男性生殖系统专题知识培训专家讲座

PhysicalExamination

Part2

XueHuiping男性生殖系统专题知识培训第1页Malereproductiveanatomy男性生殖系统专题知识培训第2页男性生殖系统专题知识培训第3页男性生殖系统专题知识培训第4页Thisillustrationrepresentsanaveragenormaladulthumanpenis.Theheadofthepenis(glans)hasacovering,calledtheforeskin(prepuce).Thiscoveringfoldsinonitself,formingadoublelayer.Theforeskinisnota`flap'ofskinontheendofthepenis,anditisnot`useless'or`redundant'skin.Thereissomenaturalvariationinthelengthoftheforeskin,whichoftencoversabitmoreorlessoftheglansthanillustrated.Inanaveragecircumcisedadultman,theareaofskinthatismissingbecauseofpenilereductionsurgerywould,whenerectandunfolded,measureapproximatelythreebyfiveinches,oralittlesmallerthanapostcard.Thatisabouthalfthetotalskinofthepenis.男性生殖系统专题知识培训第5页StructuresofthepenisTheouterforeskinlayerisacontinuationoftheskinoftheshaftofthepenis.Theinnerforeskinlayerisnotproperly`skin',butmucocutaneoustissueofauniquetypefoundnowhereelseonthebody.Thefrenarbandistheinterface(join)betweentheouterandinnerforeskinlayers.Whenthepenisisnoterect,ittightenstonarrowtheforeskinopening.Duringerection,thefrenarbandformsaridgethatgoesallthewayaround,abouthalfwaydowntheshaft.Thereddishorpurplishglansorglanspenis(headofthepenis)issmooth,shiny,moistandextremelysensitive.Thefrenulum,orfrenum,isaconnectingmembraneontheundersideofthepenis,similartothatbeneaththetongue.男性生殖系统专题知识培训第6页男性生殖系统专题知识培训第7页男性生殖系统专题知识培训第8页男性生殖系统专题知识培训第9页男性生殖系统专题知识培训第10页男性生殖系统专题知识培训第11页男性生殖系统专题知识培训第12页Hereisanormaltestisandadjacentstructures.Identifythebodyofthetestis,epididymis,andspermaticcord.Notethepresenceoftwovestigialstructures,theappendixtestisandtheappendixepididymis.男性生殖系统专题知识培训第13页Ontheleftisanormaltestis.Ontherightisatestisthathasundergoneatrophy.Bilateralatrophymayoccurwithavarietyofconditionsincludingchronicalcoholism,hypopituitarism,atherosclerosis,chemotherapyorradiation,andsevereprolongedillness.Acryptorchidtestiswillalsobeatrophic.Inflammationmayleadtoatrophy.Mumps,themostcommoncausefororchitis,usuallyhasapatchypatternofinvolvementthatdoesnotleadtosterility.男性生殖系统专题知识培训第14页Hereisalargehydroceleofthetestis.Suchhydrocelesarefairlycommon.Clearfluidaccumulatesinasacoftunicavaginalislinedbyaserosawithavarietyofinflammatoryandneoplasticconditions.Ahydrocelemustbedistinguishedfromatruetesticularmass,andtransilluminationmayhelp,becausethehydrocelewilltransilluminatebutatesticularmasswillbeopaque.男性生殖系统专题知识培训第15页完全型含有正常女性体征，有正常女性外阴且发育良好（但阴毛稀少或缺如），阴道发育良好，深度正常。青春期后乳房可发育。不完全型外阴有不一样程度畸形，阴蒂增大，阴道短浅或呈尿生殖窦。睾丸多位于腹股沟内。男性生殖系统专题知识培训第16页男性生殖系统专题知识培训第17页

Epididymis附睾

Theepididymides(pluralforepididymis附睾)arenarrow,elongatedstoragevesselsfornewlygeneratedspermatozoa.Theyarelocatedwithinthescrotum阴囊,adjoiningeachtesticle睾丸.Spermatozoa精子remaininthecord-likeepididymides附睾untilejaculation,atwhichtimetheyejectthemintothevasdeferens输精管.男性生殖系统专题知识培训第18页Cryptorchidism隐睾病

Cryptorchidismisdefinedasfailureofthetestistodescendfromitsintra-abdominallocationintothescrotum.男性生殖系统专题知识培训第19页Epididymis附睾

