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Paediatrics > Genitalia > Flashcards

Genitalia Flashcards

1
Q

What process of development can lead to predisposition to development of inguinal hernia or hydrocele?

A

The processus vaginalis is the tongue of peritoneum that precedes the migrating testis through the inguinal canal - normally it becomes obliterated after birth but sometimes this fails and the predisposition occurs

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2
Q

What sort on inguinal hernias do children get?

A

Indirect normally always because due to the patent processus vaginalis - therefore comes through inguinal canal

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3
Q

In whom are inguinal hernias more common?

A

Boys and preterm infants

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4
Q

Which side do inguinal hernias typically occur on?

A

Typically on the right side

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5
Q

How do inguinal hernias usually present?

A

Intermittent swelling in groin on crying or straining

Can make it visible by raising intra-abdominal pressure - by placing hand on abdomen or asking them to cough

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6
Q

How else can inguinal hernia present?

A

Can also present as irreducible lump in groin or scrotum, which is firm and tender
This child can be unwell with irritability and vomiting

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7
Q

Can “irreducible” hernias be reduced

A

Most can be reduced with opoid analgesia and gentle compression
Then delay surgery for 24-48 hours to allow oedema to go down

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8
Q

What to do if hernia can’t be reduced

A

Surgery is required as emergency because otherwise bowel can strangulate and can also damage the testis

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9
Q

Surgery to treat inguinal hernia

A

Ligation and division of hernial sac (processus vaginalis) via inguinal skin crease incision
Usually done as day case

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10
Q

What is a hydrocele?

A

If processus vaginalis is too narrow to allow bowel through to form an inguinal hernia then fluid can still track down it and go around testis to form hydrocele

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11
Q

Presentation of hydrocele symptomwise

A

Asymptomatic scrotal swelling. Usually bilateral and may be bluish
Can be tense or lax but non-tender and transilluminate

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12
Q

Presentation of hydrocele time wise

A

Some are evident at birth but some present in early childhood following viral or GI illness
Most will resolve spontaneously when PV continues to obliterate

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13
Q

Management of hydrocele

A

Most go automatically

Consider surgery if still present beyond 18-24 months of age

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14
Q

What is cryptorchidism?

A

Undescended testes

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15
Q

Incidence of undescended testes

A

4% of term male infants will have unilateral or bilateral undescended testes

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16
Q

When are undescended testes more common?

A

Preterm infants because descent through inguinal canal occurs in 3rd trimester

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17
Q

What can occur post birth with undescended testes?

A

Can continue to descend during early infancy and by 3 months of age 1.5% incidence

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18
Q

What can occur to a testes which was fully descended at birth?

A

Can ascend back into an inguinal position during childhood - will have late presentation of undescended or “ascended” testes

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19
Q

Examination of undescended testes?

A

In a warm room with warm hands - it is possible to bring testes into a palpable position by gently massaging contents of inguinal canal down

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20
Q

What is retractile testes?

A

Can be brought down but will be pulled back up into inguinal region by cremasteric muscle
With age testes will permenantly reside in scrotum

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21
Q

What is palpable testes?

A

Can be palpated in groin but cannot be manipulated into scrotum

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22
Q

What is impalpable testes?

A

No testis can be felt on examination - can be in inguinal canal, intra-abdominal or absent

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23
Q

Investigations for undescended testes?x 3

A

Ultrasound
Hormonal - testicular tissue if present will produce rise in serum testosterone after IM injection of HCG
Laparoscopy

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24
Q

Management of undescended testes?

A

Surgical placement of testis in scrotum - orchidopexy

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25
Q

Reasons for orchidopexy?

A

Fertility and malignancy risk

Also psychological

26
Q

Fertility after orchidopexy?

A

After unilateral undescended testes is close to normal
But reduced to 50% if bilateral palpable undescended testes
If bilateral impalpable undescended testes - usually sterile

27
Q

Malignancy after orchidopexy?

A

Risk is greatest for bilateral undescended testes - greatest risk for intraabdominal
Early orchidopexy for unilateral undescended testes reduces risk to almost normal

28
Q

What is a varicocele?

A

Variscosities of testicular veins which can develop around puberty

29
Q

Where are varicoceles normally?

