Reproductive System - Level 3 Flashcards
Definition of fat necrosis of breast?
- Fibrosis and calcification that occurs secondary to injury to breast and ischaemia of fat lobules
- Scarring results in firm lump
Causes of fat necrosis of breast?
o Iatrogenic (breast biopsy, breast reduction, augmentation) o Trauma (seat-belt injury)
Risk factors of fat necrosis of breast?
o Large, fatty breats in overweight or obese women
o Trauma
Symptoms of fat necrosis of breast?
- Painless lump
o Hard, fixed masses - Skin red, bruised or dimpled
Assessment of fat necrosis of breast?
Refer for triple assessment o Clinical Examination o Radiology – USS <35y, mammography and US for >35y Acoustic shadowing o Biopsy – FNA or core biopsy
Management of fat necrosis of breast?
- If biopsy confirms fat necrosis – no further management needed, reassure
Definition of fibrocystic disease?
- Characterised by lumpy breasts associated with pain and tenderness that fluctuate with menstrual cycle
Epidemiology of fibrocystic disease?
- Most common benign breast disorder
- 2/3 of women
- Women 20-50
Risk factors of fibrocystic disease?
o Late-onset menopause o Later age at first childbirth o Nulliparity o Obesity o Oestrogen replacement
What effects symptoms of fibrocystic disease?
- Hormonal changes thought to affect symptoms
Symptoms of fibrocystic disease?
- Lumps in breasts
- Pain and nodularity – usually bilateral
- Symptoms greatest 1 week before menstruation and decrease when it starts
- Exclude breast cancer, infection or pregnancy
Assessment of fibrocystic disease?
- Breast pain diary for at least 2 months to aid diagnosis
- Refer if symptoms persist
o US or mammogram
o Consider cyst aspiration or biopsy if suspicious
Management of fibrocystic disease - general advice?
o No pathological cause
o Better-fitting bra
o Soft support bra at night
o Oral paracetamol and ibuprofen PRN
Management of fibrocystic disease - if general measures fail?
- Referral to breast specialist if does not respond within 3 months:
o Danazol and tamoxifen (if severe, >6 months and interferes with ADLs)
Prognosis of fibrocystic disease?
- 20-30% will resolve spontaneously
- Not a risk factor for developing breast cancer
Definition of hypospadias?
- Congenital abnormality characterised by abnormal position of external urethral meatus on the ventral penis
- Urethral tubularisation occurs in a proximal to distal direction due to testosterone
How common is hypospadias?
- Affects 1 in 350 male births
Symptoms of hypospadias?
- Difficulty urinating while standing
- Cosmetic appearance problems
- Erectile deformity
Features of hypospadias?
Ventral urethral meatus
Urethra opens on or adjacent to glans penis in most cases, can be on penile shaft or in perineum
Hooded dorsal foreskin
Foreskin failed to fuse ventrally
Chordee (rare)
Ventral curvature of the shaft, most apparent on erection
Management of hypospadias?
Reconstructive surgical - urethroplasty
o Correction often taken <2 years
o Aims to produce terminal urethral meatus, straight erection, normal looking penis
Avoid circumcision
Definition of undescended testis?
- Defined as the incomplete descent of one or both testes and absence from the scrotum
- Usually remain in the abdomen or inguinal canal
Definition of cryptorchidism?
complete absence of testicle from scrotum (anorchism is absence of both)
Definition of maldescended testes?
when testes lie along the normal path of descent in the abdomen or inguinal region and have never previously been present in the scrotum
Definition of ectopic testes?
when testes lie outside of the normal path of descent, for example in the femoral region, perineum, or penile shaft
Definition of retractile testes?
when testes have previously been present in the scrotum but have come to lie permanently outside it. Normally due to excessive cremasteric reflex. Treatment is reassurance.
Epidemiology of undescended testis?
- At birth about 3% of full-term boys (30% of premature boys)
- Unilateral 4x > bilateral
Risk factors of undescended testis?
- First degree relative
* Low birth weight, small for gestational age, preterm delivery
Aetiology of undescended testis?
- Idiopathic
* Rarely chromosomal abnormalities or androgen receptor mutations
Examination of undescended testis?
- Examination carried out in warm room, warm hand and relaxed child
- Testes can be brought down by massaging inguinal canal towards scrotum
Screening performed of undescended testis?
- Screening done at 48-72 hours and 6-8 weeks
Examination findings of undescended testis?
Retractile
Can be manipulated into bottom of scrotum without tension but subsequently retracts due to cremasteric reflex
Palpable
Testis can be palpated in groin but cannot be manipulated into scrotum
Impalpable
No testis found, could be in inguinal canal, intra-abdominal or absent
Management of undescended testis - children 3 months or younger??
If ambiguous genitalia or hypospadias or undescended testes bilaterally – refer within 24 hours to senior paediatrician
If unilateral undescended testes:
If persists at 6-8 weeks – re-examine at 3 months
If still undescended – refer to paediatric surgeon before 6 months
Management of undescended testis - boys or men?
• If one or both undescended – refer to paediatric surgeon/urologist or urologist
Management of undescended testis - treatment of maldescended/ectopic testis?
Restores potential for spermatogenesis
Surgery
Orchidoplexy
Ideally before 6 months of age if picked up
Hormonal therapy
Human chorionic gonadotrophin (hCG) if undescended testes in inguinal canal
Complications of undescended testis?
- Infertility
- 40x increased risk of testicular cancer
- Testicular torsion
- Hernias
