ICM Exam 7 GU manual

What is the penis composed of?

• Corpora cavernosa

• Corpus spongiosum

• Urethra

What is the corpora cavernosa?

Extends from bulb of penis to glans (this is what fills with blood during an erection)

What is the corpus spongiosum

Encompasses the urethra

Why is it needed to clean an uncircumcised penis and how is that done?

• Needed to prevent infections

• Retract the foreskin to clear the area

• Need to replace the foreskin in its original position to prevent problems such as paraphimosis

What is the urethral meatus (male)?

Opens at the tip of the glans

Can have 2 conditions:

• Hypospadias

• Epispadias

What is hypospadias?

Abnormal congenital opening of the male urethra on the undersurface of the penis

More common

What is epispadias?

Abnormal congenital opening of the male urethra on the upper surface of the penis

Less common

Describe the anatomy of the testes.

Glands made of seminiferous tubules that are separated by interstitial tissue and covered by tunica albuginea

What is the tunica albuginea?

Fibrous capsule that surrounds the testes, covered by scrotal skin

What is the tunica vaginalis testis?

Serous membrane that surrounds the front and sides of the testicle

Describe the travel of sperm.

Sperm first produced in teste --> Seminiferous tubules --> epididymis --> vas deferens --> goes through inguinal canal into the pelvis --> meets up with seminal vesicle and travels through prostate to get to urethra

Describe the structures that encompass the spermatic cord.

Seminiferous tubules meet with and become epididymis --> meets up with and becomes vas deferens --> travels with testicular artery and pampiniform plexus

These are all enveloped by cremaster muscle and make the spermatic cord

Where does the ASIS connect?

Connects inguinal ligament and pubic tubercle

What is the inguinal canal?

Lies above the inguinal ligament, tunnel for the spermatic cord to exit

Where does the spermatic cord enter?

Enters the inguinal canal via the external inguinal ring

Travels through the canal and enters the pelvis via the internal inguinal ring

What is an indirect hernia?

Hernia through the INTERNAL inguinal ring

Loops of Bowel can get into inguinal canal and migrate into scrotum

MOST COMMON TYPE OF HERNIA

What is a direct hernia?

Hernia that protrudes through weakened muscle of the abdominal wall

These rarely enter the scrotum, is possible

How can you tell between indirect and direct hernia via examination/palpation?

Invaginate finger in the scrotum

Indirect --> will touch your finger tip

Direct --> should touch the side of your finger (because they rarely go into the scrotum)

What is a femoral hernia?

Hernia below the inguinal ligament, located more lateral

These never go into the scrotum

LEAST COMMON (if they do happen, they will happen to female pt)

Lymph drainage from the penis drains into…

Deep inguinal nodes

Lymph drainage from scrotum drains into…

Superficial inguinal nodes

For male sexual development and function, we rely on the hypothalamus and pituitary glands to stimulate the…

• Leydig cells to make testosterone

• Sertoli cells in seminiferous tubules to make sperm

Leydig cells are stimulated to make:

Testosterone

Sertoli cells in seminiferous tubules are stimulated to make:

Sperm

Describe the pathway of testosterone.

Begins at hypothalamus --> gonadotropin releasing hormone --> pituitary --> leutinizing hormone --> Leydig cells --> testosterone

Describe the pathway of sperm creation.

Hypothalamus --> gonadotropin releasing hormone --> pituitary --> follicle stimulating hormone --> Sertoli cells in seminiferous tubules --> sperm

What triggers puberty and physical changes noted in the male body?

Testosterone when covered to 5-alpha-dihydrotestosterone

Male sexual function relies on: (3)

1. Testosterone

2. Arterial blood flow

3. Neural innervation from alpha and cholinergic pathways

What do we inspect in a male genital exam?

Skin, foreskin, glans

Looking for inflammation, excoriations, ulcers, discharge, scars, nodule

What is the physical exam of the urethral meatus?

Note the location, compress and look for discharge --> may need to milk the shaft or ask patient to do this if there is a complaint of discharge

Should there be any induration or tenderness of the shaft/glans of penis?

No --> can be signs of infection or cancer

On physical exam of the testes, what should we note?

Should feel firm, be descended, symmetric, non-tender, have no masses

How do we palpate the epididymis and spermatic cord?

• Palpate each epididymis (should be nodular and cord-like, nontender)

• Palpate spermatic cord between thumb and finger

• Palpate epididymis to vas deferens (stiff and tubular) to spermatic cord

• Note for any nodules or swelling

What can you do if you note scrotal swelling on physical exam?

Transilluminate the scrotum to determine if it is a hydrocele or a mass

If the scrotum is transilluminated, what does this mean?

Hydrocele

If it is not transilluminated, means it is a mass

How do we inspect for inguinal hernias?

Patient should be standing or supine

First inspect for any bulging areas

• Invaginate index finger in the scrotum

• Follow the spermatic cord up to the external inguinal ring

• Have pt cough and feel for bulges

On physical exam, will you be able to distinguish between indirect and direct hernias?

Difficult to distinguish

If you feel a hernia, what can you try to do?

Reduce it (with slow, steady pressure, can push it back through)

Do not do if patient has pain, nausea, or vomiting

What is an incarcerated hernia?

Irreducible hernia in which the contents of the hernial sac are entrapped or stuck in the groin

What is a strangulated hernia?

Hernia that is constricted, cutt off from circulation, and likely to become gangrenous

What is the most common hernia? Least common?

Most common = indirect

Second most common = direct

Least common = femoral

What is the labia majora? Labia minora?

Labia majora = outer lips of vagina

Labia minora = inner pink-red folds of the vagina

What is the introitus?

Opening of the vagina

What is the urethral meatus (female)?

External opening of the urethra (located just below the clitoris and above the introitus)

What is the perineum in females?

Area between vaginal orifice and anus

Can be inflamed, especially when person is bed bound and has diarrhea, or sits in wet diapers for long periods of time

What are Bartholin glands?

Glands that secrete fluid to keep vulva tissue moist