Gu Flashcards
UA normal , edema and warmth of testicle and pain. Elevation increases pain
Testicular torsion
Elevation of testicle relieves pain
Epididmytis
Prehn sign
Elevation relieves pain in epididymitis not seen in testicular torsion
Causes of epididmytis
Gonorrhea/ chlamydia
Sexually active teen or sex Truama common risk factors
Chemical irritant
Structural abnormalities
Epididmytis s/s
scrotum pain SLOW BUT WORSENS OBSTRUCTIVE VOIDING dysuria Can have blood in urine Abnormal Ua could be or uti Fever N/v Edema and erythema Tender spermatic cord Normal cremation reflex Urethra discharge
Epididmytis dx
Ua : pyuria or bacteruria can be present
CBC: wbc increased
VCUG if urogenital issue or + Ua
STI/Std testing
Epididmytis management
Ice pack Elevation NSAIDS 1st: ceftriaxone 250 IM x1 dose & Doxycycline 100mg BID x10 days
Alternative:
Ofloxcin 300 mg BID X10 days
cephlexin 40 mg /kg/day x dose
Treat sex partners
Referral if only unilateral involvement
Avoid sex until cured
Testicular torsion management
EMERGENCY
SURGERY 6-12 hours
Hypospadias
Congenital abnormality urethra located in abnormal position or even ventral surface underside of penis
10% also have undescended testes , Inguinal hernia or hydrocele
Hypospadias
Dorsally hooded foreskin in newborn , and chordee
Chordee=bowing of penis
Hypospadias
Management of hypospadias
NO CIRCUMCISION
refer Peds urologist
Done at 6-12 months
Testicular decent occurs when
At 7 to 8 months gestation
Undescended testes is common and preterm at 30% low birth weight and twin infants
Cryptorchidism
Undescended testes
Cannot be manipulated into the scrotum
Understand a testes after birth can occur spontaneously in the first 3 -6 months
Bilateral is rare 10% cases
Retractable testes
A retractable testes is out of the scrotum but can be brought into the scrotum and remains there
Bilateral more common 5-6 year old boys
Gliding testes
Can be brought into the screen and returns to a high position once released
Etopic testes
Lies outside the normal path of descent
Risk factors Cryptorchidism
Family history
Testicular malignancy
Prematurity, hypospadias, low birth weight, down syndrome, Klinefelter syndrome
Cryptorchidism dx &mangement
Frog leg position
Refer at 6 months for surgical intervention
Hydrocele
Painless scrotal swelling with a collection of serous fluid in the scrotal sac
Scrotal size increases with activity and decreases with rest
Testes descended
Noncommunicating hydrocele
Collection of fluid is only in the scrotum
No treatment fluid is absorbed unless persists >1 heat or painful
Communicating hydrocele
Fluid moves from the abdomen to the scrotum is more likely associated with hernia
Can Resolved without surgery if hernia persist more than one year referral for surgical intervention
Phimosis
Foreskin that’s too tight to be retracted over the glans penis
can be physiologic over the first six years of life or pathologic when the foreskin cannot be retracted after previously being retracted after puberty
Can have urinary obstruction or ballooning of the foreskin
Phimosis mangement
Normal cleansing with gentle stretching of the foreskin can retract by five or six years old never forcefully retract the foreskin
Can get a circumcision
Persistent phimosis can be treated with corticosteroid cream TID for a month
Paraphimosis
More common and adolescents it is a retracted foreskin that cannot be reduced to the normal position causes constriction on the penis and result in pain Adema of the glands and possible necrosis
Seen in sexually active adolescences sexual abuse and forceful retraction
Paraphimosis management
Reduction by lubricating the foreskin and pulling back the glands if not successful may need surgery
Wilms tumor
Mass in the abdomen or flank
Can have fever, dyspnea, diarrhea, vomiting, weight loss, or malaise, pain if mass has undergone rapid growth or hemorrhage
Ascended testes
Testicles that have fully descended but has spontaneously re-ascended and lies outside the scrotum
Pain and cramping with the absence of any pelvic pathology
Primary dysmenorrhea
Occurs 6 to 12 months after first menses
ovulation is needed
Primarily in adolescence
Painful menses, lore of Domino pain, back pain, nausea, vomiting, fatigue, headache, and diarrhea
Symptoms of dysmenorrhea
Painful menses results from my underlying cause such as pelvic disease ,pregnancy, PID, and Endometriosis, cyst, tumors
Secondary dysmenorrhea
treatment for mild dysmenorrhea
Heat application exercise Tylenol good diet Motrin 400 mg Q6 to 8 hours, 1 to 3 days
Primary dysmenorrhea moderate
NSAIDS inhibit prostaglandin synthesis
Naproxen sodium 500 mg PO then 250 mg Q6 to 8 hr
mefenamic 500 mg PO, 250 mg every 6-8 h
Assess 2 to 3 cycles if effective NSAID Tx
No NSAIDS for clotting disorders, renal, or peptic ulcer‘s, preop, or allergy
Primary severe dysmenorrhea treatment
If unresponsive to inserts and mild treatments start with OCP‘s
Check in 3 to 4 cycles to see improvement
A continuous >4 months GYN referral
Hydronephrosis
Blocks urine from the kidney
S/S: nausea; flank pain; decreased urine
TX: surgery
Bacterial infection of the urinary tract
UTI
UTIs are greater in_____In the first year of life ____ especially if they are _______. Then it’s more common in______.
Males in the first year of life especially if they are uncircumcised and then more common in females
Biggest pathogen of a UTI
E. coli 80 to 90% of cases
Pathogens of UTI
Viral but rare adenovirus
E. coli 80 to 90%
Staphylococcus aureus
Klebsiella
Staphsaprophyticus
Infants have a weight loss, failure to thrive, irritable
Teens experience dysuria, nocturia, frequency, urgency, hematuria, fever, abdominal pain
s/s uti
Cath culture sensitivity
Positive > 1000 CFU Single or multiple organism
Clean catch sensitivity is performed when
Done with mild symptoms or follow up
Positive UTI for a clean catch specimen
Positive at 50,000 to 100,000 CFU single organism
A positive UTI on a UA shows what
Leukocytes, erythrocytes, nitrates, Estrace, leukocytosis in a CBC
When should Reno or bladder ultrasound be performed in a UTI
Febrile infants
First UTI, children 2 to 24 months
Symptoms of pyelonephritis at any age
UTI <3 months —hospital
When should a VCUG be performed
If abnormal ultrasound
Increase blood pressure symptoms
Anabiotic for UTI
Bactrim/cephalosporin/nitrofurtin/Augmentin
10 to 14 days; follow up to days if no improvement change antibiotic
Common history for primary nocturnal enuresis
Positive family history, related to maturational delay, some nighttime winters can stop wetting without treatment
Common in enuresis type for school-age children
Primary diurnal enuresis
