27- groin pain Flashcards
Absence of the cremasteric reflex is a sensitive but non-specific finding for
testicular torsion.
blue dot sign
A small bluish discoloration known as the “blue dot sign”, may be visible through the skin in the upper pole of the testes.
pathognomonic for appendiceal torsion when tenderness is also present.
testicular torsion presentation
Swollen, tenderness limited to the upper pole of the testis, especially when a hard, tender nodule is palpable in this region.
abrupt severe pain, +/- N/V
Prehn sign
physical lifting of the testicles relieves the pain caused by epididymitis but not pain caused by testicular torsion.
Inguinal hernia
painless swelling in the inguinal region,
enhanced by maneuvers that raise intra-abdominal pressure, such as cough or Valsalva maneuver.
swelling becomes painful and tender when it is incarcerated.
types: direct vs indirect
indirect hernia
result of a persistent process vaginalis.
content follows inguinal canal into sac
medial to inferior epigastric arteries
direct hernia
defect or weakness in the transversalis fascia area of the Hesselbach triangle.
Hesselbach triangle borders
The triangle is defined inferiorly by the inguinal ligament, laterally by the inferior epigastric arteries, and medially by the conjoint tendon.
hydrocele
Cystic painless scrotal fluid collection
Positive transillumination
generally asymptomatic unless associated with trauma or infection
most common cause of painless scrotal swelling.
hydrocele
Henoch-Schönlein purpura (HSP)
nonthrombocytopenic purpura, arthralgia, renal disease, abdominal pain, gastrointestinal bleeding, and occasionally scrotal pain.
The onset of scrotal pain may be acute or insidious.
testicular tumor presentation
scrotal mass that is rarely accompanied by tenderness.
The swelling is solid so should not transilluminate.
A testicular tumor is usually non-tender to palpation.
Varicocele
dilated and tortuous veins in the pampiniform plexus surrounding the spermatic cord in the scrotum
associated with infertility
can be asymptomatic or may complain of a dull ache or fullness of the scrotum upon standing.
mass-like and nontender or mildly tender to palpation
referred pain travels through what 3 nerves
the genitofemoral, ilioinguinal, and posterior scrotal nerves.
how many hours of window for surgery for testicular torsion
4-12 hrs
within 6 hrs apparently tho
Torsion of the testicular appendages
less common, less morbid
age 7-14
abrupt pain, less severe, localized to appendix testis
what is the Appendix testis
a small vestigial structure (embryonic remnant of Mullerian duct) located on the anterosuperior aspect of the testis.
does Torsion of the testicular appendages have a pos o neg blue dot sign?
positive
most frequent cause of sudden scrotal pain in adults.
Epididymitis
time course of Epididymitis
slowly progressive over several days rather than abrupt.
cause of Epididymitis
It is caused by bacterial infection of the epididymis, typically from a urinary tract or sexually-transmitted infection.
Epididymitis presentation
The patient may appear comfortable except when examined.
Severe swelling and exquisite pain are present on the involved side, often accompanied by high fever, rigors, and irritative voiding symptoms.
scrotum is tender to palpation and edematous on the involved side. The cremasteric reflex is usually present, and the testis is in its normal location and position.
Causes of Testicular Torsion
A. Congenital anomaly
B. Undescended testicle
C. Trauma
D. Exercise
Congenital anomaly that would cause testicular torsion
Failure of normal posterior anchoring of the gubernaculum, epididymis, and testis is called a bell clapper deformity because it leaves the testis free to swing and rotate within the tunica vaginalis of the scrotum much like the gong (clapper) inside of a bell, causing an intravaginal torsion.
A large mesentery between the epididymis and the testis can also predispose itself to torsion. Contraction of the muscles shortens the spermatic cord and may initiate testicular torsion.
what can confirm testicular torsion if pain is less severe and the diagnosis is in question
Color Doppler ultrasonography
Radionuclide scintigraphy
is a diagnostic test that uses a radioisotope to visualize testicular blood flow.
Patients with testicular torsion have decreased radiotracer in the ischemic testis, resulting in a photopenic lesion.
more sensitive than US but less available
orchiopexy
surgical fixation of both testes to prevent retorsion
do on both sides when you get torsion
Guidelines for Adolescent Preventive Services (GAPS)
GAPS recommendations are organized into four types of services that address 14 separate topics or health conditions. (everything but DM)
most common malignancy affecting males between the ages 15 and 35
testicular cancer
What are the risk factors for testicular tumors?
A. Genetics B. Family history C. Cryptorchidism D. Environment E. Prior testicular cancer
disorders that are more likely to cause germ cell tumors
Klinefelter Down syndrome, testicular feminizing syndrome, true hermaphrodites, persistent mullerian syndrome, cutaneous ichthyosis
Cryptorchidism is
the absence of one or both testes from the scrotum, usually as the result of an undescended testis.
Germ cell tumor types
seminomas (45%)
nonseminomatous germ cell tumors (NSGCTs): 50%
Embryonal cell tumor (20%)
Mixed GCTs (40%)
Teratomas and teratocarcinomas (30%)
Yolk sac tumors (also known as endodermal sinus tumors)
Choriocarcinoma (1%)
most common prepubertal germ cell tumor
Yolk sac tumors (also known as endodermal sinus tumors)
prognosis of yolk sac tumors
benign but are most often malignant. Most affected patients require surgery and chemotherapy because of the aggressive nature of the tumors, but the overall prognosis is excellent.
most lethal germ cell tumor
choriocaricinoma
Non-germ cell tumors types
Non-germ cell tumors (Leydig cell tumors and Sertoli cell tumors)
most common malignancies that metastasize to the testicle (extragonadal tumors).
Lymphoma, leukemia, and melanoma
