GU Flashcards
scrotal pain differentials
-MOST THREATENING:
-testicular torsion
-fournier’s gangrene
-GU trauma
-AAA
-OTHER GU:
-Appendage torsion!
-Epididymitis* ± orchitis
-Hematocoele or hydrocoele or varicocoele
-Idiopathic scortal edema
-Skin disorder
-Tumor
-HSP
-NON-GU:
-Appendicitis
-Hernia
-Renal colic
-Pyelonephritis
scrotal absces
-Abscess = suppurative mass with surrounding erythema
-May start as a small pustule and increase in size
-Induration & fluctuance
-Tx:
-Uro consult
-I&D, with instructions for sitz baths and dressing changes
-Immunocompromised or complex abscesses need IV abx
-!Consider CT or US imaging
fourniers gangrene
-rare form of Polymicrobial necrotizing fasciitis that affects deep and superficial tissues of perineal, anal, scrotal, and genital regions
-DM, immunocompromised, alcoholics
-Initially minimal skin manifestations (appears like cellulitis)
-Severe !pain out of proportion!
-!Rapidly progressive -> crepitus!, purpura, bulla, patchy black tissue discoloration, putried odor
-!Mortality rate 22-40%
-Requires !emergent surgical debridement! and broad spectrum antibiotic therapy!
epididymitis
-Epididymis: tightly coiled structure along posterior aspect of testicle
-where sperm mature prior to transfer to vas deferens.
-Epididymitis: Infection of epididymis
-bacteria travel retrograde down the vas deferens
-MC intrascrotal infection
-Rare in prepubertal pts
-18-35yo is MC
-Testicular infection (orchitis) may occur as well
-MC pathogen in those:
-<35yo -> STI
->35yo -> E.coli UTI
-Enteric pathogens can be cause in pts who do anal intercourse
-Good hx- Sexual activity, GU anomalies, GU instrumentation
-Urinary symptoms- Dysuria, frequency, discharge
-Pain and swelling of testicle- More gradual onset
-Fever is rare, N/V is rare
-Tendon epididymis- progressing to diffuse hemi-scrotal involvement
-intact cremasteric reflex
-normal anatomic position of testes
-Prehn’s sign- decreased pain with lifting of the scrotum
epididymitis dx and tx
-Urinalysis- Pyuria
-STI testing
-Doppler US of scrotum -> Increased blood flow & inflammation of the epididymis
-Tx:
-STI related -> Ceftriaxone, Doxycycline
-Enteric pathogen -> Fluoroquinolone
-Outpt f/u with urology
-Admit if signs of systemic infection
A 68-year-old male with a history of insulin-dependent diabetes mellitus, benign prostatic hypertrophy (BPH) and hypertension (HTN) presents to the ED with fatigue, subjective fevers for two days, and dysuria. He endorses myalgias and lower back discomfort. He denies any recent surgeries, procedures, or antibiotic use. He had an episode of non-bloody, non-bilious vomiting prior to arrival. The patient reports his blood sugars at home today were 273 and 315. He’s currently complaining of bladder pressure and has not voided in 6 hours. He is tachycardic and febrile.
prostatitis
prostatitis
-4 categories; beyond scope of this class
-!Acute bacterial prostatitis
-Chronic bacterial prostatitis
-Chronic prostatitis / chronic pelvic pain syndrome
-Asymptomatic inflammatory prostatitis
-E. Coli MC
-Fever
-Urge incontinence or urinary hesitancy
-Flu like symptoms: nausea, weakness, chills
-Tender, edematous and boggy prostate
-U/A Ucx may be negative
-Clinical dx!
acute bacterial prostatitis
-Consider prostatitis in those who do not respond to tx for acute cystitis
-Outpt antibiotics should be based on local UTI anti-biograms
-1st line: TMP/SMX or Fluoroquinolone (Ciprofloxacin, Levofloxacin)
-STI tx if suspected cause