Along,narrow,convolutedtube,partofthespermaticductsystem,thatliesontheposterioraspectofeachtesticle,connectingittothevasdeferens.男性生殖系统专题知识培训第20页男性生殖系统专题知识培训第21页Elephantiasis象皮肿ofthescrotum男性生殖系统专题知识培训第22页scrotalhernia

aninguinalhernia腹股沟疝whichhasdescendedintothescrotum.男性生殖系统专题知识培训第23页TheProstateGland前列腺男性生殖系统专题知识培训第24页Theprostateisawalnut-sizedglandthatformspartofthemalereproductivesystem.Theglandismadeoftwolobes,orregions,enclosedbyanouterlayeroftissue.Asthediagramsshow,theprostateislocatedinfrontoftherectumandjustbelowthebladder,whereurineisstored.Theprostatealsosurroundstheurethra尿道,thecanalthroughwhichurinepassesoutofthebody.男性生殖系统专题知识培训第25页Normalurineflow

男性生殖系统专题知识培训第26页

SeminalVesicle

producesamucoidsecretionthat'sreleasedintothesemen精液男性生殖系统专题知识培训第27页Femalereproductiveanatomy男性生殖系统专题知识培训第28页

ExternalGenitalia

Externalorgansincludethesensitiveanderoticsexorgans:monspubis,labia唇andclitoris阴蒂(alsoknowncollectivelyasthevulva外阴),andthebreasts.男性生殖系统专题知识培训第29页男性生殖系统专题知识培训第30页男性生殖系统专题知识培训第31页TheMonsPubis

Themonspubis(sometimescalledthemonsvenerisafterVenus,theRomangoddessoflove)istheregionoffattytissueabovethepubicbone.Atpuberty,themonspubisenlargesandbecomescoveredbypubichair.男性生殖系统专题知识培训第32页

TheLabia

Oftenreferredtoas"lips,"thelabiaarethefoldoftissuesurroundingthevaginalandurethralopenings,protectingthesensitiveorificesfromdamage.Theouter,fleshyhair-coveredfoldsformthelabiamajoraandtheinnerhairlessfoldsformthelabiaminora.Thelabiaarerichwithnerveendingsandgenerallyrespondwelltostimulation.男性生殖系统专题知识培训第33页TheClitoris阴蒂

Thefemaleglans(themaleglansisthepenis),theclitorisisextremelysensitiveandengorgeswithbloodduringsexualarousal.Protectedbytheclitoralhood,theclitorisisabovetheurethralopeningandbelowtheclitoralshaft,whichhastwoarms(calledcrura)thatstretchbackwardsintothewoman'sbody,undertheskinoneithersideabovethevaginalopening.Nervescontrollingclitoralmusclecontractionstravelalongsidethewallsofthevagina阴道,thebladderandurethra,passingalongthesensationsproducedinanypartoftheregion.男性生殖系统专题知识培训第34页

InternalStructures

Internalorgansincludetheuterus子宫,Fallopiantubes输卵管andovaries卵巢,whichcontainthefemale’ssexcells:theova,oreggs.男性生殖系统专题知识培训第35页男性生殖系统专题知识培训第36页TheOvaries

Theovariesarepairedstructures,approximatelythesizeofawalnut,thatareanchoredtothebodycavityandtotheuterusbystrongcord-likestructuresknownasligaments.Theovariescontaintheovaandproducethefemalesexhormonesestrogenandprogesterone孕酮.男性生殖系统专题知识培训第37页TheFallopianTubes

TheFallopiantubes,alsocalledtheuterinetubesoroviducts,extendfromtheuterusuparoundtheovaries.TheFallopiantubesdisplaymuscularcontractionsthathelpdrawtheovumintotheuterus.Theupperportionofthetubesiswherefertilizationofanovumbyaspermcommonlyoccurs;ifthezygotedoesnotmovedownintotheuterus,anectopicpregnancyoccurs,whichcanbefataltothemotherandmustbeterminated.TheFallopiantubesaresurgicallyalteredwhenawomanundergoesthesterilizationprocedureknownasatuballigation.男性生殖系统专题知识培训第38页TheUterus

Theuterus(orwomb)isapear-shapedmulti-layeredorganlocatedatthebaseofthepelviccavity.Theopeningoftheuterus,knownasthecervix子宫颈,containsanarrowopeningthatservesasapassagewayformenstrualfloworforafetustoexitthevagina.Theinnermostlayeroftheuterusistheendometrium,whichispartiallyshedwitheachthemenstrualflow.Theuteruscanbehosttoanumberofsexualhealthproblems,includingendometriosis子宫内膜异位,cervicalcanceranduterinecancer.男性生殖系统专题知识培训第39页TheVagina

Thevaginaisathreetofour-inchlong,thin-walledmucous-linedtube.Inadditiontoprovidinganexitformenstrualbloodorafetus,thevaginaisthereceptionsiteforthepenisduringintercourse.男性生殖系统专题知识培训第40页AnusandRectumExam男性生殖系统专题知识培训第41页男性生殖系统专题知识培训第42页♣

Patientpositionandpreparation

Leftlateraldecubitusposition

Assistantorpatientspreadsglutei

♠FindingsonInspection

AnalFissures

肛裂

Analfistula瘘

Perianal肛周dermatitis

Analmass

ExternalHemorrhoid

外痔

Condyloma湿疣

♣Rectalexamination

DigitalRectalExam

Anoscopy

肛门镜检验术

男性生殖系统专题知识培训第43页男性生殖系统专题知识培训第44页男性生殖系统专题知识培训第45页WHATISANANALFISSURE?

