Diseases Flashcards
Hydrocele Varicocele Kleinfelters Spina bifida Cryptorchidism PCOS Endometriosis
What is varicocele?
abnormal enlargement of the pampiniform venous plexus in the scrotum due to increased venous pressure
What is hydrocele?
Accumulation of fluid around a testicle
How can you distinguish between varicocele and hydrocele?
Varicoceles don’t transluminate with light, hydroceles do
Varicoceles have a “bag of worms” appearance
Epidiymo-orchitis aka epididymtitis is a common cause of scrotal pain and swelling. What are other possible symptoms besides pain and what causes it?
inflammation, warmth, redness of scrotum
STIs and UTIs
What is testicular torsion, how does it present and why does it need to be recognised urgently
- twisting of the spermatic cord, cutting of testicular blood supply > ischemia
- sudden onset testicular pain
- outcome can be necrosis of testicle
What is Kelinfelters syndrome and what are the symptoms
1 (or more) extra X chromosomes in a male (XXY)
> less testosterone, more oestrogen > less sperm production & less development of male characteristics
Symptoms: hypogonadism (small testicles) sterile tall, long legs, short torso, broad hips gynacomastia (develop breast tissue) weaker bones, less muscle mass less body and facial hair
What is cryptorchidism
undescended testes - they can be anywhere along the path of descent
testes will usually descend on their own within the first 3 months of life, or they can be assisted surgically (orchiopexy)
however men were born with cryptochidism will have reduced spermatogenesis
What are the 3 types of spina bifida
spina bifida occulta
meningocele
myelomeningocele
Describe the abnormality seen in spina bifida occulta
most common and mild form - defective/absent vertebral arch but meninges and spinal cord do not protrude
usually birth mark/dimple/hair grow over the lesion
Describe the abnormality seen in meningocele
least common form - defective/absent vertebral arch and meninges protrude but the spinal cord does not
Describe the abnormality seen in myelomeningocele
most severe form - defective/absent vertebral arch and both meninges and the spinal cord protrude
What is spina bifida
a portion of the neural tube doesn’t close properly (typically in the lower back) so failure of the mesoderm to organise causes a defect in/absence of vertebral arch over the area
Symptoms of myelomeningocele
paralysis below the lesion loss of sensation bladder and bowel movement problems seizures leg and foot deformities
Symptoms of spina bifida occulta
usually none
Risk factors for spina bifida
- folate deficiency during pregnancy- development that causes the condition occurs in weeks 3-4 of pregnancy when woman may not know she’s pregnant - so we put folate in cereal
- obesity
- poorly controlled diabetes
- medications interfering with folate metabolism
Treatment for spina bifida
- prenatal surgery to close myelomeningocele (dangerous)
- post-natal surgery within a few days of birth to minimise infection (meningitis) risk
- urinary catheter
- wheelchair/crutches
What is endometriosis
Endometrial cells migrate and proliferate outside the endometrium - usually effects the ovaries, fallopian tubes, or uterine ligaments. Can even occur in the lungs and heart.
Lots of different theories as to why/how this occurs.
Symptoms of endometriosis
The implanted endometrial tissue bleeds due to changes in hormone levels and chronic inflammation
Symptoms:
Pelvic pain, bleeding, painful menstruation, painful sex, painful defecation if pouch of douglas is involved, painful urination is bladder involved, abdominal pain if intestines involved, sub-fertile (link unclear but potentially due to inflammation > scarring of structures > egg release/movement/implantation blocked)
Symptoms vary with hormone levels - worse during menstruation
Treatment for endometriosis
Pain - combined pill relieves pain via ovarian suppression/ progesterone only pill - inhibits endometrial growth
- danazole (steroid) - inhibits mid-cycle FSH&LH surges and prevents steroidogenesis in corpus luteum
GnRH modulators - decrease oestrogen levels
Surgical - excision of implants or hysterectomy & oophorectomy
Symptoms subside after menopause on their own
What is PCOS and what causes it
Multiple follicular cysts* caused by dysfunction of HPO axis
(No LH surge and so the follicle doesn’t rupture.)
Symptoms of PCOS
PCOS causes chronic anovulation resulting in:
- amenorrhea
- excess androgen produced –> excessive hair growth
- unable to conceive
- weight gain
Symptoms can also include;
- dull aching lower abdo pain
- pain during sex
- feeling of pressure - more frequent urination/bowel movement
Treatment for PCOS
Incurable but can address symptoms.
Amenorrhea - combined/progesterone only pill to induce periods (also decreases endometrial cancer risk)
Fertility issues - usually solved with treatment. clomifene (encourages ovulation); metformin (diabetes drug) and letrozole (breast cancer drug) sometimes used off-label instead. Laproscopic ovarian drilling surgery is medication doesn’t work.
Excessive hair growth - specific combined contraceptive pill (eg Yasmin), spironolactone to decrease testosterone levels
Weight loss - lifestyle changes, orlistat
