男性生殖系統(tǒng)專題知識培訓(xùn)專家講座

PhysicalExamination

Part2

XueHuiping男性生殖系統(tǒng)專題知識培訓(xùn)第1頁Malereproductiveanatomy男性生殖系統(tǒng)專題知識培訓(xùn)第2頁男性生殖系統(tǒng)專題知識培訓(xùn)第3頁男性生殖系統(tǒng)專題知識培訓(xùn)第4頁Thisillustrationrepresentsanaveragenormaladulthumanpenis.Theheadofthepenis(glans)hasacovering,calledtheforeskin(prepuce).Thiscoveringfoldsinonitself,formingadoublelayer.Theforeskinisnota`flap'ofskinontheendofthepenis,anditisnot`useless'or`redundant'skin.Thereissomenaturalvariationinthelengthoftheforeskin,whichoftencoversabitmoreorlessoftheglansthanillustrated.Inanaveragecircumcisedadultman,theareaofskinthatismissingbecauseofpenilereductionsurgerywould,whenerectandunfolded,measureapproximatelythreebyfiveinches,oralittlesmallerthanapostcard.Thatisabouthalfthetotalskinofthepenis.男性生殖系統(tǒng)專題知識培訓(xùn)第5頁StructuresofthepenisTheouterforeskinlayerisacontinuationoftheskinoftheshaftofthepenis.Theinnerforeskinlayerisnotproperly`skin',butmucocutaneoustissueofauniquetypefoundnowhereelseonthebody.Thefrenarbandistheinterface(join)betweentheouterandinnerforeskinlayers.Whenthepenisisnoterect,ittightenstonarrowtheforeskinopening.Duringerection,thefrenarbandformsaridgethatgoesallthewayaround,abouthalfwaydowntheshaft.Thereddishorpurplishglansorglanspenis(headofthepenis)issmooth,shiny,moistandextremelysensitive.Thefrenulum,orfrenum,isaconnectingmembraneontheundersideofthepenis,similartothatbeneaththetongue.男性生殖系統(tǒng)專題知識培訓(xùn)第6頁男性生殖系統(tǒng)專題知識培訓(xùn)第7頁男性生殖系統(tǒng)專題知識培訓(xùn)第8頁男性生殖系統(tǒng)專題知識培訓(xùn)第9頁男性生殖系統(tǒng)專題知識培訓(xùn)第10頁男性生殖系統(tǒng)專題知識培訓(xùn)第11頁男性生殖系統(tǒng)專題知識培訓(xùn)第12頁Hereisanormaltestisandadjacentstructures.Identifythebodyofthetestis,epididymis,andspermaticcord.Notethepresenceoftwovestigialstructures,theappendixtestisandtheappendixepididymis.男性生殖系統(tǒng)專題知識培訓(xùn)第13頁Ontheleftisanormaltestis.Ontherightisatestisthathasundergoneatrophy.Bilateralatrophymayoccurwithavarietyofconditionsincludingchronicalcoholism,hypopituitarism,atherosclerosis,chemotherapyorradiation,andsevereprolongedillness.Acryptorchidtestiswillalsobeatrophic.Inflammationmayleadtoatrophy.Mumps,themostcommoncausefororchitis,usuallyhasapatchypatternofinvolvementthatdoesnotleadtosterility.男性生殖系統(tǒng)專題知識培訓(xùn)第14頁Hereisalargehydroceleofthetestis.Suchhydrocelesarefairlycommon.Clearfluidaccumulatesinasacoftunicavaginalislinedbyaserosawithavarietyofinflammatoryandneoplasticconditions.Ahydrocelemustbedistinguishedfromatruetesticularmass,andtransilluminationmayhelp,becausethehydrocelewilltransilluminatebutatesticularmasswillbeopaque.男性生殖系統(tǒng)專題知識培訓(xùn)第15頁完全型含有正常女性體征，有正常女性外陰且發(fā)育良好（但陰毛稀少或缺如），陰道發(fā)育良好，深度正常。青春期后乳房可發(fā)育。不完全型外陰有不一樣程度畸形，陰蒂增大，陰道短淺或呈尿生殖竇。睪丸多位于腹股溝內(nèi)。男性生殖系統(tǒng)專題知識培訓(xùn)第16頁男性生殖系統(tǒng)專題知識培訓(xùn)第17頁