Ananalfissureisasmalltearorcutintheskinliningtheanuswhichcancausepainand/orbleeding.

男性生殖系统专题知识培训第46页Athinslit-liketearintheanaltissue,ananalfissureislikelytocauseitching,pain,andbleedingduringabowelmovement.男性生殖系统专题知识培训第47页Thetypicalsymptomsofananalfissureareextremepainduringdefecationandredbloodstreakingthestool.Patientsmaytrytoavoiddefecationbecauseofthepain.男性生殖系统专题知识培训第48页Howisitdiagnosed?

Thediagnosisofananalfissureismadebyexaminationoftheanusandanalcanal.Thetearusuallyiseasytosee,althoughoccasionallyasmallviewinginstrument,calledananoscope,maybeusedintheevaluation.

男性生殖系统专题知识培训第49页WhatAreHemorrhoids痔?男性生殖系统专题知识培训第50页Thetermhemorrhoidsreferstoaconditioninwhichtheveinsaroundtheanusorlowerrectumareswollenandinflamed.

Hemorrhoidsmayresultfromstrainingtomovestool.Othercontributingfactorsincludepregnancy,aging,chronicconstipationordiarrhea,andanalintercourse.

Hemorrhoidsareeitherinsidetheanus(internal)orundertheskinaroundtheanus(external).男性生殖系统专题知识培训第51页男性生殖系统专题知识培训第52页WhatAretheSymptomsofHemorrhoids?

男性生殖系统专题知识培训第53页Althoughmanypeoplehavehemorrhoids,notallexperiencesymptoms.Themostcommonsymptomofinternalhemorrhoidsisbrightredbloodcoveringthestool,ontoiletpaper,orinthetoiletbowl.However,aninternalhemorrhoidmayprotrudethroughtheanusoutsidethebody,becomingirritatedandpainful.Thisisknownasaprotrudinghemorrhoid.男性生殖系统专题知识培训第54页

Internalhemorrhoidsoccurhigherupintheanalcanal,outofsight.Bleedingisthemostcommonsymptomofinternalhemorrhoids,andoftentheonlyoneinmildcases.男性生殖系统专题知识培训第55页Sometimes,internalhemorrhoidswillcomethroughtheanalopeningwhenstrainingtomoveyourbowels.Thisiscalledaprolapsed脱垂internalhemorrhoid;itisoftendifficulttoeasebackintotherectum,andisusuallyquitepainful.男性生殖系统专题知识培训第56页Symptomsofexternalhemorrhoidsmayincludepainfulswellingorahardlumparoundtheanusthatresultswhenabloodclotforms.Thisconditionisknownasathrombosedexternalhemorrhoid.男性生殖系统专题知识培训第57页Inaddition,excessivestraining,rubbing,orcleaningaroundtheanusmaycauseirritationwithbleedingand/oritching,whichmayproduceaviciouscycleofsymptoms.Drainingmucusmayalsocauseitching.男性生殖系统专题知识培训第58页

Externalhemorrhoidsarevisible-occurringoutsidetheanus.Theyarebasicallyskin-coveredveinsthathaveballoonedandappearblue.Usuallytheyappearwithoutanysymptoms.Wheninflamed,however,theybecomeredandtender.男性生殖系统专题知识培训第59页男性生殖系统专题知识培训第60页Whenabloodclotformsinsideanexternalhemorrhoid,itoftencausesSeverepain.This

thrombosedexternalhemorrhoidcanbefeltasafirm,tendermassintheanalarea,aboutthesizeofapea.男性生殖系统专题知识培训第61页ExtremitiesandArticulus男性生殖系统专题知识培训第62页男性生殖系统专题知识培训第63页男性生殖系统专题知识培训第64页Koilonychia反甲

Fingernail

NailAbnormality

Signs

Concave凹orSpoonshapednails

AssociatedConditions

♥Anemia

♥Thyroid甲状腺dysfunction

♥Trauma

♥Impairedperipheralcirculation

♥Familial家族性

♥Normalfindingininfants

男性生殖系统专题知识培训第65页Koilonychiamaybecausedbyorfeatureof(sortedbycategory)

♪Autosomaldominantconditions

Steatocystoma皮脂腺囊瘤multiplex

♪Nutritionalconditions

Irondeficiency男性生殖系统专题知识培训第66页Thenailsareflattenedandhaveconcavities.Thisconditionmaybeassociatedwithirondeficiency.男性生殖系统专题知识培训第67页acropachy杵状指

"Clubbing"ofthefingerswiththickeningofskinatthebaseofthenails,oftenwithanincreaseinthecurvatureofthenails.

