endorectal approach because it results in improved visualization of the gland and surrounding structures. The patient’s bladder must be empty. The patient is placed in the left lateral decubitus position with the knees bent into the chest. Gel and a probe cover are placed over the probe and lubricating gel is applied to the probe. The transducer is then inserted into the rectal cavity. The ultrasound image is inverted during a prostate examination with the near field at the bottom of the image and the far field at the top. In the transverse plane, the right lobe of the gland is at the left side of the image and the left lobe of the gland is on the right side. In the sagittal plane, the base of the gland is at the left side of the image and the apex of the gland is at the right side of the image. Contraindications include rectal fissures, rectal tumors, thrombosed hemorrhoids, and prostatitis, which may prevent insertion of the probe due to patient discomfort
Where is the location of the seminal vesicles?
Posterior to the urinary bladder
Denonvilliers’ fascia
lies between the rectum and the prostate.
The prostate is laterally supported by which of the following?
the obturator internus and levator ani muscles.
Which of the following is NOT one of the four zones within the glandular prostate?
Prostatic urethral
Which zone of the glandular prostate is located at its superior edge?
Central
The anterior fibromuscular region, or stroma, is ___ to the prostatic urethra.
anterior
The prostatic urethra is divided into proximal and distal segments by which of the following.
the verumontanum.
The inferior margin of the prostate is called?
the apex
Which of the following diagnostic tests is second only to direct physical palpation of the prostate by a urologist?
Sonography
The seminal vesicles are encapsulated by___
connective tissue
t/f: The ejaculatory ducts enter the prostate at its superior margin.
FALSE
The transition zone is made up of a single lobe superior to the verumontanum.
FALSE
Sperm could not survive to complete the process of reproduction without the secretions of ________________.
the accessory organs???
The prostate normally measures approximately __________ wide.
4cm
Each seminal vesicle measures less than __________ in diameter.
1.1cm
Normal serum prostatic specific antigen is less than __________.
4
Which prostate zone borders the central zone posteriorly and laterally?
peripheral zone
The tissue that lines the proximal prostatic urethra forms which prostate zone?
periurethral zone
glandular zone located at the superior edge bordering the bladder and seminal vesicles
central zone
inferior to urinary bladder, posterior to symphysis pubis, anterior to rectum
prostate
paired gland posterior to bladder, superior to prostate
seminal vesicles
benign ductal ectasia seen in ___ men
older
visible as single or grouped 1-2mm diameter tubular structures in peripheral zone
benign ductal ectasia
t/f: benign ductal ectasia can be mistaken for cancer bc of hypoechoic area
true
normal finding, common with increasing age, show as bright echogenic foci or clumps in prostate
prostatic calcifications and corpora amylacea
create a “twinkle artifact” on colour doppler
corpa amylacea
corpora amylacea has __ clinical significance and typically develop along ____ capsule
NO
surgical
proteinaceous debris in dialated prostatic ducts
corpora amylacea
corpora amylacea can cause sound attenuation that prevents ___ exams
transrectal (TRUS)
t/f: TRUS commonly preformed by general sonographer
FALSE usually by radiologist bc of sensitive area
prostate associated tests after US
MRI
biopsy
sigmoid colon is in the __ pelvis
true
__ is continuous with the descending colon and is loosly attached to the posterior abdominal wall by ___
- sigmoid colon
- mesocolon
sigmoid colon courses ___ towards the rectum
inferioposteriorly
t/f: rectum is fixed in position
true
small bowel is displaced out of true pelvis when ___
bladder is full (TA)
on ___ peristalsis can be seen in small bowel surrounding the uterus
empty bladder (TV)
anything below the ileocecal opening is considered
cecum
cecum is located in what quadrant
RLQ
blind ending tubular structure in RLQ
appendix
appendix has characteristic __
gut signature
muscular sac that stores urine
bladder
4 layers of bladder
- inner mucosa
- submucosa
- muscularis
- serosa
t/f: mucosa folds when bladder is empty
true
serosa is the outermost layer at the superior portion and is an extention of ___
peritoneum
inferior bladder composed of
trigone & neck
trigone job
communicate with ureters and urethra
separates the pubic symphysis from anterior bladder wall
space of retzius
bladder wall measurement
3-6mm
ureters can be seen through __ exam
TV
ureters course ___ in the pelvis to the orifice in the ___
posteromedial
trigone
t/f: urethra can be seen TV
true
anechoic tube from neck of bladder to the external orifice
urethra
pelvic musculature on either side of the lateral bladder walls
ileopsoas (PSOAS & ILIACUS)
pelvic musculature posterior and medial to ileopsoas
obturator internus
pelvic diaphragm
levator ani (puboccygeus, iliococcygeus, puborectalis) , coccygeus
pelvic musculature posterior to uterus, anterior to sacrum
piriformis
pelvic musculature most anterior portion of abdominopelvic wall
rectus abdominus
t/f: lymph nodes are routinely seen on US
false
abnormal lymph nodes typically surround ___ and ___ walls
vessels
pelvis sidewalls
best exam to see lymph nodes (TA or TV)
TV
when zones are compared on US, the peripheral zone may ppear more echogenic that which of the following:
- central
- transitional
- periurethral
- all of the above
4
t/f: the periurethral tissue can be easily differentiated from the anterior fibromuscular stroma
false
semen is composed of
- 60% alkaline fructose, 13-33% alkaline fluid, sperm
- 13-33% alkaline fructose, 70% alkaline fluid, sperm
- 70% alkaline fructose, 13-33% sperm, acid fluids
- 60% sperm, 13-33% alkaline fluid, fructose
1
when imaging glandular prostate the best technique to describe the prostate is to use
- regions
- zones
- A&P terminology
- medial & lateral terminology
2
which statement is NOT true about seminal vesicles
- they are paired glands
- they are posterior to the bladder and inferior to the prostate
- each gland empties into the distal ductus deferes
- they help from the ejaculatory duct
2 - they are superior to the prostate
the transition zone lines the proximal prostatic urethra
false, the periurethral glandular zone lines the prostatic urethra
the seminal vesicle joins with the ductus deferens to form the ejaculatory ducts
true
t/f: only alkaline fluid is produced by the seminal vesicles
false - also fructose
the anterior fibromuscular region or stroma
- is anterior to most of the zonal anatomy
- is more clinically significant than posterior glandular
- accounds for most of the weight of the prostate
- lies adjacent to the seminal vesicles
1
which areas are posterior to the periurethral zone
- central, anterior fibromuscular, transition zone
- central, transition, and verumontanum
- central, peripheral, and verumontanum
- central, peripheral, and seminal vesicles
3
alkaline, viscous, fructose is produced by the prostate gland
false - no fructose from prostate only from seminal vesicles
the part of the prostate that is in contact with the bladder is the
base
on a sonogram of the prostate and seminal vesicles, the prostate appears ___-echoic to the seminal vesicles
hyperechoic
the prostate is supported by the
obturator internus and levator ani muscles
the largest portion of the prostate is the
peripheral zone
the prostate weights
20g
the part of the prostate that provides an exit for the urethra is the
apex
the area closest to the center of the prostate is called the
verumontanum
denonviller’s fascia
- is the external coating of the seminal vesicles
- lies between the prostate and rectum
- denonvillier’s fascia
- lines the external wall of the urinary bladder
2
the peripheral zone comprises what percentage of the glandular prostate
70%