Epididymis附睪

Theepididymides(pluralforepididymis附睪)arenarrow,elongatedstoragevesselsfornewlygeneratedspermatozoa.Theyarelocatedwithinthescrotum陰囊,adjoiningeachtesticle睪丸.Spermatozoa精子remaininthecord-likeepididymides附睪untilejaculation,atwhichtimetheyejectthemintothevasdeferens輸精管.男性生殖系統(tǒng)專題知識培訓(xùn)第18頁Cryptorchidism隱睪病

Cryptorchidismisdefinedasfailureofthetestistodescendfromitsintra-abdominallocationintothescrotum.男性生殖系統(tǒng)專題知識培訓(xùn)第19頁Epididymis附睪

Along,narrow,convolutedtube,partofthespermaticductsystem,thatliesontheposterioraspectofeachtesticle,connectingittothevasdeferens.男性生殖系統(tǒng)專題知識培訓(xùn)第20頁男性生殖系統(tǒng)專題知識培訓(xùn)第21頁Elephantiasis象皮腫ofthescrotum男性生殖系統(tǒng)專題知識培訓(xùn)第22頁scrotalhernia

aninguinalhernia腹股溝疝whichhasdescendedintothescrotum.男性生殖系統(tǒng)專題知識培訓(xùn)第23頁TheProstateGland前列腺男性生殖系統(tǒng)專題知識培訓(xùn)第24頁Theprostateisawalnut-sizedglandthatformspartofthemalereproductivesystem.Theglandismadeoftwolobes,orregions,enclosedbyanouterlayeroftissue.Asthediagramsshow,theprostateislocatedinfrontoftherectumandjustbelowthebladder,whereurineisstored.Theprostatealsosurroundstheurethra尿道,thecanalthroughwhichurinepassesoutofthebody.男性生殖系統(tǒng)專題知識培訓(xùn)第25頁Normalurineflow

男性生殖系統(tǒng)專題知識培訓(xùn)第26頁

SeminalVesicle

producesamucoidsecretionthat'sreleasedintothesemen精液男性生殖系統(tǒng)專題知識培訓(xùn)第27頁Femalereproductiveanatomy男性生殖系統(tǒng)專題知識培訓(xùn)第28頁

ExternalGenitalia

Externalorgansincludethesensitiveanderoticsexorgans:monspubis,labia唇andclitoris陰蒂(alsoknowncollectivelyasthevulva外陰),andthebreasts.男性生殖系統(tǒng)專題知識培訓(xùn)第29頁男性生殖系統(tǒng)專題知識培訓(xùn)第30頁男性生殖系統(tǒng)專題知識培訓(xùn)第31頁TheMonsPubis

Themonspubis(sometimescalledthemonsvenerisafterVenus,theRomangoddessoflove)istheregionoffattytissueabovethepubicbone.Atpuberty,themonspubisenlargesandbecomescoveredbypubichair.男性生殖系統(tǒng)專題知識培訓(xùn)第32頁

TheLabia

Oftenreferredtoas"lips,"thelabiaarethefoldoftissuesurroundingthevaginalandurethralopenings,protectingthesensitiveorificesfromdamage.Theouter,fleshyhair-coveredfoldsformthelabiamajoraandtheinnerhairlessfoldsformthelabiaminora.Thelabiaarerichwithnerveendingsandgenerallyrespondwelltostimulation.男性生殖系統(tǒng)專題知識培訓(xùn)第33頁TheClitoris陰蒂

Thefemaleglans(themaleglansisthepenis),theclitorisisextremelysensitiveandengorgeswithbloodduringsexualarousal.Protectedbytheclitoralhood,theclitorisisabovetheurethralopeningandbelowtheclitoralshaft,whichhastwoarms(calledcrura)thatstretchbackwardsintothewoman'sbody,undertheskinoneithersideabovethevaginalopening.Nervescontrollingclitoralmusclecontractionstravelalongsidethewallsofthevagina陰道,thebladderandurethra,passingalongthesensationsproducedinanypartoftheregion.男性生殖系統(tǒng)專題知識培訓(xùn)第34頁

InternalStructures

Internalorgansincludetheuterus子宮,Fallopiantubes輸卵管andovaries卵巢,whichcontainthefemale’ssexcells:theova,oreggs.男性生殖系統(tǒng)專題知識培訓(xùn)第35頁男性生殖系統(tǒng)專題知識培訓(xùn)第36頁TheOvaries

