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Surgery M4 part 1 > Inguinoscrotal Swellings > Flashcards

Inguinoscrotal Swellings Flashcards

1
Q

What are the different causes of an inguinal swelling?

A
  • hernia
  • lipoma of the cord
  • LN enlargement
  • Subcutaneous swelling
  • aneurysm of vessels
  • undescended testis
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2
Q

What are the causes of inguinoscrotal swellings?

A
  • hernia
  • varicocele
  • hydrocele
  • lipoma of cord
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3
Q

DD of scrotal swelling?

A
  • Testicular tumor
  • hydrocele
  • epididimo-orchitis
  • epididimal cyst
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4
Q

The dilation and tortuosity of the pampiniform plexus is caused by what disorder?

A

Varicocele

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5
Q

Varicocele is more common in who and where?

A
  • more common in tall thin young men

- more common on the left side

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6
Q

What is the common complication of varicocele?

A

due to increased temperature in scrotum which depresses spermatogenesis and leads to correctable infertility

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7
Q

What are the types of varicocele?

A
  • primary/idiopathic 95% (incompetence in valves of testicular vein)
  • secondary: left sided renal complication or retro-peritoneal mass
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8
Q

Why is varicocele more common on the left side?

A
  • left testicular vein joins left renal vein at right angle
  • liable to get compressed by loaded sigmoid
  • left renal vein is compressed between aorta and superior mesenteric artery (NUTCRACKER)
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9
Q

What are the clinical features of varicocele?

A
  • dragging pain in testis aggravated by standing & relieved by lying down
  • impaired sperm quality
  • cosmetic attention
  • swelling in scrotum
  • failure of affected testis to grow
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10
Q

How should a varicocele patient be examined?

A
  • warm room standing & lying down with and without valsalva maneuver
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11
Q

You feel a painless compressible mass with a feeling of bag of worms and a thrill and a testis smaller than the other. What should be your diagnosis?

A

Varicocele

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12
Q

What investigations should be done for a varicocele patient?

A
  • venous doppler of scrotum and groin (to check if there is reflux and to know what grade)
  • U/S of the abdomen to see if there’s a secondary cause
  • semen analysis (MEDICO-LEGAL)
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13
Q

What are the complications of a varicocele?

A
  • Male infertility

- testicular atrophy

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14
Q

When should intervention occur to reverse a varicocele?

A
  • SYMPTOMATIC
    • impaired sperm quality
    • dragging pain
    • cosmetic
  • MEDICALLY UNFIT for army
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15
Q

What it the best approach to ligate the pampiniform plexus?

A

inguinal approach

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16
Q

What are the complications of pampiniform ligation?

A
  • hydrocele formation due to ligation of lymphatics
  • recurrence
  • testicular infarction
  • infection & hemorrhage
17
Q

What disorder would be caused if the processus vaginalis was not completely obliterated?

A

hydrocele: collection of fluid between the 2 layers of tunica vaginalis

18
Q

What are the causes of hydrocele?

A
  • congenital
  • acquired
    • defective absorption from processus vaginalis
    • excess production of fluid
    • impaired lymphatic drainage
    • communication with peritoneal cavity
19
Q

What are the types of hydrocele?

A

Primary Vaginal Hydrocele

  • fluctuant
  • transilluminant (clear serous)
  • testis is not palpable
  • can get above swelling

Infantile hydrocele

  • tunica and processus vaginalis are distended up to internal ring
  • no connection to peritoneal cavity
  • in the morning like the night (no change in size)
  • conserve for 1 year

Congenital hydrocele

  • communication between processus vaginalis and peritoneal cavity
  • in the morning is a different size than the evening
  • can not be emptied by pressure (inverted ink bottle)

Encysted hydrocele

  • part of the processus vaginalis is open
  • smooth oval swelling associated with spermatic cord
  • on traction becomes less mobile

Hydrocele-en-bisac (bilocular hydrocele)
- 2 intercommunicating sacs one above and on ebelow neck of scrotum

Hydrocele of the canal of Nuck

  • in females in relation with the round ligament
  • always in inguinal canal

Hydrocele of hernial sac
- due to adhesions of content of hernial sac

20
Q

What are the causes of a secondary hydrocele?

A

Infection

  • filariasis
  • Tuberculosis of epididymis
  • Syphilis

Injury

  • trauma
  • post herniorrhaphy (due to tightening of internal ring)

Tumor
- malignancy secondary hydrocele

(small lax and testis is palpable except filariasis can be very large)

21
Q

What are the complications of hydrocele?

A
  • infection
  • pyocele
  • haematocele
  • atrophy of testis (long standing)
  • infertility
22
Q

How is hydrocele treated?

A

SURGERY

  • sub-total
  • partial excision and eversion
  • evacuation & eversion
  • Lord’s plication (stitch on tunica vaginalis to limit its growth)
23
Q

Congenital swelling that feels like a bunch of tiny grapes (multilocular) and is brilliantly transilluminant appearing like Chinese lanterns is called?

A

Cyst of epididimis

24
Q

How to manage the cyst of epididimis?

A

AVOID EXCISION because it can result in infertility

25
Q

What is a unilocular, acquired retention cyst derived from blockage of a portion of sperm conducting mechanism of epididymis?

A

Spermatocele

26
Q

Where is the location of a spermatocele?

A

in the head of the epididymis above and behind the body of the testis

27
Q

What are the contents of a spermatocele swelling?

A
  • barley water like fluid containing spermatozoa

- soft cystic and transilluminant (described as a 3rd testis)

28
Q

What is the difference between an epididymal cyst & a spermatocele?

A

EPIDIDYMAL CYST SPERMATOCELE
- congenital - acquired
- behind body of testis - behind and above testis
- multilocular - unilocular
- bunch of grapes appearance - 3rd testis
- clear fluid - barley water fluid
containing spermatozoa
- brilliantly transilluminant - transilluminant
- excision avoided in young - can be excised

29
Q

What are the acute scrotal swellings?

A
  • torsion testis (always first)
  • epididymo-orchitis
  • hernia
  • trauma
  • dermatological
30
Q

What is the true surgical emergency of the highest order?

A

testicular torsion

  • irreversible ischemic injury begins 4 hours after occlusion
  • intravaginal torsion results from lack of normal fixation
  • abnormally mobile testis that hangs freely in tunical space
31
Q

what is the commonest age for testicular torsion?

A

prepubertal males

32
Q

How does a patient present with testicular torsion?

A 
Pain
Nausea 
Vomiting 
poor appetite 
previous episodes 
tender swelling 
high riding transverse orientation
loss of cremasteric reflex
33
Q

How to treat testicular torsion?

A

doppler US to confirm diagnosis
scrotal exploration
detorte the affected testis and PEX THE OTHER SIDE while waiting for the testis to pink up

if testis is not alive do orchiectomy

Surgery M4 part 1 (47 decks)

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