abdomen 2 exam 5

noncompressible veins

Abdominal malignancy invading left renal vein may cause varicocele with what?

4-6 hours

Testicular torsion is a medical emergency and treatment must be sought within ____ of onset to prevent necrosis of testis.

torsion

Testis and epididymis twist within scrotum, cutting off vascular supply within spermatic cord is called what?

testicular cancer

The presentation of what disease is painless mass, mild pain or heaviness. 10% present with acute scrotum

maintaining continence

The prostate gland produces most components of semen and forms part of the sphincter mechanism essential for what?

70%, 30%

The prostate is comprised of ____ glandular tissue, and ___ fibromuscular or stromal tissue

testicular rupture

These are sonographic findings of what? - irregular fibrous testicular capsule - inhomogenous testicle - may see a discrete fracture line (20% of cases) - extrusion of the testis into the scrotal sac - hematocele (hemorrhage within the scrotum)

testicular rupture

These clinical findings are related to what? - scrotal pain, scrotal swelling, palpable scrotal mass

LUTS (lower urinary tract syndromes)

These symptoms are indicative of what? urinary frequency, urgency, dysuria, nocturia, poor voiding stream, hesitancy, incomplete voiding, incontinence

microlithiasis

This condition is usually bilateral, measuring <3mm, and has association with testicular malignancy .

prostate

This gland is part of the male reproductive system and is the largest male accessory gland. It provides 30% of the volume of seminal fluid

Bell Clapper deformity

This is a deformity in which the testicle is not attached to the scrotal walls, and can rotate freely on the spermatic cord within the tunica vaginalis. This deformity is linked to testicular torsion.

60%

This many torsion patients have anatomic anomaly on both sides

real time imaging

Tubes may contain echoes that move with what?

classic, limited

Two types of microlithiasis are?

10x

Undescending testes are ___ more likely than normal testes to be affected by torsion, and have a higher risk of cancer

> 4mm (diameter)

Varicocele measurement is? And increase in diameter with valsalva maneuver

left

Varicoceles usually affect which side? Testis usually being normal

hematoceles

What are collections of blood associated with trauma, surgery, neoplasms or torsion?

seminal vesicles

What are paired sac-like (ovoid) male exocrine glands (5-7cm) that secrete fluid (a major component of semen) into the vas deferens?

acid phosphatase

What are the PSA lab values?

seminomas

Which GCT tend to be homogenous, hypoechoic masses with smooth border?

germ cell tumors

#1 seminoma #2 choriocarcinoma #3 teratoma

<3mm

(microlithiasis) microcalcification measurement is?

epididymo-orchitis sonographic findings

- enlarged and hypoechoic epididymis and testis - if secondary hemorrhage occured, these may contain focal hyperechoic areas (inhomogenous echotexture) - exhibits hyperemic flow confirmed w color doppler -scrotal wall thickening -hydrocele-may have debris and septations -pyocele in severe cases

testes descend by what age

6 months

varicocele

An abnormal dilation of veins of pampiniform plexus (located within spermatic cord) is called what?

less

Are pyoceles and hematoceles (less/more) common that hydroceles?

yes

Are varicoceles painful?

no

Do seminomas often contain calcification or cystic components?

carcinoma, has spread beyond the prostate capsule

If PSA is elevated, what does this indicate?

arterial flow

If torsion continues, THIS is obstructed and testicular ischemia follows.

20%

If torsion surgery is performed after 12 hours of onset of pain, testes can be salvaged with this success rate

0%

If torsion surgery is performed after 24 hours hours of onset of pain, testes can be salvaged with this success rate

80-100%

If torsion surgery is performed within 5-6 hours of onset of pain, testes can be salvaged with this success rate

70%

If torsion surgery is performed within 6-12 hours of onset of pain, testes can be salvaged with this success rate

cancer

If you find a solid mass, it's most likely this...