A

On the left

30
Q

Association of varicoceles

A

Associated with reduced fertility

31
Q

When do you treat varicocele

A

If symptoms of dragging/aching, if impaired testicular growth or if infertility

32
Q

Treatment of varicocele?

A

Obliteration of testicular veins by conventional surgery, laparoscopy or radiological embolisation

33
Q

Causes of acute scrotal symptoms x5

A 
Testicular torsion 
Torsion of testicular appendage 
Viral/bacterial epididymo-orchitis or epididymitis 
Idiopathic scrotal oedema
Incarcerated inguinal hernia
34
Q

When is testicular torsion most common?

A

In adolescents but can occur at any age

35
Q

Presentation of testicular torsion

A

Pain - not always in scrotum but may be in groin or lower abdomen
Can get atypical presentation therefore suspect in any boy/young pain with inguinal/lower abdominal pain

36
Q

Time for treatment of testicular torsion

A

Must be treated within 6-12 hours of onset to maintain testicular viability

37
Q

Management of testicular torsion

A

Surgery with fixation of contralateral testis because can be anatomical predisposition to torsion - such as bell clapper testis where testis is not anchored properly

38
Q

What sort of testis is associated with increased risk of torsion

A

Undescended testes - also at risk of confusion with incarcerated hernia

39
Q

What is torsion of testicular appendage

A

Torsion of the hydratid of Morgagni which is an embroyological remnant on upper pole of testes

40
Q

When does torsion of testicular appendage typically occur?

A

It typically occurs in boys just before puberty due to rapid enlargement of hydratid in response to hormones

41
Q

Presentation of torsion of testicular appendage

A

Pain may increase over 1-2 days and occasionally torted hydratid can be seen or felt (blue dot sign)

42
Q

Management of torsion of testicular appendage

A

Surgical exploration and excision of appendage

43
Q

What can epididymitis be associated with

A

UTI

44
Q

Presentation of idiopathic scrotal oedema

A

Painless bilateral scrotal swelling and redness in pre-school children

45
Q

What is hypospadias?

A

Failure of urethral tubularisation leading to urethral opening not being in normal position on glans but instead being located proximally

46
Q

Features of hypospadias?

A

Ventral urethral meatus
Hooded dorsal foreskin
Chordee - ventral curvature of penis shaft most apparent on erection (only marked in more severe forms)

47
Q

Incidence of hypospadias

A

Common congenital abnormality

1 in 200 boys

48
Q

Surgery for hypospadias

A

Often done before 2 years of age to correct penis for cosmetic and functional reasons

49
Q

Foreskin retraction in developing penis

A

At birth foreskin is adherent to the glans
Adhesions separate over time making the foreskin eventually more mobile and retractable
At 1 year - 50% have non-retractable
At 4 years - 10% have non-retractable
At 16 years - 1%

50
Q

Circumcision recommendations

A

Not recommended anywhere as routine neonatal procedure - only a few medical indications

51
Q

3 medical indications for circumcision

A

Phimosis
Recurrent balanoposthitis
Recurrent UTI

52
Q

What is phimosis?

A

Inability to retract foreskin - pathological not physiological
Will have whitish scarring of foreskin

53
Q

What causes phimosis?

A

Localised skin disease known as balanitis xerotica obliterans - can also cause meatal stenosis

54
Q

Age of phimosis?

A

Rare before age 5

55
Q

What is balanoposthitis?

A

Redness and inflammation of foreskin and glans, sometimes with purulent discharge

56
Q

Management of balanoposthitis?

A

If occurs once, common and can be treated with warm baths and antibiotics
If recurrent - uncommon and circumcision may be indicated

57
Q

When is circumcision indicated with UTI

A

If upper urinary tract problems complicated by recurrent UTI’s

58
Q

What other than surgery can be used to help irritractable foreskin?

A

Topical corticosteroids to the prepuce to facilitate retraction

59
Q

What is paraphimosis

A

Foreskin trapped in retracted position proximal to a swollen glans

60
Q

Management of paraphimosis

A

Adequate analgesia to help reduce foreskin

Problem not usually recurrent

61
Q

What are labial adhesions

A

Adhesions of labia minora in midline

62
Q

Management of labial adhesions

A

If asymptomatic can be left alone and will often lyse spontaneously
If perineal soreness or urinary irritation - topical oestrogen 2x day for 1-2 weeks

Paediatrics (16 decks)

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