Theovariesarepairedstructures,approximatelythesizeofawalnut,thatareanchoredtothebodycavityandtotheuterusbystrongcord-likestructuresknownasligaments.Theovariescontaintheovaandproducethefemalesexhormonesestrogenandprogesterone孕酮.男性生殖系統(tǒng)專題知識培訓(xùn)第37頁TheFallopianTubes

TheFallopiantubes,alsocalledtheuterinetubesoroviducts,extendfromtheuterusuparoundtheovaries.TheFallopiantubesdisplaymuscularcontractionsthathelpdrawtheovumintotheuterus.Theupperportionofthetubesiswherefertilizationofanovumbyaspermcommonlyoccurs;ifthezygotedoesnotmovedownintotheuterus,anectopicpregnancyoccurs,whichcanbefataltothemotherandmustbeterminated.TheFallopiantubesaresurgicallyalteredwhenawomanundergoesthesterilizationprocedureknownasatuballigation.男性生殖系統(tǒng)專題知識培訓(xùn)第38頁TheUterus

Theuterus(orwomb)isapear-shapedmulti-layeredorganlocatedatthebaseofthepelviccavity.Theopeningoftheuterus,knownasthecervix子宮頸,containsanarrowopeningthatservesasapassagewayformenstrualfloworforafetustoexitthevagina.Theinnermostlayeroftheuterusistheendometrium,whichispartiallyshedwitheachthemenstrualflow.Theuteruscanbehosttoanumberofsexualhealthproblems,includingendometriosis子宮內(nèi)膜異位,cervicalcanceranduterinecancer.男性生殖系統(tǒng)專題知識培訓(xùn)第39頁TheVagina

Thevaginaisathreetofour-inchlong,thin-walledmucous-linedtube.Inadditiontoprovidinganexitformenstrualbloodorafetus,thevaginaisthereceptionsiteforthepenisduringintercourse.男性生殖系統(tǒng)專題知識培訓(xùn)第40頁AnusandRectumExam男性生殖系統(tǒng)專題知識培訓(xùn)第41頁男性生殖系統(tǒng)專題知識培訓(xùn)第42頁?

Patientpositionandpreparation

Leftlateraldecubitusposition

Assistantorpatientspreadsglutei

?FindingsonInspection

AnalFissures

肛裂

Analfistula瘺

Perianal肛周dermatitis

Analmass

ExternalHemorrhoid

外痔

Condyloma濕疣

?Rectalexamination

DigitalRectalExam

Anoscopy

肛門鏡檢驗術(shù)

男性生殖系統(tǒng)專題知識培訓(xùn)第43頁男性生殖系統(tǒng)專題知識培訓(xùn)第44頁男性生殖系統(tǒng)專題知識培訓(xùn)第45頁WHATISANANALFISSURE?

Ananalfissureisasmalltearorcutintheskinliningtheanuswhichcancausepainand/orbleeding.

男性生殖系統(tǒng)專題知識培訓(xùn)第46頁Athinslit-liketearintheanaltissue,ananalfissureislikelytocauseitching,pain,andbleedingduringabowelmovement.男性生殖系統(tǒng)專題知識培訓(xùn)第47頁Thetypicalsymptomsofananalfissureareextremepainduringdefecationandredbloodstreakingthestool.Patientsmaytrytoavoiddefecationbecauseofthepain.男性生殖系統(tǒng)專題知識培訓(xùn)第48頁Howisitdiagnosed?

Thediagnosisofananalfissureismadebyexaminationoftheanusandanalcanal.Thetearusuallyiseasytosee,althoughoccasionallyasmallviewinginstrument,calledananoscope,maybeusedintheevaluation.

男性生殖系統(tǒng)專題知識培訓(xùn)第49頁WhatAreHemorrhoids痔?男性生殖系統(tǒng)專題知識培訓(xùn)第50頁Thetermhemorrhoidsreferstoaconditioninwhichtheveinsaroundtheanusorlowerrectumareswollenandinflamed.

Hemorrhoidsmayresultfromstrainingtomovestool.Othercontributingfactorsincludepregnancy,aging,chronicconstipationordiarrhea,andanalintercourse.

Hemorrhoidsareeitherinsidetheanus(internal)orundertheskinaroundtheanus(external).男性生殖系統(tǒng)專題知識培訓(xùn)第51頁男性生殖系統(tǒng)專題知識培訓(xùn)第52頁WhatAretheSymptomsofHemorrhoids?

