Flashcards in 5/14 Scrotum, Penis, Testis Deck (84)
What two tools can almost always help you diagnose scrotal masses??
ULTRASOUND *know this*
Transilluminatio n(helps to see cystic structures)
What is acute scrotum?
acute painful swelling of the scrotum; various etiologies (infectious, inflammatory, neoplastic, trauma, vascular problems etc etc - we'll go through 1-2 examples of each)
∆ btwn Epididymitis and Epididymo-orchitis?
Epididymitis - Infection of epididymis
Epididymo-orchitis - Infection of epididymis that extends to the testes
both are infectious causes of acute scrotum
What are the common causes of Epididymitis and Epididymo-orchitis?
Children – congenital GU abnormalities; E. coli or GNR
Young men – Chlamydia and gonorrhea (usually sudden onset of pain in the testicles (indicative of infection), burning with voiding)
Older men – associated with LUTS, E. Coli or Pseudomonas
How can you tell if someone has chlamydia vs BPH as the cause of their Epididymitis and Epididymo-orchitis?
chlamydia - usually sudden onset of pain in the testicles (indicative of infection), burning with voiding
BPH - lower urinary tract symptoms (urgency/frequency)
How would gonorrhea cause Epididymitis or Epididymo-orchitis?
urethra --> prostate --> seminal vesicles --> epididymis
inflammation may lead to abscess and destruction!
How do you know if mumps is causing the orchitis?
acute orchitis occurs ~1 wk after the onset of swelling in the parotid glands
How do you know if TB is causing the orchitis?
orchitis usually occurs after subsequent infection in upper GU tract (prostate, seminal vesicles, kidney)
How do you know if syphillis (3˚) is causing the orchitis?
testes --> epididymis
presence of inflammation and endarteritis or gumma
What is the gross hx of Epididymitis or Epididymo-orchitis?
suppurative inflammation and abscesses (may lead to chronic inflammation and scarring)
What is the hx findings of Epididymitis or Epididymo-orchitis?
how do these things form?
integrity of BM of seminiferous tubules disrupted after inflammation/orchitis --> spillage of spermatozoa into the interstitium
Body mounts a strong immune response against acid-fast component in the lipid in spermatozoa --> formation of granuloma (contains histiocytes)
US finding of Epididymitis or Epididymo-orchitis?
increased or “reactive” flow secondary to inflammation
review: what causes fournier's gangrene?
polymicrobial (aerobic + anaerobic) infection
Necrotizing cellulitis and fasciitis, crepitus (air in skin)
emergency surgical debridement otherwise it can spread rapidly
What type of reaction does Henoch-Scholein Purpura cause in acute scrotum?
inflammatory cause of acute scrotum
review: what causes Henoch-Scholein Purpura?
When does it usually occur?
Systemic vasculitis due to IgA immune complex deposition in post-capillary venules
often follows an acute respiratory illness (peak incidence is during the winter)
review: what is the typical presentation of Henoch-Scholein Purpura? (obv related it to acute scrotum..)
Tetrad of sx usually affects gravity dependent areas:
orchitis can result (pain/swelling of the testicles)
how can tumors cause acute scrotum?
Tumor that causes the tunica albuginea surrounding the testicle to tear
how can trauma to the testes cause acute scrotum?
Testicular rupture due to trauma, causes tears in the tunica albuginea surrounding the testicle, resulting in damage to the testicle. blood in the scrotum
What is a hematocele and how does it cause an acute scrotum?
hematocele - occur when blood collects under the tunica albuginea
usually occurs due to trauma to the testes...ouch.
How does testicular torsion cause an acute scrotum? What are the presenting sx?
Torsion (twisting of the spermatic cord and blood supply to the testicle), resulting in intense engorgement and hemorrhagic infarction if it is not rapidly corrected
- sudden onset in testicular pain
- absent cremasteric reflet
What are the 2 types of testicular torsion? Who does it usually affect?/
Intravaginal torsion - adults
Extravaginal torsion - neonates
What is intravaginal torsion of the testicles and how does it cause an acute scrotum?
who is most at risk?
testicle torsion occurs within the tunica vaginalis, usually bilateral
high risk with “bell clapper deformity”, where the tunica vaginalis testis completely encircles the testis, epididymis, and distal spermatic cord, thus predisposing the testes to torsion at a high point of attachment
What does intravaginal torsion occur?
increased weight of the testicle after puberty + sudden contraction of the cremaster muscle (which inserts in a spiral fashion into the spermatic cord) causes torsion
What is extravaginal torsion of the testicles and how does it cause an acute scrotum?
who is most at risk?
testicle torsion occurs outside of the tunica vaginalis, where the testes and gubernaculum are not fixed and can freely rotate.
The spermatic cord undergo torsion as a unit, twisting on its blood supply and causing infarction
NOTE that this is NOT associated with bell clapper deformity
US findings testicular torsion?
absence of flow in testes (can be unilateral or bilateral)
∆ in etiology btwn incarcerated hernia and strangulated hernia?
Incarcerated: bowel, omental, or abdominal content herniates but can be returned to its original compartment with manual manipulation
strangulated: blood supply to the herniated tissue is compromised (herniated contents pass through a restrictive opening that reduces venous return -> swelling that compromises circulation to affected area)
∆ in sx btwn incarcerated hernia and strangulated hernia?
incarcerated: severe pain + pulling in groin, nausea + vomiting
strangulated: severe pain + tenderness
Which one is a surgical emergency: incarcerated hernia and strangulated hernia
surgical emergency due to tissue necrosis risk
Path of indirect hernia?
enters internal (deep) inguinal ring (lateral to inferior epigastric artery)
exits the external (superficial) ring, and into the scrotum; usually follows the path of the descent of the testes.
covered by all 3 layers of the spermatic fascia