Anatomy
Abdomen
A 29 year patient presents to ED complaining of a painless lump in his scrotum. Imaging shows a tumour affecting the scrotum but sparing the testis. Where would the lymph from this area of pathology drain to initially:
Answer:
The lymph drainage of the testis is to the lumbar (para-aortic) nodes in the abdomen, in contrast to that of the scrotum which drains to the superficial inguinal nodes.Testis and Epididymis
Anatomy / Abdomen / Male Reproductive System
Last Updated: 11th April 2019
The testis and epididymis are suspended in the scrotum by the spermatic cord. The inferior pole of the testis is attached to the scrotal wall by the scrotal ligament, which is the remnant of the gubernaculum testis.
![Modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons](https://mrcemsuccess.com/wp-content/uploads/2017/02/Testes-1.png)
Testis and Epididymis. (Image modified by FRCEM Success. Original by Henry Vandyke Carter [Public domain], via Wikimedia Commons)
Functional Anatomy
Each testis is composed of seminiferous tubules (which produce spermatozoa) and interstitial tissue (which secretes testosterone) surrounded by a thick connective tissue capsule, the tunica albuginea. The spermatozoa collects in the epididymis, the tail of which is continuous with the ductus deferens, which transports the spermatozoa to the ejaculatory ducts in the pelvic cavity.
Development
The testes develop high on the posterior abdominal wall and then descend, normally before birth, through the inguinal canal in the anterior abdominal wall and into the scrotum of the perineum. During the descent, the testes carry their vessels, lymphatics, nerves and ductus deferens with them. The spermatic cord is the tube-shaped connection between the pouch in the scrotum and the abdominal wall.
The sides and anterior aspect of the testis are covered by the serous tunica vaginalis, derived from the embryonic processus vaginalis which is originally connected to the abdominal cavity. Normally after testicular descent, the connection closes, leaving a fibrous remnant. Failure of closure can result in the development of an indirect inguinal hernia.
Blood supply
The testes receive their arterial supply from the testicular artery, direct branch of the abdominal aorta, which travels in the spermatic cord.
Lymphatics
The lymph drainage of the testes is to the lumbar (para-aortic) nodes in the abdomen, in contrast to that of the scrotum which drains to the superficial inguinal nodes.
Innervation
The testes receive their autonomic nerve supply from the testicular plexus. Visceral afferent fibres usually follow the sympathetic fibres to spinal cord levels T10 - L1; pain is thus referred to the periumbilical region, suprapubic region and groin.
The scrotum is innervated by nerves derived primarily from spinal roots L1 and S2 - S3:
- anterolaterally by the genital branch of the genitofemoral nerve (L1 - L2)
- anteriorly by scrotal branches of the ilioinguinal nerve (L1)
- posteriorly by scrotal branches of the perineal nerve of the pudendal nerve (S3)
- inferiorly by perineal branches of the posterior femoral cutaneous nerve (S2)
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
