Hernias and Male GU Dermatology Flashcards
What is a groin hernia? What are 2 types?
a protrusion of abdominal-cavity contents through the inguinal canal
inguinal or femoral
What body landmark divides inguinal and femoral hernia?
inguinal ligament
inguinal above
femoral below
Location of ventral hernia
above umbilicus
Which type of groin hernia is more rare? Which is more common in men?
femoral (rare, more in women)
inguinal (common, more in men)
Ages that are most affected by groin hernias
< 1 yo and > 50 yo
Most common abdominal wall hernias
inguinal
Risk factors for groin hernias
Older age Male Caucasian Smoking Chronic cough Chronic constipation Abd wall injury H/O Cryptorchidism H/O or FHX hernia
Location of indirect vs direct inguinal hernias
indirect: through natural weakness of deep inguinal ring; LATERAL to inferior epigastric artery
direct: directly through abdominal wall - posterior/floor of inguinal canal; MEDIAL to inferior epigastric artery
congenital and acquired etiologies of groin hernias
due to failure of the processus vaginalis to obliterate and internal ring to close
due to a weakening or disruption of the fibromuscular tissues of the abdominal wall
Risks with cryptorchidism
groin hernias, testicular torsion, sterility
Hesselbach’s triangle
inferior epigastric artery, inguinal ligament, rectus abdominis muscle
contains inguinal canal
where direct inguinal hernias protrude
Most common: indirect or direct?
indirect
Which type of inguinal hernia is found more in children?
indirect
*direct more in adults
Which groin hernias are congenital?
indirect and direct inguinal hernias
*femoral is acquired
How is hernia best seen on exam?
patient standing and Valsalva maneuver
Differences of indirect and direct inguinal hernia on PE
bulge shape: direct more rounded; indirect more oval
location: direct medial; indirect lateral
palpation: indirect more pointy
Complications of inguinal hernia if painful on palpation
incarceration - trapping of hernia contents (localized pain)
strangulation - ischemia, decreased blood flow, and necrosis of hernia contents (erythema, greater pain)
bowel obstruction - blocked passage of stool/gas through hernia (N/V and diffuse abd pain)
Findings on palpation of uncomplicated hernia
- usually non-tender
- may not be visible externally
When should you get U/S for hernia?
occult (hidden) hernia
differentiating inguinal from femoral
When should you get CT for hernia?
complicated
differentiating hernia from other causes of pain
incarcerated vs unincarcerated hernia
incarcerated is painful and unincarcerated is not
4-6 hrs of strangulation. next step?
refer
Treatment of uncomplicated hernias with minimal symptoms
watchful waiting
When is elective repair an option for patient with hernia?
uncomplicated hernias with significant symptoms or femoral hernia
Treatment for acutely incarcerated hernias who do not have sx of strangulation
Manual reduction
Treatment for unreducible incarcerated hernias and/or strangulated hernias
Emergent repair
Benign dome-shaped subcutaneous papules on scrotum
Follicular or sebaceous cysts
Follicular or sebaceous cysts treatment
Reassurance
Surgical removal
if unsightly, painful, infected
Man comes in thinking he has STI because small dome-shaped flesh-colored papules on coronal margin or sulcus of glans penis
Pearly penile papules
Pearly penile papules treatment
Reassurance
Laser ablation for cosmetic reasons if desired
Well-demarcated scaly erythematous plaques
Frequently accompanied by perianal & intergluteal cleft plaques
psoriasis
Psoriasis treatment
Hydrocortisone during symptomatic periods
Calcipotriene (vit D3 analog) cream for prevention
Recurrences are normal
black, blue, or dark red, dome-shaped papules ranging from 1-6 mm in diameter on the scrotum
May bleed if scratched
May be present elsewhere on the body
Angiokeratomas of Fordyce
Angiokeratomas of Fordyce treatment
Reassurance (benign)
Laser ablation, electrocautery, or cryotherapy for cosmetic reason if desired
When do Angiokeratomas of Fordyce usually occur?
after puberty
Violet, flat-topped lesions usually seen on glans & shaft
May develop pruritic or painful erosive lesions
Lichen planus
Lichen planus
Reassurance – usually resolves spontaneously after several years (possibly decades)
Papular Lesions - tx with topical corticosteroids
Erosive Lesions - tx with intralesional steroid injection
Progression of Lichen sclerosis symptoms
Early: Atrophic Pruritic white plaques/papules
Progressing: dysuria, painful erection
Later: phymosis, meatal stenosis
How is Lichen sclerosis dx’d?
biopsy
Lichen sclerosis also called ________.
Balanitis xerotica obliterans (BXO)
Treatment of Lichen sclerosis
Early stages = High potency topical
Later stages = High potency intralesional corticosteroids
Long term use may cause epidermal atrophy
Circumcision may be necessary if foreskin affected
Uncircumsized boy under 5 yo with small red erosions and swelling of glans and foreskin. Started to have discharge.
balanitis
Balanitis treatment
Antibiotics, Antifungal, or Steroid depending on suspected underlying cause
Collection of thick whitish discharge under the foreskin
smegma
Smegma treatment
Retract foreskin and clean regularly