benign

If you find an extratesticular mass, it's usually (benign/malignant)

malignant

If you find an intratesticular mass, it's usually (benign/malignant)

orchitis

In severe cases of this, testicular infarction may occur

epididymo-orchitis

In severe cases of which disease might you see: - swollen testis confined within rigid tunica albuginea - excessive swelling that can cause obstruction to testicular blood supply - decreased or absent color flow compared with contralateral testis - decreased flow, spectral doppler waveform, high resistance w little or no diastolic flow

torsion

Presenting symptoms of THIS are: sudden onset of scrotal pain with swelling on affected side, severe pains that cause nausea and vomiting

internal septations, loculations, debris

Pyocele contains what? And has same appearance following trauma or surgery

epididymal head

Sonographic evaluation of varicocele shows numerous tortuous tubes of varying sizes within spermatic cord near where?

peripheral zone, central zone, transitional zone

What are the prostates 3 zones?

primary varicoceles

What are usually caused by incompetent venous valves within spermatic vein?

torsion

What compresses blood flow to testis, epididymis and intrascrotal portion of spermatic cord?

cancer

What disease are undescended testicles 2.5-8x more likely to develop?

microlithiasis

What disease has been associated with cryptorchidism, Klinefelter's syndrome, infertility, varicoceles, testicular atrophy, and male pseudohermaphroditism?

malignant testicular masses

What disease occurs most frequently between the median ages of 20-45?

transurethral resection of the prostate

What does TURP stand for?

varicoceles

What does increased abdominal pressure cause?

hydroceles

What forms in the space between layers of tunica vaginalis (potential space)

prostate

What gland is a walnut sized exocrine gland located between the bladder and penis? Anterior to rectum.

prostate size

What is 4.0 x 3.5 x 2.5, is shaped like a walnut, is composed of fibromuscular and glandular tissue and is retroperitoneal?

prostate BPH size

What is 7 cm long? Must be surgically removed... metal probe is located within the urethra

epididymis

What is a long, coiled duct on the outside of the testis, in which sperm mature and is stored? It's a duct for seminal fluid, secretes part of that fluid. Sperm becomes mobile while they are passing through this area, but not truly mobile until they reach the vagina.

vas deferens

What is a long, narrow tube carrying sperm from epididymis to ejaculatory duct?

ejaculatory duct

What is a tube through which semen enters the male urethra? Transverse through the CZ? Originates from combination of vas def and seminal vesicles

venous flow

What is affected first with occluded veins, causing swelling of scrotal structures on affected side?

germ cell tumors

What is associated with elevated levels of hcg and alpha-fetoprotein?

secondary varicoceles

What is caused by increased pressure on spermatic vein and pampiniform plexus?

testicular cancer

What is the #1 cancer killer of young men? Peak ages 20-45, 90% white

95%

What is the % of testicular tumors that are germ cell tumors and are highly malignant but have excellent prognosis?

trauma

What is the etiology of testicular rupture?

BPH (prostate cancer, prostatitis, acute urinary retention, surgical manipulation, abscesses and age are others)

What is the main cause for prostate enlargement?

transrectal (7.5 MHz Tx used. empty bladder, transverse images of base and apex, seminal vesicles and VD imaged at base, transverse taken at the largest diameter, sag images include urethra, verumontanum, right left prostate)

What is the preferred approach for scanning the prostate?

TURP

What is the surgery most often used for prostate cancer treatment?

95%

What is the survival rate of testicular cancer? (one of the most curable forms of cancer)

surgical capsule

What is the thin, hyperechoic band that separates the PZ from the CZ and TZ?

secondary varicoceles

What may be the result of renal hydronephrosis, abdominal mass or pelvic lymphadenopathy?

hydrocele, pyocele, hematocele

What may develop in the potential space that exists between visceral and parietal layers or tunica vaginalis?

pyocele

What occurs with untreated infection or when an abscess ruptures into space between layers of tunica vaginalis?

TURP

What procedure uses an instrument inserted into the urethra to remove prostate tissue that is pressing against the upper part of the urethra restricting urine flow? Results in the removal of mostly TZ tissue in pt with BPH.

