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THE PEDIATRIC DIAGNOSTIC EXAMINATION - PART 9

Mục tiêu của chương này là 1. Để phác thảo sinh lý học và giải phẫu bình thường của các sinh dục nam nhi khoa (GU) 2 hệ thống. Để phác thảo sinh lý bệnh tạo ra các triệu chứng và dấu hiệu referable hệ thống nhi khoa của GU trai 3. Cập nhật cho các vấn đề phổ biến ở trẻ sơ sinh, trẻ em và thanh thiếu niên | Chapter 19 The Male Genitourinary System Julian Wan The goals of this chapter are 1. To outline the normal physiology and anatomy of the pediatric male genitourinary GU system 2. To outline the pathophysiology that produces the symptoms and signs referable to the pediatric male GU system 3. To catalogue the major common problems in infants children and adolescents 4. To explain how to perform a complete physical examination referable to GU symptoms and signs 5. To synthesize a list of GU diagnoses in tabular form 6. To outline confirmatory laboratory imaging and investigative procedures and when to refer to a specialist Anatomy Physiology and Mechanics Normal The male genitourinary GU system constitutes the union of two major physiologic organizations the urinary system and the male reproductive system. They join at the lower urinary tract where the bladder empties into the prostatic urethra. At this point the vas deferens meets the ejaculatory ducts emptying into the verumontanum at the prostatic urethra just above the external urinary sphincter. They share a common pathway thereafter down the bulbous and pendulous urethra and fossa navicularis which exit the penis at the urethra meatus. FIGURE 19-1 illustrates the gross anatomy. The urinary system consists of the kidney collecting system of the renal pelvis and ureter the bladder and the urethra. The kidneys lie behind the eleventh and twelfth ribs in the retroperitoneum. The kidneys filter blood continuously at the glomerulus. As the filtrate progresses down the collecting system the renal tubules reabsorb and secrete other solutes and fluids. As the filtrate enters the collecting ducts it becomes more concentrated in the medulla to become urine. The urine then gathers into calyces which drain into a central collecting space the renal pelvis. From there the urine actively continues via peristalsis down long 645 Copyright 2008 by The McGraw-Hill Companies Inc. Click here for terms of use. Chapter 19 The Male .