男性生殖系统专题知识培训第68页Acromegaly肢端肥大症

AcromegalyistheGreekwordfor"extremities"and"enlargement."Whenthepituitaryglandproducesexcessgrowthhormones,thisresultsinexcessivegrowth--calledacromegaly.Theexcessivegrowthoccursfirstinthehandsandfeet,assofttissuebeginstoswell.Acromegalyaffectsmostlymiddle-agedadults.Untreated,thediseasecanleadtosevereillnessanddeath.男性生殖系统专题知识培训第69页Acromegaly-Hands-Normalfemalehandforcomparison

男性生殖系统专题知识培训第70页男性生殖系统专题知识培训第71页genuvalgum膝外翻,

adeformityinwhichthekneesareabnormallyclosetogetherandthespacebetweentheankles踝关节isincreased;knownalsoasknockknee.男性生殖系统专题知识培训第72页genuvarum膝内翻,

adeformityinwhichthekneesareabnormallyseparatedandthelowerextremitiesarebowedinwardly;thedeformitymaybeinthethighorleg,orboth.Knownalsoasbowleg.男性生殖系统专题知识培训第73页(A),Genuvarum;(B),genuvalgum.genua[

pluralofgenu]男性生殖系统专题知识培训第74页Genuvalgum男性生殖系统专题知识培训第75页GenuvarumStandingradiographinachildwithhypophosphataem-icricketsdemonstratinggenuvarum.男性生殖系统专题知识培训第76页Flatfoot

Definition

Footmediallongitudinalarchdepressionorloss

Associatedconditions

Heel足跟eversion外翻(valgus)

Forefoot前足abduction外展

男性生殖系统专题知识培训第77页男性生殖系统专题知识培训第78页Muscularatrophy

Muscularatrophyisthedecreaseinsizeandwastingofmuscletissue.Musclesthatlosetheirnervesupplycanatrophyandsimplywasteaway.男性生殖系统专题知识培训第79页男性生殖系统专题知识培训第80页Skeletalspine男性生殖系统专题知识培训第81页Thespineisdividedintoseveralsections.Thecervicalvertebraemakeuptheneck.Thethoracicvertebraecomprisethechestsectionandhaveribsattached.Thelumbarvertebraearetheremainingvertebraebelowthelastthoracicboneandthetopofthesacrum骶骨.Thesacralvertebrae骶椎arecagedwithinthebonesofthepelvis骨盆,andthecoccyx尾骨representstheterminalvertebraeorvestigial残迹tail.男性生殖系统专题知识培训第82页男性生殖系统专题知识培训第83页男性生殖系统专题知识培训第84页Kyphosis脊柱后凸男性生殖系统专题知识培训第85页男性生殖系统专题知识培训第86页Kyphosisisacurvingofthespinethatcausesabowingoftheback,suchthattheapexoftheanglepointsbackwardsleadingtoahunchback驼背orslouchingposture.男性生殖系统专题知识培训第87页Kyphosisisaspinaldeformitythatcanresultfromtrauma,developmentalproblems,ordegenerativedisease.Kyphosiscanoccuratanyage,althoughitisrareatbirth.男性生殖系统专题知识培训第88页Adolescentkyphosis,alsoknownasScheuermann'sdisease,resultsfromthewedgingtogetherofseveralconsecutivevertebrae(bonesofthespine).ThecauseofScheuermann'sdiseaseisunknown.男性生殖系统专题知识培训第89页Inadults,kyphosiscanbearesultofosteoporoticcompressionfractures(fracturescausedbyosteoporosis),degenerativedisease(suchasarthritis),orspondylolisthesis脊椎前移(slippingofonevertebraforwardonanother).男性生殖系统专题知识培训第90页

Symptoms

Mildbackpain

Fatigue

Tendernessandstiffnessinthespine

Roundbackappearance

Difficultybreathing(inseverecases)

男性生殖系统专题知识培训第91页Signsandtests

Physicalexaminationbyahealthcareproviderconfirmstheabnormalcurvatureofthespine.Thedoctorwillalsolookforanyneurologicchanges(weakness,paralysis,orchangesinsensation)belowthelevelofthecurve.

AspineX-raywillbedonetodocumenttheseverityofthecurveandallowserialmeasurementstobeperformed.

Occasionally,pulmonaryfunctiontestsmaybeusedtoassesswhetherthekyphosisisaffectingbreathing.

Ifthereisanyquestionofatumor,infection,orneurologicsymptoms,thenanMRImaybeordered.男性生殖系统专题知识培训第92页L