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prostate

Terms

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tubuloalveolar gland composed mainly of fibromuscular tissue that surrounds the neck and the bladder and urethra
prostate
prostate is located directly beneath the __between the symphysis pubis and the rectum; it encircles the neck of the bladder and ___ which goes through the prostate; it is an oval-shaped, retroperitoneal structure with a base and __.
bladder, urethra, apex
normal size of prostate is __X___X___
3.8X3X4 (LWH)
relational anatomy of prostate: superiorly the base is conitnuous with the neck of the ___. inferiorly the apex lies on the upper urogenital __. anterior is the __ and posterior is the anterior surface of the rectal __. lateral margins include the __ m
bladder, diaphragm, pubis symphysis, ampulla, obturator internus
zonal anatomy divides the prostate into four glandular zones surrounding the prostatic urethra. what are the four zones
peripheral, central, transitional, periurethral
represents 70-75% of the glandular tissue; largest of the glandular zone; occupies the posterior, lateral, and apical regions of the prostate; most cancer starts here
peripheral zone
represents 25% of glandular tissue; located like a midline wedge at the prostate base between the peripheral and transition zone; ducts of the vas deferens and seminal vesicles enters this zone forming the ejaculatory duct
central zone
area where the ejaculatory duct joins the urethra, where the central zone terminates
verumontanum
presents 5% of the glandular tissue; BPH starts here
transition zone
1% of the glandular tissue
periurethral gland
represent non glandular tissue, the anterior portion of the prostate
fibromuscular stroma
blood flow to the prostate is supplied by the __ arteries arising from the ___ arteries on each side. these vessesls then give rise to the __ and __ arteries.
prostaticovesicle arteries, internal iliac arteries, prostatic, vesicle
the prostatic artery gives rise to the __ and __ arteries. the __ artery supplies the bladder base, seminal vesicles, and ureter. the __ supplies about 1/3 of the prostate, whereas the __ branches supply the remainder fo the gland
urethral and capsular*inferior vesicles artery*urethral*capsular branches
what is the main function fo the prostate
sore and secret a clear, slightly alkaline (ph7.29) fluid that constitutes 25-30% of the volume of the seminal fluid, that, along with spermatazoa, constitutes semen
the fluid secreted by the prostate contains a large amount of __, which liquefies teh previously gelatinous mixture and it helps the protect and nourish the sperm during intercourse.
PSA
the PSA levels should be <__
4 (prostate also contains some smooth muscles that help expel semen during ejaculation
the american cancer society recommends that all men over the age of __ and earlier if they are at a high risk, be screened for prostate cancer by a digital rectal exam and PSA levels.
50
enzyme whose purpose is to break down coagulated semen; made exclusively within the prostate; the most accurate method to calculate prostate function
prostate specific antigen (PSA)
to calculate the PSA levels, you divide the laboratory PSA by the __ of the prostate which is calculated by LWH X 1.57. normal levels are __ng/mL and abnormal is >__ng/ml
volume, 4, 10
elevated PSA indicates one of these three:
cancer, infection, BPH (the higher the PSA, the larger the tumor burden and the higher the risk for spread beyond the prostate
patient prep: patients require an enema _to_ hours before exam which reduces the risk of contamination of the prostate and eliminates fecal material that might affect the quality of the image. patients are placed in __ position
1-2 hours, LLD
transrectal probe is __ to __ mhz. latex condom is placed over the probe to ensure cleanliness. a rectal exam before probe insertion can ensure no abnormalities that could create a problem with a scan. previous DRE is suggested to rule out any __ to pr
*5-10 *obstruction *cephalad
scan planes: coronal and axial: probe is rotated __ and __ to evaluate the lateral aspect of the gland, and moved cephalad and caudad to evaluate the whole gland from __ to __ aspect. this is the preferred plane for assessment of lateral portions and sym
*clockwise, counter-clockwise *superior, inferior *width
scan plane: sagittal: probe is again rotated to image the outermost aspects of the gland. preferred plane to exam __ and __ of gland
base, apex
minimum protocol: thoroughly image prostate and __ in coronal/axial and sagittal scan planes; asses prostate for shape, __, symmetry, and echogenicity. measure the gland; assess seminal vesicle for size, shape, __, symmetry, and echogenicity; evaluate th
*seminal vesicles *contour *position *perirectal
is located superoposterior to prostate; always document in cor and sag planes
seminal vesicles
paired structures lying superior to the prostate, posterior to the bladder, and lateral to the ductus deferens; transports sperm from the vas deferens to the ejaculatory duct
seminal vesicles
the seminal vesicles are __ cm long and __ to __ cm thick
3, 1-3
secrete a significant portion of the fluid that ultimatley becomes semen; composes about 65% of semen; the high fructose concentrations provide nutrient energy for the spermatozoa as they travel through the female reproductive system
seminal vesicles
sono appearance: bilateral hypoechoic, multiseptated structures surrounding the rectum are seen; slightly less echogenic than prostate, often without distinct borders; seen superior to the prostate
seminal vesicles
axial anatomy: the __ urethra and its surrounding smooth muscle and glandular areas appear relatively hypoechoic and can be quite prominent measuring 2 cm in diameter. the inner gland is separated from the peripheral zone by the __. often __ (calcificat
*anterior *surgical capsule *corpora amylacea *transition
sagittal anatomy: the base of the gland, the seminal vesicles are seen immediately adjoin to the __ and __ zones
peripheral, central
indications for transrectal ultrasound (8)
bladder outlet obstruction, urinary frequency, nocturia (nighttime urination), dribbling, enlarged prostate on DRE, pain in lower back, upper thighs, and pelvis, pus or blood in urine and semen, abnormal PSA
indications for prostate biopsy (3)
presence of hypoechoic lesion in both long and trv planes, palpable nodule on DRE, elevate PSA
purpose is to obtain tissue for histologic dx; needle-guided system that clamps onto side of the probe with and automatic gun; enema prior to exam; informed consent is obtained prior to procedure
prostate biopsy
originates in transitional zone; enlarged prostate which is common in older patients; common cause of hydronephrosis because it compresses urethra
BPH
patient presents with frequent urination, dribbling, and nocturia
BPH
sono appears as an enlarge gland with hypoechoic inner region compared to the peripheral region; the central and peripheral zone may be compressed; enlarged AP diameter; calcification and some areas of cystic change may be seen; enlarged surgical capsule
BPH
prostate cancer is the__ leading cause of death in men after lung cancer, and it is the highest leading cause of death in men over the age of __. more common in __ males; commonly found in men over age of __. majority of the cancers are in __ which some
2nd, 75, african american, 50, PZ, TZ, CZ
patient presents with micurition, urgency, dribbling, hematuria, and elevated PSA
prostate cancer
sono appears as small nodules located in the PZ with varied echogenicity; typically hypoechoic to some extent; protate may lose its smooth contour appearance in the area of the lesion; hydronephrosis may be seen; calcification are not usually present; ear
prostate cancer

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