Ch 19 - Genitalia Flashcards
Inguinal hernia: definition (direct vs indirect), features (3), management (1)
D - passing of abdo contents via a defective abdo wall (direct) or through inguinal canal (indirect) - its almost always indirect in children due to patent processus vaginalis
F - RHS; groin/testicular swelling on straining/crying
M - manual reduction > surgical repair
Hydrocele: defiinition, features (3), management (2)
D - tracking of peritoneal fluid via patent processus vaginalis
F - asymp, non-tender, transilluminable compressible swellings - usually bilateral
M - majority resolve spontaneously > surgery if not resolved within 2 years
Undescended testis (cryptorchidism): define, feature (1), classification; retractile, palpable, impalpable, Ix (3), management (1)
D - testis arrests along its normal pathway of descent
F - empty hemi-scrotum
Classification:
- Retractile- testis can be manipulated into scrotum without tension > but subsequently retracts into inguinal region due to cremasteric muscle > resolves with age
- Palpable - palpable but cannot be manipulated into scrotum; can be ectopic > found in perinieum/femoral triangle
- Impalpale - cannot be felt > can be in inguinal canal/ intra-abdominal/absent
Ix: USS, IM HCG - to see if get a testosterone rise to confirm presence of tesicular tissue (in bilate impalpable testis), laparoscopy
M - Orchidopexy (mainly psychological benefit)`
Varicocele: definition, features (2), management (1)
D - testicular varicosities develop during puberty
F - LHS; associated with reduced fertility ‘bag of worms’
M - surgical/radiological obliteration of testicular vein
Testicular torsion: Features (4), management (2)
Twisting of epididymis & testis
F - could be due to ‘bell-clapper’ testis (not anchored properly), severe pain, N & V, black horizontal testis
M - surgical exploration also fixation of contralateral testis
Torsion of Hydatid of Morgagni: Definition, features (1), management (2)
D - torsion of an embryological remnant on upper pole of testis; happens just prior to puberty (LH/FSH action on Hydatid)
F - Less severe pain + blue dot sign (can see/palpate hydatid)
M - analgesia > surgical excision
Idiopathic scrotal oedema - features (2)
painless bilat scrotal swelling + redness in preschool child
Hypospadias: definition, Features (3), management (1)
D - failure to completion of urethral tubularization (which normally occurs proximally to distally under influence of fetal testosterone) > leads to urethral opening more proximal to normal meatus on glans penis
F - VENTRAL URETHRAL MEATUS - urethra opens on/adjacent to glans (but can also be on shaft or perineum in severe cases) HOODED DORSAL FORESKIN - failure to fuse ventrally,
CHORDEE - ventral curvature of penile shaft
M - surgery before 2yrs (DO NOT CIRCUMSIZE - require skin for reconstructive surgery)
Indications for circumsion (3)
Phimosis - inability to retract foreskin - whitish scarring of foreskin due to balanitis xerotica obliterans
Recurrent balanoposthitis
Recurrent UTIs - only if they have upper UT anomalies complicated by UTIs
Inguinal hernias in girls
Rare Somtimes ovary can become incarcerated in hernial sac Rarely androgen insensitivity can present as a hernia in phenotypic female (with male genotype)
Labial adhesions management (2)
Labia minora adherence > if asymptomatic leave alone and will spontaneously lyse if perineal soreness > topical oestrogen
Vulvovaginitis/ vaginal discharge management (3)
hygeine avoid bubble bath/scented soaps oestrogen cream on vulva
