Surgery + WRAP UP Flashcards
What is the definition of phimosis and paraphimosis?
Phimosis - adhesion of foreskin to glans after 3years
Paraphimosis - irreducible retraction of foreskin beyond glans
What are the signs and symptoms of an inguinal hernia?
Intermittent swelling in groin/scrotum Tenderness worse at end of day Relieved by lying down/pressing on it Palpable impulse with coughing/straining Abdominal fullness Danger signs: hardness, tenderness, oedematous, vomiting - usually indicates incarceration
What investigations are required for a suspected hernia?
Physical examination is usually sufficient
Can do and ultrasound +/- CT
What are some complications of hernias?
Strangulation –> ischaemia
Incarceration
What is a hydrocele and how do they appear?
Collection of fluid within the processus vaginalis producing swelling in scrotum, caused by incomplete obliteration of PV (thinner = hydrocele (fluid), thicker = hernia (bowel))
Caused by non-closure of processus vaginalis - communicating hydrocele
OR imbalance in fluid production/absorption (inflammation, tumours, trauma) - non-communicating
What are the clinical features of a hydrocele?
Painless swelling in scrotum, can get above it
Transilluminates
Can palpate testes inside
Scrotum is smooth
What are the two different types of undescended testes?
Retractable - normally descended but exaggerated cremasteric reflex
Maldescended - arrested descent (found in normal pathway) or ectopic (deviated from normal pathway)
What is the pathophysiology commonly causing testicular torsion?
Inadequate fixation of testes to tunica vaginalis –> allows testes to rotate and occlude vascular supply
“Bell clapper” deformity - testes transverse lie
What are the clinical features of testicular torsion?
Sudden onset testicular pain and swelling
Occasional N&V, sometimes fever
Pain may be in iliac fossa, pain may lessen as the testicle dies
Discoloured scrotum
Riding high, abnormal lie (transverse)
Cremasteric reflex absent
What are the different causes of a testis not present in the scrotum?
Maldescended testes - true undescended: arrested along normal path
Ectopic
Retractile testes: overactive cremaster reflex
Hypoplastic: testicular agenesis
Is undescended testes more common in left or right?
Right (left comes down first)
How do you determine whether an absent testis is retractile or truly undescended?
Can it be milked downwards
Upon release does it spring back upwards straight away (undescended) or remain in the scrotum until cremasteric kicks in (retractile)
What is the treatment for retractile testis?
Nothing
Overactive cremaster reflex reduces with age
What are the complications of persistent cryptorchidism?
Infertility
Increased risk of testicular cancer
Torsion
Hernia
What is the management for cryptorchidism?
Surgery at 6mo
Karyotype
What kind of deformity predisposes males to testicular torsion?
Bell clapper deformity - where testes lay horizontally rather than vertically
How does testicular torsion present in neonates?
Usually testes is already dead
Painless, discoloured (blue or black), swollen
What is the treatment for testicular torsion?
Immediate surgery!
Detort in 6hrs can save
>24 hours cannot save
What is torsion of a testicular appendage?
Twisting of remnants of mullerian or wolffian ducts
You can have the ‘blue dot sign’ (necrotic appendage)
Less painful, cremasteric reflex is intact
What causes indirect hernias?
Failure of obliteration of processus vaginalis - abdominal contents can now enter the sac
Are direct hernias more likely to present on the left or right side?
RIGHT
Left comes down first
What is the management for inguinal hernias?
Surgical correction - inguinal hernias to not spontaneously heal
- Usually explore other wise as well
What is the treatment for hydrocele?
Nothing - will resolve by 12mo
>2 years - surgery
What are the clinical features of hypospadias?
Urethral meatus opens ventral side of penis shaft
