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Time Completed: 01:07:02

Final Score 54%

98
82

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Anatomy

Abdomen

Question 108 of 180

Which of the following best describes the relationship of the bladder and prostate gland:

Answer:

The prostate lies immediately inferior to the bladder and the internal urethral sphincter, superior to the external urethral sphincter (with the levator ani lying inferolaterally to the gland) and anterior to the rectum.

The prostate is an unpaired accessory structure of the male reproductive system that surrounds the prostatic urethra in the pelvic cavity. It typically weighs between 20 - 40 g with an average size of 4 x 3 x 2 cm (its width being the greatest).

Function

Secretions from the prostate, together with secretions from the seminal vesicle, contribute to the formation of semen during ejaculation.

The prostatic ducts open into the floor of the prostatic portion of the urethra.

The ejaculatory ducts (formed from the union of the ductus deferens with the duct of the seminal gland) pass almost vertically in an anteroinferior direction through the posterior aspect of the prostate to open into the prostatic urethra.

Ejaculatory Ducts Opening into the Prostate. (Image by Henry Vandyke Carter [Public domain])

Relations

The prostate lies immediately inferior to the bladder and the internal urethral sphincter, superior to the external urethral sphincter (with the levator ani muscle lying inferolaterally to the gland) and anterior to the rectum. The urethra passes through the prostate.

By CFCF (Own work) [CC BY-SA 3.0 , via Wikimedia Commons

Male Reproductive System. (Image by CFCF (Own work) [CC BY-SA 3.0 , via Wikimedia Commons)

Structure

Traditionally the prostate gland is divided anatomically into lobules, but more important clinically is specific anatomical zones rather than lobes:

  • The transitional zone is the most central part of the gland that surrounds the prostatic urethra and the area most prone to prostatic hyperplasia, resulting in urinary symptoms.
  • The central zone encircles the transitional zone and encompasses the ejaculatory ducts posterior to the prostatic urethra.
  • The peripheral zone is the outermost region of the prostate and the area most prone to carcinomatous transformation. This is the zone palpated on PR examination.

Modified by FRCEM Success. Original by Unknown Illustrator [Public domain or Public domain], via Wikimedia Commons

Zones of the Prostate. (Image modified by FRCEM Success. Original by Unknown Illustrator [Public domain or Public domain], via Wikimedia Commons)

Lymphatic Drainage

The prostate gland has several lymphatic drainage pathways primarily to the internal iliac nodes with some drainage to external iliac and presacral nodes.

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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

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