Genituurinary anorectal Flashcards
the most common cause of scrotal pain
epididymitis (posterior and inferior)
Hx of epididymitis
- Gradually increasing pain and swelling (over days)
2. Dysuria/Fever
MC ways an epididymitis get’s infected
STD
BUT not always infectious can be
Trauma”, Autoimmune dz, Vasculitis
Prehn’s Sign
Elevation of the scrotum relieves pain
This is unreliable to differentiate Testicular Torsion but is supposed to help you differentiate
Cremasteric Reflex
- Stroking the thigh on the affected side causes the ipsilateral testis to pull upwards
a. Can use for testicular torsion
predominant method of choice for dx testicular complaints
what would epididymitis look like
Ultrasound
Inflammation increases blood flow which shows up on the doppler
if blood is not getting to the testicle you might suspect something like torsion
also STD testing, ULS (hydrocele), urine culture (E.coli, pseudomonas)
Tx for epididymitis
UA, STD Testing, ?ULS (reactive Hydrocele Vs.)
Possible Urine culture (E.coli, Pseudomonas,)
Presumptive Therapy:
F/U instructions/expectations
Presumptive Therapy for epididymitis
Ceftriaxone 250 mg IM and Doxycycline or azithromyocin 100mg PO BID X days
(can’t tell if gonorrhea or chlamydia)
If over age 35, consider Levofloxacin 500 mg qd X 10 days
Analgesics, SITZ baths, Scrotal Support (jock strap so that the testicles don’t bounce)
hydrocele is a collection of fluid where
painful or nah?
Collection of fluid between the Parietal and Visceral layers of the Tunica Vaginalis.
arise over a longer period of time
usually asymptomatic BUT increasing pain w/ increasing size
hydrocele dx
Dx: Transillumination
on ULS you see tis as
tx for a hrydocele
iv. Treatment rarely needed, Aspiration doesn’t work, Surgery will.
Most large hydroceles need to go to the urologist who will decide on surgery but it’s not preferred b/c it causes recurrent hydroceles
Varicocel
dilation of the Pampiniform plexus of spermatic veins. Left hemiscrotum.
ii. 20% of men; more common on the L
iii. Occas. Dull, achy pain.
DX test for ULS
Put your hands on the scrotum and ask them to grunt or bear down (valsalva) and it should dilate the vessels or can use ULS and have them bear down
how would you treat varicocele
Scrotal Support, NSAID, Surgery for infertility.
Epididymal cysts and Spermatoceles
are found where
Arise on the head of the epididymis, when larger than 2cm called Spermatoceles
Epididymal cysts and Spermatoceles vs cancer presentation
Generally asymptomatic, found on ULS
if they do get too large they can cause discomfort
Testicular Cancer
Usually painless, unless it causes hemorrhage or infarction
Testicular cancer ULS
less homogenous on ULS
can look abnormal
want to get a CT to look for METS most commonly to the lungs
Orchitis is defined as ___
what sxs do we see associated
Extension of epididymal infection into the testes, or complication of Mumps.
More systemic symptoms:
Fever, myalgias, malaise, parotid swelling
inguinal hernia is the result of
Failure of adequate embryonic closure of the Processus vaginalis in the inguinal canal, allowing intestines to force downwards into the scrotal sac.
inguinal hernia sx
Uncomfortable but not acutely painful, usually reducible by a push or lying supine. Often gradually enlarge.
Inguinal Hernia on PE
supine, and if not palpable, standing.
- If acutely painful, think:
a. Obstructed vs. Incarcerated vs. Strangulated
“i think it is an inguinal hernia that is likely reducible. I have not reduced one before but could i practice”
dx tests for inguinal hernia
ULS/CT –> look with ULS but can’t tell where bowel gets narrow and pinched on the side so CT is very useful for this
can you push an inguinal hernia back in
Let the surgeon decide to push –>if you push dead bowel back inside, then the dead bowel gets dead-er
tx of inguinal hernia
Scrotal Support, Analgesics, Stool softeners, Surgical Referral.
CAT scan with air
necrotizing fasciitis seen as dark black hyperecohoic air
blue dot sign for
torsion
