Male GU disorders Flashcards
Cause of ST epididymitis
chlamydia or gonorrhea
Cause of non-ST epididymitis
seen in older men, GNR
CP of epididymitis
pain in scrotum and may radiate to the flanks and along the spermatic cord
usually fever and swelling
+/- prostate tenderness
Labs of epididymitis
CBC: left shift
Gram stain: N gonorrhea or white cells with no organisms (chlamydia)
UA: pyuria, bacteriuria, varying hematuria
Imaging of epididymitis
scrotal U/S to confirm diagnosis
DDx of epididymitis
tumor (usually painless) testicular torsion (Prehn's sign-elevation- makes tortion worse and epididymitis better)
tx for epidiymitis
bed rest, scrotal elevation
STD suspected: Rocephin (ceftriaxone) and doxycycline (10 days) or zithromax
Non-ST tx of epididiymitis
Levofloxacin x 10 days
NSAIDs
treat promptly to avoid orchitis, abscess, infertility
Most common cause of STD? age group? Sx?
Gonorrhea, 15-29, yellowish discharge and urethral pain
CP of gonorrhea in men? Women?
dysuria and clear to yellow discharge; less severe or asymptomatic but with dysuria, fq, urgency, and vaginal discharge, + chandelier’s sign. Look for eyes, throat, anal, or blood stream infection
diagnosis of gonorrhea in men? Women?
gram stain; women purely clinical
DDx for gonorrhea
chlamydia, trichomonas, gardnerella, candida
Tx of gonorrhea
rocephin IM
cefixime po
Chlamydia
usually an insidious infection, may spread to the lymph
CP of chlamydia in men? Women?
clear to white d/c, lymphadenopthy, or asymptomatic, possibly epidid or prostatitis;
PID, cervicitis, etc or asymptomatic
most reliable dx for chlamydia? Most used?
Culture (takes too long); immunoflourescence assay, enzyme-linked assay, and DNA PROBE (best)
What is the DDx for chlamydia
all other STDs
tx for chlamydia
zithromax (uncomp) or erythromycin (10 days) or doxycycline 7-10 days plus rocephin IM
Prognosis for chlamydia
if left untreated, females have probability of infertility
What is the one radiolucent stone? Most common type?
Uric acid; calcium
Labs of stones
possible hematuria
most common symptom of urinary stones
pain, won’t stop moving (unlike appendicitis)
What medications may cause ED?
beta blockers and thiazides
diagnostic studies for ED?
CBC, UA, glucose, Lipids, testosterone, Prolactin (endocrine consult indicated)
What are the treatments used for ED?
vascular reconstruction, etc
MEDICAL: injections…. OR DRUGS
Viagra, Cialis, Levitra
What drugs should you not use ED meds with?
Nitrates or vasodilators!
FATAL
When is infertility work up indicated?
after 6 months of unprotected intercourse
What are some common causes of inferility in men?
Testicular trauma, MUMPS, epididymitis, radiation, chemo, use of lubricants
What are important causes of mostly reversible infertility?
Meds: Steroids, cimetidine, spiro, phenytoin, sulfa, nitrofurantoin, marijuana, ETOH
What may indicate a pituitary tumor?
Loss of libido, HA, bitemporal hemiopsia
Labs for infertility
semen analysis after 72 hours of abstinence, analyzed within 1 hour
Lab testing for infertility
FSH, LH, testosterone, and serum prolactin
Imaging for infertility
scrotal U/S may reveal varicocele
Tx for infertility
hypogonadotropic hypogonaism: tx with chorionic gonadotropin IM 3x a week
Imipramine TID
Most common age of testicular torsion
10-20, usually with physical activity, some during sleep
SUDDEN ONSET OF SEVERE TESTICULAR PAIN
Testicular torsion
DIAGNOSTIC STUDY FOR TESTICULAR TORSION
DOPPLER U/S
If testicular torsion is ruled out, what are other causes of testes pain?
epididymitis, varicocele, hydrocele
Treatment for testicular torsion
SURGICAL EMERGENCY, scrotal exploration
CP of varicocele
get out of supine position, valsalva or standing: the veins of the plexus become dilated and feel like a “bag of worms”
DETERMINE THAT THE VARICOCELE REDUCES WHEN THE PATIENT IS SUPINE
Diagnostics for varicocele
None indicated unless there is infertility, then semen analysis (transillumination)
If it doesn’t reduce: venography
Ddx for varicocele
inguinal hernia
Treatment for varicocele
watch and wait/surgery
Hernia that comes down into the inguinal canal and occurs lateral of inferior epigastric vessels
indirect; do occur in women, often become incarcerated
hernia that protrudes through Hesselbach’s triangled
direct, rarely incarcerate
What is the second leading cause of bowel obstruction?
incarcerated hernias
Pt presents with an indirect inguinal hernia and pain. What diagnostics are indicated?
CBC: elevated WBC with a left shift
Electrolytes and elevated BUN=dehydration and toxic state
acute abdominal series to r/o free air and obstruction, +/- barium enema
DDx for inguinal hernia
LYMPH NODE ENLARGEMENT
Hydrocele (non-tender, transillumination)
Testicular torsion (acute incarcerated hernia)
RULE OUT TORSION FIRST
Tx for acute incarceration? Chronic?
Acute: attempt reduction
Chronic: DON’T ATTEMPT IF THERE IS ANY QUESTION OF DURATION! Do surgery with hydration and antibiotics pre-op