男性生殖系統(tǒng)專題知識培訓(xùn)第53頁Althoughmanypeoplehavehemorrhoids,notallexperiencesymptoms.Themostcommonsymptomofinternalhemorrhoidsisbrightredbloodcoveringthestool,ontoiletpaper,orinthetoiletbowl.However,aninternalhemorrhoidmayprotrudethroughtheanusoutsidethebody,becomingirritatedandpainful.Thisisknownasaprotrudinghemorrhoid.男性生殖系統(tǒng)專題知識培訓(xùn)第54頁

Internalhemorrhoidsoccurhigherupintheanalcanal,outofsight.Bleedingisthemostcommonsymptomofinternalhemorrhoids,andoftentheonlyoneinmildcases.男性生殖系統(tǒng)專題知識培訓(xùn)第55頁Sometimes,internalhemorrhoidswillcomethroughtheanalopeningwhenstrainingtomoveyourbowels.Thisiscalledaprolapsed脫垂internalhemorrhoid;itisoftendifficulttoeasebackintotherectum,andisusuallyquitepainful.男性生殖系統(tǒng)專題知識培訓(xùn)第56頁Symptomsofexternalhemorrhoidsmayincludepainfulswellingorahardlumparoundtheanusthatresultswhenabloodclotforms.Thisconditionisknownasathrombosedexternalhemorrhoid.男性生殖系統(tǒng)專題知識培訓(xùn)第57頁Inaddition,excessivestraining,rubbing,orcleaningaroundtheanusmaycauseirritationwithbleedingand/oritching,whichmayproduceaviciouscycleofsymptoms.Drainingmucusmayalsocauseitching.男性生殖系統(tǒng)專題知識培訓(xùn)第58頁

Externalhemorrhoidsarevisible-occurringoutsidetheanus.Theyarebasicallyskin-coveredveinsthathaveballoonedandappearblue.Usuallytheyappearwithoutanysymptoms.Wheninflamed,however,theybecomeredandtender.男性生殖系統(tǒng)專題知識培訓(xùn)第59頁男性生殖系統(tǒng)專題知識培訓(xùn)第60頁Whenabloodclotformsinsideanexternalhemorrhoid,itoftencausesSeverepain.This

thrombosedexternalhemorrhoidcanbefeltasafirm,tendermassintheanalarea,aboutthesizeofapea.男性生殖系統(tǒng)專題知識培訓(xùn)第61頁ExtremitiesandArticulus男性生殖系統(tǒng)專題知識培訓(xùn)第62頁男性生殖系統(tǒng)專題知識培訓(xùn)第63頁男性生殖系統(tǒng)專題知識培訓(xùn)第64頁Koilonychia反甲

Fingernail

NailAbnormality

Signs

Concave凹o(jì)rSpoonshapednails

AssociatedConditions

?Anemia

?Thyroid甲狀腺dysfunction

?Trauma

?Impairedperipheralcirculation

?Familial家族性

?Normalfindingininfants

男性生殖系統(tǒng)專題知識培訓(xùn)第65頁Koilonychiamaybecausedbyorfeatureof(sortedbycategory)

?Autosomaldominantconditions

Steatocystoma皮脂腺囊瘤multiplex

?Nutritionalconditions

Irondeficiency男性生殖系統(tǒng)專題知識培訓(xùn)第66頁Thenailsareflattenedandhaveconcavities.Thisconditionmaybeassociatedwithirondeficiency.男性生殖系統(tǒng)專題知識培訓(xùn)第67頁acropachy杵狀指

"Clubbing"ofthefingerswiththickeningofskinatthebaseofthenails,oftenwithanincreaseinthecurvatureofthenails.

男性生殖系統(tǒng)專題知識培訓(xùn)第68頁Acromegaly肢端肥大癥

AcromegalyistheGreekwordfor"extremities"and"enlargement."Whenthepituitaryglandproducesexcessgrowthhormones,thisresultsinexcessivegrowth--calledacromegaly.Theexcessivegrowthoccursfirstinthehandsandfeet,assofttissuebeginstoswell.Acromegalyaffectsmostlymiddle-agedadults.Untreated,thediseasecanleadtosevereillnessanddeath.男性生殖系統(tǒng)專題知識培訓(xùn)第69頁Acromegaly-Hands-Normalfemalehandforcomparison

