Scrotum

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What are the three major structures contained in the scrotum?

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1

What are the three major structures contained in the scrotum?

  1. Spermatic cord

  2. Epididymis

  3. Testes

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2

What structure separates the scrotum into two sacs?

Median raphe

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3

What is the External Spermatic Fascia?

Fascial layer derived from the external oblique muscle

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4

What is the Cremaster Muscle?

A suspender muscle that arises from the internal oblique muscle of the abdominal wall

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5

What does the Cremaster Muscle consist of?

Bands of skeletal muscle

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6

What wrinkles the scrotal skin?

Dartos Fascia and Dartos Muscle

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7

What elevates the testes?

Cremaster Muscle

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8

What does the Dartos Fascia and Dartos Muscle continue internally to form?

Median raphe (septum)

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9

What is the Cremasteric Fascia derived from?

Fascia of internal oblique muscle

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10

What is the Internal Spermatic Fascia?

Transversalis fascia

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11

How many layers does the Tunica Vaginalis have?

Double-layer extension of peritoneum

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12

What is the serous layer covering the testis?

Tunica Vaginalis

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13

What two structures does the Tunica Vaginalis seperate?

Separates scrotal layers from tunica albuginea

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14

What does the Tunica Vaginalis cover specifically?

The testes except for where the epididymis is attached

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15

What three structures does the Tunica Vaginalis consist of?

  1. Parietal (outer) layer

  2. Visceral (inner) layer

  3. Vaginalis sac

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16

What layer of the Tunica Vaginalis lines the walls of the scrotal sac?

Parietal (outer) layer

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17

What layer of the Tunica Vaginalis covers the testis, epididymis, and lower portion of spermatic cord?

Visceral (inner) layer

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18

What is the potential space between the
two layers of tunica vaginalis? What does it contain?

Vaginalis sac containing fluid

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19

What are the three ducts that deliver sperm to the outside of the body?

  1. Epididymis

  2. Ductus deferens

  3. Urethra

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20

What are the three accessory sex glands that empty into the ducts during ejaculation?

  1. Seminal vesicles

  2. Prostate gland

  3. Bulbourethral glands

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21

What are the testicles?

  1. Symmetric

  2. Oval shaped glands

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22

What is the Appendix Testis?

Small remnant tissue on the testicle created from the degeneration of paramesonephric ducts

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23

What is the Tunica Albuginea?

Dense, fibrous capsule covering testis

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24

What does the tunica albuginea divide the testicles into?

Divides each testicle into 250-400 lobules

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25

What are lobules?

Internal compartments of the testicle

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26

What do the lobules contain?

  1. Seminiferous tubules

  2. Interstitial cells (Leydig)

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27

How many Seminiferous Tubules do lobules contain?

1-3

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28

What do Seminiferous Tubules produce? How?

Produce sperm by spermatogenesis

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29

What do Seminiferous Tubules contain?

Sustentacular (Sertoli) cells

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30

What do Sustentacular (Sertoli) cells produce? Why is this important?

The blood-testis barrier needed for immunity

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31

Where do the seminiferous tubules move spermatazoa to?

  1. Seminiferous tubules

  2. Straight (rectus) tubules

  3. Rete testis

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32

What do the seminiferous tubules converge to form?

The rete testis

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33

Where is the rete testis located?

Testicular mediastinum

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34

What is the thickened portion of albuginea along the posterior border of testis?

Mediastinum teste

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35

Where do the Semineferous Tubules converge and exit into the Rete Testis and Efferent Ducts?

Mediastinum teste

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36

What is the Ductus (Vas) Deferens/Seminal Duct?

Muscular cord that ascends along posterior border of testis

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37

What are the functions of the Ductus (Vas) Deferens/Seminal Duct?

  1. Pump sperm into prostatic segment of urethra

  2. Store sperm for several months

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38

How does the Ductus (Vas) Deferens/Seminal Duct enter the pelvic cavity?

Through inguinal canal

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39

What structure does vas deferens merge into? What does this form?

The Vas Deferens merges with the Seminal Vesicles to form the Ejaculatory Ducts

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40

What is the epididymis?

Comma-shaped structure that curves along posterior
border of testis

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41

What is the appendix epididymis?

The most cranial portion of the mesonephric duct

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42

What is the epididymis head (globus major)?

Most superior portion of epididymis

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43

What does the epididymis head consist of?

First part of efferent ducts that transport sperm out of testes

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44

What does the epididymis body (corpus) contain?

Ductus epididymis

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45

What is the ductus epididymis?

Tightly coiled single tube where efferent ducts drain into

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46

What is the epididymis tail (globus minor)?

Distal part of epididymal ducts

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47

What part of the epididymis exits and continues as ductus (vas) deferens in the spermatic cord?

Epididymis tail

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48

What are the normal measurements for the epididymis?

  1. Head = 10-12 mm

  2. Body = Less than 4 mm

  3. Tail = Less than 4 mm

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49

Where are the efferent ductules located?

From rete testes to enter upper portion of epididymis

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50

What are the normal measurements of a testicle?

  1. Length = 4.0-5.0 cm

  2. Width = 2.0-3.0 cm

  3. AP = 2.0-3.0 cm

  4. Weight = 12.5-19 g

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51

Where are each testicle located?

  1. Obliquely positioned within scrotum

  2. Attached to spermatic cord

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52

Where is the upper pole of the testicle located relative to the scrotum? Lower pole?