Denonvillier's Fascia

What separates the lower 1/3rd of the rectum from the prostate, base of the bladder, or vagina?

classic

What type of testicular microlithiasis is defined as 5 or more echogenic foci per view in either or both testes?

limited

What type of testicular microlithiasis is definied as <5 echogenic foci per view in either or both testes?

peripheral zone (70-80%, and appear as hypoechoic lesions or nodules)

What zone do most prostate cancers arise from?

central zone

What zone has the most highly invasive form of prostate cancer, but only 3% occur there?

transitional zone

What zone is responsible for BPH?

hydroceles

What's the most common cause of painless scrotal swelling?

prostate, semen

Where is acid phosphatase (ACP/SAP) found?

80%

With regard to microlithiasis, this percentage of patients if both testicles affected.

cryptorchidism

With testicular cancer, the incidence of GCT increased with what?

scrotum

With varicoceles, patients often palpate a lump where?

epididymo-orchitis cause in children

ascending UTI via spermatic cord

torsion

at the bare area, the testicle is attached against the scrotal wall, preventing what?

epididymis anatomy

becomes vas deferens and continues into spermatic cord, follows posterolateral aspect of testis from upper to lower pole

two things that herniate into scrotum

bowel (strangulated bowel = medical emergency) and mesenteric fat

corpora amylacea

calcifications commonly seen in the inner gland of the prostate (proteinaceous)

sertoli cells

cells that produce sperm

right testicular vein

drains into IVC

left testicular vein

drains into LT renal vein

rete testis

drains sperm from testicle lobules in mediastinum into epididymus, only see sonographically when cystic

benign testicular masses

granulomas and microlithiasis are catagories of what?

serous

hydroceles contain what kind of fluid?

epididymo-orchitis and torsion

hydroceles may be idiopathic, but are commonly associated with what?

orchitis

infection in testes, usually starts in epididymus first

epididymo-orchitis

infection of the epididymis and testis, most common cause of acute scrotal pain in adults

epididymitis

inflammation of the epididymis usually caused by bacterial infection (or trauma). May appear enlarged. Affected side may have a hydrocele. May contain debris, complex, septation), increased vascularity

blood-testis barrier

large molecules cannot pass from the blood into the lumen of a seminiferous tubule due to tight junctions between adjacent sertoli cells-contains Ca infiltration partially, can prevent autoimmune response

cremaster muscle

lifts testicle toward body when cord and lowers testicle when too warm

leydig cells

localized between seminiferous tubules, produce and secrete testosterone

normal flow in testes and epididymus

low flow

function of scrotum

maintenance of lower body temp for sperm survival

benign

non germ cell tumors are usually (benign/malignant)

14

peak incidence of torsion occurs at this age (but can occur at any age)

need to look at what to R/o bowel strangulation

peristalsis and vascularity

epididymo-orchitis cause in adults

possible STD

function of testis

production of testosterone and sperm

pyocele

pus fills space between layers of tunica albuginea

function of epidiymus

store and transport sperm produced by the testicle

prostate

this gland does not have a true capsule but instead has a fibromuscular band which surrounds it.

cowpers gland (bulbourerethral glands)

two pea sized glands (2.5cm) just below the prostate which opens into the urethra, they secrete a clear sticky (alkaline) fluid that is part of semen (5%)

spermatic cord

vas deferens, testicular arteries, venous pampiniform plexus, lymphatics, autonomic nerves and fiber of remaster form what?

pampiniform plexus

venous drainage of the scrotum occurs here, exits mediastinum and courses into spermatic cord

pus

what is pyocele a collection of?

tunica vaginalis

what lines the inner walls of scrotum, covering each testis and epididymis?

prostate gland

what produces fluid that mixes with sperm (and fructose) to make seminal fluid?

blood vessels, lymphatics, nerves, spermatic ducts

what travels through the bare area?

vasectomy

when can you see cystic changes in rete testis?

rete tubular ectasia

when rete testis are cystic, can cause low fertility and sperm count

posterior

where is the small bare area found?

parietal vaginalis

which layer is the inner lining of the scrotal wall?

visceral vaginalis

which layer surrounds testis and epididymis?