scrotum + testicles Flashcards
what is the tunica vaginalis
serous membrane pouch that covers testes
what is hydrocele
fluid within tunica vaginalis
what is communicating hydrocele
allows peritoneal fluid to drain to scrotum
who commonly gets communicating hydrocele
male nweborns and resolve in a few months
what is non-communicating hydrocele
excess fluid production within tunic vaginalis
causes hydrocele
epididymo-orchitis // testicular torsion // testicular tumour
o/e hydrocele
soft, nontender swelling // confined to scrotum // transilluminates // testes difficult to palpate
diagnosis hyrocele
usually clinical but can be USS
mx hydrocelle
conservative –> USS to check for tumour
what is varicocele
enlarged testicular veins
features varicocele
subfertile // left sided // ‘bag of worms’
invx + mx varicole
USS // conservative, maybe surgery if painful
what is a worrying cause of varicocele
renal cancer
what is testicular torsion
torsion of spermatic cord –> ischaemia + necrosis
who gets testicular torsion
males 10-30 (usually kids) //during exercise
symptoms testicular torsion
severe + sudden pain // lower abdo pain // N+V
o/e testicular torsion (4)
swollen // tender testis retracted // no cremasteric reflex (stroke thigh teste retracts) // elevation of testis does not relieve pain (prehn’s)
mx testicular torsion
(USS) // urgent surgical exploration // fixation of both testis
what is the most common cause of scrotal swelling in primary care
epidiymal cysts
o/e epidiymal cysts
painless // usually over 40yrs // separate from body of testis // posterior
symptoms (3)
PKD, CF, von hippel-landeua
invx epidiymal cysts
USS
what is Epididymo-orchitis
infection of epididymis +/- testes
causes Epididymo-orchitis
young men = chlamydia or gonorrhea // older = E.Coli
symptoms Epididymo-orchitis
unilateral pain and swelling // maybe urethral discharge // dysuria
important differential Epididymo-orchitis
torsion
invx Epididymo-orchitis
young = STI // older = mid urine stream for microscopy and culture
mx Epididymo-orchitis
STI = ceftriaxome IM 500 mg + doxy 100mg BD 10 days // E.coli = quinilone eg oflocaxin 2 weeks
what drug can cause Epididymo-orchitis
amiodarone
symptoms inguinal hernia
superior and medial to pubic tubercle // ache // may reduce with cough
what age group get testicular cancer
20-30
testicular tumour types
germ cell (95%) seminomas or non-seminomas // leydig // sarcoma
RF testicular cancer
infertility // cyrpotochordism // FH // klinefelters // mumps
symptoms testicular cancer
painless lump // hydrocele // gynaecomastia
what ratio is raised to cause gynaecomastia in testicular cancer
increased oestrogen:androgen
how does gynaecomastia develop in testicular cancer
germ cells –> hCG –> increase oestrodiol (+ testosterone) // Leydig –> secrete more oestradiol
tumour markers for germ cell tumours
seminomas hCG in // non-seminoma AFP +/- hCG // both = LDH
invx testicular cancer
USS // (CT staging)
mx testicular cancer
orchidectomy, chemo, radio (good prognosis)
non-seminatous germ cell tumours
teratoma, yolk sac, choriocarcinoma, mexed
what is Cryptorchidism
congenital undescended testes at 3 montrhs of age
differentials Cryptorchidism
intersex conditions
assoc conditions Cryptorchidism
infertile, testicular cancer, torsion
o/e Cryptorchidism
soap test // retracts quickly to inguinal canal –> surgery
