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pathophys > testicular and prostate disorders > Flashcards

testicular and prostate disorders Flashcards

1
Q

testicular torsion

A

twisting of spermatic cord causing a loss of blood supply to ipsilateral testicle (EMERGENCY)

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2
Q

testicular torsion: intravaginal

A
  • tunica vaginalis attachment to posterior (back) side of testicle too high
  • allows the spermatic cord to rotate
  • 17% incidence
  • common in adolescence: increased weight of testicle and sudden contraction of cremaster muscle (covers testes and spermatic cord) and hormone changes
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3
Q

testicular torsion manifestations

A
  • severe distress within hours of symptoms onset, nausea/vomiting, tachycardia
  • testis large and tender
  • radiating pain to inguinal area
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4
Q

testicular torsion: extravaginal

A
  • most common in neonates (undescended testicles)
  • inadequate fusion diagnosed in 1st 7-10 days of life
    > firm, smooth, painless scrotal mass
  • testicle high in scrotum, abnormal orientation that results in spermatic cord twisting
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5
Q

testicular torsion diagnosis

A
  • based on symptoms and presentation
  • doppler and color ultrasound for blood flow
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6
Q

testicular torsion treatment

A
  • surgery
  • prevent tissue necrosis (maintain blood flow)
  • testicle function
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7
Q

epididymitis

A

> acute (common) or chronic inflammation of the epididymis
- 19-35 years old, associated with STI

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8
Q

epididymitis cause

A

> infection, UTI (under 14/over 35), STI, trauma, post-prostatic biopsy
- gonorrhea/chlamydia is most common cause in heterosexual men
- children: viral enterovirus/adenovirus infection

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9
Q

epididymitis manifestations

A
  • unilateral pain, chills, fever, discharge, dysuria, erythema, edema
  • testis and epididymis become one mass
  • tenderness over spermatic cord (inguinal area) and lower abd
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10
Q

epididymitis diagnosis

A
  • labs: urinalysis/culture/WBC count
  • doppler ultrasound
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11
Q

epididymitis treatment

A
  • supportive: elevation of scrotum, ice packs, bed rest
  • antibiotics, pain meds
  • abstinence if STI is positive
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12
Q

testicular cancer

A
  • not common (1%)
  • ages 15-35
  • white men
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13
Q

testicular cancer risk factors

A
  • cryptorchidism
  • genetic factors
  • disorders of testes development (Klinefelter syndrome)
  • HIV positive: germ cell tumors (seminomas)
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14
Q

testicular cancer pathogenesis

A
  • primary germ cell tumors: seminomas or nonseminomas
  • based on tissue origin and if it turns into cancer
  • Germ cell origin: multipotential (secretes enzymes/hormones not found in adult men)
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15
Q

testicular cancer: seminomas

A
  • most common (under 40)
  • from seminiferous epithelium of testes
  • produce uniform cell population
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16
Q

testicular cancer: nonseminomas

A
  • more than one cell type
  • less differentiated
17
Q

testicular cancer manifestations

A
  • common 1st sign: slight enlargement of testicle
  • may or may not have discomfort
  • can spread before found
  • metastasis: swelling of lower extremities, back pain, neck mass, cough, hemoptysis
18
Q

testicular cancer diagnosis

A
  • ultrasound
  • CT/MRI
  • tumor markers: alpha fetal protein and B-HCG
  • clinical staging: TNM
19
Q

testicular cancer treatment

A
  • orchiectomy: removal of testicle
  • additional treatment depends on staging and grading
20
Q

prostatitis

A
  • acute or chronic infection of prostate gland
  • highest in 20-40 years or over 70
  • most cases: ascending urethral infection or intraprostatic reflux
21
Q

prostatitis risk factors

A
  • BPH
  • genitourinary infections
  • STI
  • immune compromised
22
Q

prostatitis causes

A
  • infection after prostate biopsy, STI, transurethral manipulation
  • direct lymphatic spread from rectum (bacterial sepsis)
  • community acquired (more common) and hospital acquired
23
Q

prostatitis manifestations

A
  • rapid onset
  • irritative: dysuria, frequency, urgency
  • obstructive: hesitancy, incomplete void, straining, weak stream
  • suprapubic, rectal, perineal pain
  • painful ejaculation
  • systemic symptoms: fever, chills
24
Q

prostatitis diagnosis

A
  • physical exam
  • urinalysis
  • digital rectal exam/prostatic massage
25
Q

prostatitis treatment

A
  • depends on severity
  • antibiotics, bedrest, hydration, antipyretics, analgesics, stool softeners
  • can progress to chronic condition > diagnosed w positive bacterial culture (prostatic fluid w leukocytosis)
26
Q

benign prostatic hypertrophy (BPH)

A

nonmalignant enlargement of prostate gland

27
Q

BPH etiology

A
  • 2 growth periods: puberty (doubles in size); 25 (enlarges/impinges)
  • urethra narrowing
  • formation of large, discrete lesion
  • aging men
    > does NOT develop when testes are removed before puberty
  • decrease active testosterone w age and increased estrogen
  • DHT hormone production
28
Q

BPH risks

A
  • under 40
  • family history/physical inactivity
  • cardiovascular disease
  • DM 2
  • ED
29
Q

BPH manifestations

A
  • static: increased size
  • dynamic: related to smooth muscle tone
  • detrusor instability and impaired bladder contractility
  • nocturia, urgency, low stream, dribbling, incontinence
30
Q

BPH diagnosis

A

> size not always correlated with symptom severity
- patient experience is key
- blood and urine analysis, PSA, digital rectal exam (surface)
- prostate specific antigen (PSA)
- transabdominal/transrectal ultrasound (other urinary structures)

31
Q

BPH treatment: medical

A
  • lifecycle changes, avoiding caffeine and certain meds (antihistamine, decongestant, diuretics)
  • pelvic floor training
  • training bladder
  • prevent constipation
  • taking 5^alpha - reductase inhibitors (prevents conversion of testosterone to DHT)
32
Q

BPH treatment: surgical

A

transurethral prostatectomy (TURP), stents

33
Q

prostate cancer

A
  • most common non-skin cancer
34
Q

prostate cancer incidence

A
  • african american men
  • disease of aging > 85% of diagnosis are 65+
35
Q

prostate cancer etiology

A
  • unclear
  • multistep process in genes controlling cell differentiation and growth
36
Q

prostate cancer risk factors

A
  • age, race, heredity
  • hormone level
  • environment
37
Q

prostate cancer pathophysiology

A
  • adenocarcinomas
  • growth is influenced by hormones
  • cancer can invade bladder
  • cancer metastis to bone
  • can spread before found
    > 1st symptom: prostate is nodular, SOB, anemic
38
Q

prostate cancer diagnosis

A
  • history/physical
  • biopsy
  • bone scan (radionucleotide)
  • prostate specific antigen (PSA)
  • staging (glesin) TNM
39
Q

prostate cancer treatment

A

> expectant therapy (watchful waiting): no symptoms, slow growth, small/contained, comorbidities
- surgery: radical prostatectomy (seminal vesicles, prostate, ampullae)
- radiation: external beam or brachytherapy
- hormone support
palliative care: pain control, focal radiation of symptomatic/unstable bone disease
bisphosphonates: inhibit osteoclast activity

pathophys (6 decks)

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