  1. Upper pole = anterolateral

  2. Lower pole = posteromedial

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53

What muscle does the spermatic cord contain?

Cremaster muscle

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54

What is the path of arterial blood flow to the testes?

  1. Aorta

  2. Testicular Artery

  3. Capsular Arteries

  4. Centripetal Arteries

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55

What is the arterial blood flow pattern of the testes?

  1. Low resistance = high blood flow

  2. Broad systolic peaks

  3. High diastolic flow

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56

What is the path of arterial blood flow to the scrotum and epididymis?

  1. Inferior Epigastic Artery

  2. Cremasteric (External Spermatic) Artery

  3. Inferior Vesicle Artery

  4. Deferential Artery

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57

What artery courses through the epididymis tail and divides into a capillary network?

Deferential Artery

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58

What is the arterial blood flow pattern of the scrotum and epididymis?

  1. High resistance = low blood flow

  2. Narrow systolic peaks

  3. Diminished/absent diastolic flow

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59

What is the path of venous blood flow to the testes?

  1. Intratesticular Veins

  2. Venous Outflow

  3. Pampiniform Plexus

  4. Internal Spermatic Vein

  5. IVC

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60

Where does the left internal spermatic vein drain into?

  1. Left renal vein

  2. IVC

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61

Where does the right internal spermatic vein drain into?

Directly into IVC

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62

What is the path of lymphatic drainage of the testes?

  1. Lymph plexuses under tunica vaginalis, testis, and epididymis

  2. Traverse in spermatic cord

  3. Testicular vessels

  4. Lumbar (para-aortic) nodes as high as renal veins

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63

What are the chief phases of the male sexual response?

  1. Erection

  2. Ejaculation

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64

What is spermatogenesis?

Sperm formation

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65

What is a male gamete?

Sperm or spermatozoa

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66

How much sperm does an adult male produce each day?

400 million

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67

What is meiosis?

  1. “A lessening”

  2. Nuclear division

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68

Where does meiosis occur?

Mostly in gonads

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69

How many divisions does meiosis consist of? What does this produce?

  1. Two consecutive nuclear divisions

  2. Produces four daughter cells

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70

What does the hormonal regulation of reproductive function involve?

Brain-Testicular Axis

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71

What does hormonal regulation of spermatogenesis and testicular androgen production involve?

  1. Interactions between

    1. Hypothalamus

    2. Anterior pituitary gland

    3. Testes

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72

What hormone directly stimulates the testes? What type of cell is this hormone?

  1. Gonadotropins (FSH and LH)

  2. Pituitary cells

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73

What hormone stimulates spermatogenesis in the testes?

FSH

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74

What hormone indirectly stimulates the testes? How?

GnRH via its effects on the release of FSH and LH

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75

What hormone binds to pituitary cells?

GnRH

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76

What serves as the final trigger for spermatogenesis?

Testosterone

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77

What hormones exert negative feedback?

  1. Testosterone

  2. Inhibin

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78

How are testosterone and the number of sperm produced related?

  1. Directly

    1. More testosterone = more sperm

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79

Why is it important that the testicles are held outside of the body, but within the scrotum?

Temperature is more optimum for sperm maturation

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80

What is the site of sperm maturation?

Epididymis

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81

How do the testicles function as an exocrine gland?

Producing sperm

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82

How do the testicles function as an endocrine gland?

Synthesizing and secreting testosterone

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83

What is human chorionic gonadotropin (HCG) produced by?

Tumors

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84

What structures cause an elevation of human chorionic gonadotropin (HCG) in the blood?

  1. Seminoma

  2. Embryonic cell tumors of testes

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85

What is the main androgen secreted by Leydig cells?

Testosterone

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86

What hormone induces puberty in males?

Testosterone

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87

What structures cause an elevation of testosterone in the blood?

  1. Testicular tumor

  2. Adrenal hyperplasia

  3. Benign or malignant tumors of testes, adrenal, pituitary

  4. Adrenal tumor

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88

What structures cause a decrease in testosterone in the blood?

  1. Orchiectomy

  2. Testicular or prostate cancer

  3. Cirrhosis of liver

  4. Primary or secondary hypogonadism

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89

What is the normal ultrasound appearance of the testicles?

  1. Homogenous

  2. Smooth walls

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90

What is the normal ultrasound appearance of the mediastinum testis?

  1. Highly echogenic

  2. Parallel to epididymis

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91

What is the normal ultrasound appearance of the appendix testis?

  1. Small ovoid

  2. Under epididymis head

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92

What is the normal measurement of the scrotal wall?

2-8 mm thick

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93

What is the normal ultrasound appearance of the epididymis head? Body? Tail?

  1. Head = Isoechoic or MORE echogenic than testis

  2. Body = Isoechoic or LESS echogenic than testis

  3. Tail = Thicker than body

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94

What is cryptorchidism?

Undescended testis

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95

What is the normal age for the testes to descend into the scrotal sac?

8 months gestational age

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96

What does cryptorchidism look like in adults?

Small testis with normal echogenicity

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97

Where is cryptorchidism most commonly found?

At or below level of inguinal canal

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98

What are the potential concerns of cryptorchidism?

  1. Increased chance of malignancy (seminoma) in
    undescended testicle

  2. Infertility

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99

Where can undescended testis appear?

Anywhere along normal track of decent from
retroperitoneum to scrotum

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100

Who is acute painful scrotum commonly found in?

  1. Children

  2. Adults

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