Testicular and Groin - Inguinal hernias, Femoral hernias, Hydrocele, Varicocele, Testicular torsion, Epididymo-orchitis, Epididymal cyst Flashcards
Inguinal hernias
-presentation
-risk factors and types
-investigations
-management
Groin lump - superior medial to pubic tubercle
-disappears on pressure or when patient lies down
Discomfort and ache - worse on activity
If strangulated, extremely painful
Direct - leaves through weakness in abdominal wall and superficial ring
-more common in older adult males
Indirect - through deep and superficial ring
-more common in infant males
CLINICAL DIAGNOSIS but if in doubt
-US, CT/MRI
Treat even if asymptomatic - mesh repair
-unilateral - open approach
-bilateral/recurrent - laparoscopically
Strangulated vs incarcerated
-presentation of strangulated
-investigations
-management
Incarcerated - cannot be reduced, no pain but at risk of strangulation
Strangulated - blood supply cut off to intestines
Pain
Fever
Increased size of hernia
Redness
Peritonitic
Bowel obstruction signs - distention, N/V
Bowel ischemia - bloody stools
Pain, groin discomfort
Irreducible groin mass
Tender distended abdo with lack of bowel sounds
N/V
Constipation
CLINICAL DIAGNOSIS
-FBC, U&E, LFT CRP, ABG, lactate, urinedip, G&S
-US, CT/MRI of groin/abdo - to exclude other pathologies
GEN SURG REFERRAL URGENTLY
-mesh repair
Femoral hernias
-presentation
-risk factors
Groin lump, mild pain
Often non reducible, no cough impulse due to narrow femoral ring
If strangulated
Less common than inguinal
More common in women especially if
-multiparous
-obese
CLINICAL DIAGNOSIS but US done to rule out other differentials
Surgical repair needed due to risk of strangulation
-laparotomy, laparoscopy
Hydrocoele
-what is it
-presentation
-investigations
-management
Accumulation of fluid in tunica vaginalis
-communicating - peritoneal fluid drains down into scrotum (common in newborn males, resovle within few months)
-non communicating - excess fluid produced within tunica vaginalis
Secondary to
-epididymo-orchitis
-torsion
-testicular tumours
Soft, non tender swelling of scrotum
Can get above mass on examination
Transillumination
CLINICAL DIAGNOSIS, US if doubt or cannot palpate underlying testis
Infantile - surgically repaired if not self resolving by 1-2years
Adults - US to exclude underlying causes
Testicular torsion
-what is it
-presentation
Twisting of spermatic cord => testicular ischemia and necrosis
Most common in males 10-30
Severe, sudden onset, lower abdo pain
N/V
Swollen, tender retracted tested
Cremasteric reflex lost
Elevation of testes does not ease pain
CLINICAL DIAGNOSIS
URGENT SURGICAL EXPLORATION
-fix both testes
Epididimo-orchitis
-what is it
-presentation
-investigations
-management
Infection of epididymus+testes => pain and swelling
-local spread of genital tract infections
Chlamydia, Gonorrhea - sexually active young people
Ecoli - older adults
Testicular pain, swelling
May be discharge
RULE OUT TESTICULAR TORSION!
Investigations guided by age
-younger adults - STI screening
-older adults - MSU urine
If STI => urgent referral to local SH clinic
-unknown organism - ceftriaxone 500mg IM 1 dose, doxy 100mg PO BDS 14days
If enteric => empiric PO quinolone 2wks
Varicoele
-what is it
-presentation
-investigations
-management
Abnormal enlargement of testicular veins
Often asymptomatic
-bag of worms
-association with subfertility
US doppler
Conservative management
Surgery if patient troubled by pain
Epididymal cysts
-associated conditions
-presentation
-investigations
-management
Most common cause of scrotal swelling
-separate from body of testicle
-posterior
PKD
CF
CLINICAL DIAGNOSIS, confirmed by US
Supportive management
-surgical removal/sclerotherapy if large or symptomatic
Testicular cancer - seminoma (germ cell cancer)
Germ cells produce sperm
MOST COMMON
-average age of diagnosis - 40
Secretes HCG but can be normal
-if AFP secreted, CANNOT BE SEMINOMA
Testicular cancer - non seminomatous (germ cell cancer)
Germ cells produce sperm
More agressive
Secretes AFP
Yolk sac, teratoma - most common in children
Chroriocarcinoma
Embryonal carcinoma
Testicular cancer - sex cord stromal tumours
Stroma and sex cords - tissues that support testicle and cell development
Rarer
-leydig cell
-sertoli cell
-granulosa cell
Generally do not respond well to chemo
Testicular cancer
-risk factors
-presentation
-diagnosis
-management
Cryptorchidism
Infertility
FHx
Klienefelter’s
Mumps orchitis
Painless irregular lump, often found incidentally
May have gynecomastia, hydrocele
1st line - US
CT CAP staging
Tumour markers - AFP, HCG
Orchidectomy
Chemo/RT depending on staging
Abdominal lesions 1cm+ after chemo may need retroperitoneal LN dissection