男性生殖系統(tǒng)專題知識培訓(xùn)第70頁男性生殖系統(tǒng)專題知識培訓(xùn)第71頁genuvalgum膝外翻,

adeformityinwhichthekneesareabnormallyclosetogetherandthespacebetweentheankles踝關(guān)節(jié)isincreased;knownalsoasknockknee.男性生殖系統(tǒng)專題知識培訓(xùn)第72頁genuvarum膝內(nèi)翻,

adeformityinwhichthekneesareabnormallyseparatedandthelowerextremitiesarebowedinwardly;thedeformitymaybeinthethighorleg,orboth.Knownalsoasbowleg.男性生殖系統(tǒng)專題知識培訓(xùn)第73頁(A),Genuvarum;(B),genuvalgum.genua[

pluralofgenu]男性生殖系統(tǒng)專題知識培訓(xùn)第74頁Genuvalgum男性生殖系統(tǒng)專題知識培訓(xùn)第75頁GenuvarumStandingradiographinachildwithhypophosphataem-icricketsdemonstratinggenuvarum.男性生殖系統(tǒng)專題知識培訓(xùn)第76頁Flatfoot

Definition

Footmediallongitudinalarchdepressionorloss

Associatedconditions

Heel足跟eversion外翻(valgus)

Forefoot前足abduction外展

男性生殖系統(tǒng)專題知識培訓(xùn)第77頁男性生殖系統(tǒng)專題知識培訓(xùn)第78頁Muscularatrophy

Muscularatrophyisthedecreaseinsizeandwastingofmuscletissue.Musclesthatlosetheirnervesupplycanatrophyandsimplywasteaway.男性生殖系統(tǒng)專題知識培訓(xùn)第79頁男性生殖系統(tǒng)專題知識培訓(xùn)第80頁Skeletalspine男性生殖系統(tǒng)專題知識培訓(xùn)第81頁Thespineisdividedintoseveralsections.Thecervicalvertebraemakeuptheneck.Thethoracicvertebraecomprisethechestsectionandhaveribsattached.Thelumbarvertebraearetheremainingvertebraebelowthelastthoracicboneandthetopofthesacrum骶骨.Thesacralvertebrae骶椎arecagedwithinthebonesofthepelvis骨盆,andthecoccyx尾骨representstheterminalvertebraeorvestigial殘跡tail.男性生殖系統(tǒng)專題知識培訓(xùn)第82頁男性生殖系統(tǒng)專題知識培訓(xùn)第83頁男性生殖系統(tǒng)專題知識培訓(xùn)第84頁Kyphosis脊柱后凸男性生殖系統(tǒng)專題知識培訓(xùn)第85頁男性生殖系統(tǒng)專題知識培訓(xùn)第86頁Kyphosisisacurvingofthespinethatcausesabowingoftheback,suchthattheapexoftheanglepointsbackwardsleadingtoahunchback駝背orslouchingposture.男性生殖系統(tǒng)專題知識培訓(xùn)第87頁Kyphosisisaspinaldeformitythatcanresultfromtrauma,developmentalproblems,ordegenerativedisease.Kyphosiscanoccuratanyage,althoughitisrareatbirth.男性生殖系統(tǒng)專題知識培訓(xùn)第88頁Adolescentkyphosis,alsoknownasScheuermann'sdisease,resultsfromthewedgingtogetherofseveralconsecutivevertebrae(bonesofthespine).ThecauseofScheuermann'sdiseaseisunknown.男性生殖系統(tǒng)專題知識培訓(xùn)第89頁Inadults,kyphosiscanbearesultofosteoporoticcompressionfractures(fracturescausedbyosteoporosis),degenerativedisease(suchasarthritis),orspondylolisthesis脊椎前移(slippingofonevertebraforwardonanother).男性生殖系統(tǒng)專題知識培訓(xùn)第90頁

Symptoms

Mildbackpain

Fatigue

Tendernessandstiffnessinthespine

Roundbackappearance

Difficultybreathing(inseverecases)

男性生殖系統(tǒng)專題知識培訓(xùn)第91頁Signsandtests

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

AspineX-raywillbedonetodocumenttheseverityofthecurveandallowserialmeasurementstobeperformed.

Occasionally,pulmonaryfunctiontestsmaybeusedtoassesswhetherthekyphosisisaffectingbreathing.

Ifthereisanyquestionofatumor,infection,orneurologicsymptoms,thenanMRImaybeordered.男性生殖系統(tǒng)專題知識培訓(xùn)第92頁L