Things not to miss Flashcards
What are 6 things not miss?
Obstructive stone w/Fever testicular torsion Fournier's gangrene acute urinary retention Priapism paraphimosis
why is obstructive stone w/fever important not to miss?
infected urine upstream of obstruction
unable to drain infx
abscess
Tx for obstructive stone w/fever?
requires drainage: nephrostomy tube, ureteral stent
IV abx
testicular torsion is MCly seen in what age range?
12-18 y/o
what is testicular torsion and what is the classic finding?
acute onset of severe testicular pain
Bell-clapper deformity
PE for testicular torsion
Tender firm testicle High riding Horizontal lie Absent cremasteric reflex No pain relief with elevation of testis Thick/knotted spermatic cord Epididymis not posterior to testis
Differential dx for testicular and how can you diagnose?
epididymitis:
doppler U/S, nuclear scan, prehn’s sign
Tx for testicular torsion
detorsion: “open the book”
surgical: scrotal exploration, detorsion and orchidopexy (uni/bilateral)
what is Fournier’s Gangrene?
Necrotizing fasciitis of male genitalia and perineum
Involves mainly subcutaneous tissues
Infx advances rapidly, over minutes
RF’s for Fournier’s Gangrene
Diabetes
Alcohol abuse
Immunocompromised state
Presentation of Fournier’s gangrene
Painful swelling and induration of the penis, scrotum, or perineum Cellulitis Eschar Necrosis Ecchymosis Crepitus Cutaneous anesthesia Foul odor Fever (absent in immuno)
what will you see on imaging in Fournier’s gangrene?
Gas in subcutaneous tissues
Tx for Fournier’s Gangrene
IV antibiotics to cover aerobic and anaerobic Surgical debridement Wet to dry dressings Whirlpool therapy HBO
causes of acute urinary rentention
BPH
Anticholinergic meds
Acute urinary retention: bladder capacity, imaging, tx?
Normal bladder capacity Bladder scan (Ultrasound) Lidocaine gel/ Lubrication Foley catheter Coude catheter Suprapubic tube
