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RB Y2 Renal > Acute Scrotum > Flashcards

Acute Scrotum Flashcards

1
Q

when is torsion of spermatic cord most common

A

at puberty due to enlragment of the testes

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2
Q

cause of torsion of spermatic cord

A

usually spontaneous, can occur with trauma or athletic activity

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3
Q

clinical presentation of torsion of spermatic cord

A
  • sudden onset pain and swelling, hot
  • pain in abdomen, nausea and vomiting are common
  • there sometimes may have been previous episodes of self limiting pain
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4
Q

on examination of torsion of spermatic cord

A
  • testis may lie high and transversely
  • absence of cremasteric reflex
  • hydrocele and oedema
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5
Q

cremasteric reflex

A
  • the cremaster muscle is a spiral circular muscle that surrounds the spermatic cord
  • when contracted it lifts and rotates the testes
  • touching the inner thigh triggers contraction
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6
Q

investigation of torsion of spermatic cord

A

only performed if diagnosis is equivocal - surgery must be done in under 6 hours!

  • doppler US will demonstrate lack of blood flow
  • normal blood and urine results
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7
Q

when does irreversible ischemia begin in torsion of spermatic cord

A
  • starts at 4 hours
  • surgery within 6!!
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8
Q

management of torsion of spermatic cord

A
  • 6 hours
  • obtain consent for possible orchidectomy
  • at surgery expose and untwist the testes
  • if colour looks good, fix both testes to the scrotum
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9
Q

bell clapper deformity

A
  • the tunica vaginalis joints high onto the spermatic cord
  • prone to torsion
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10
Q

torsion of appendage

A
  • this can present similarly to torsion of testis, or can be insidious
  • if seen early there may be localisd tenderness at the upper pole and a blue dot sign
  • testis should be mobile and the cremasteric reflex present
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11
Q

management of torsion of appendage

A

will resolve spontaneously without surgery

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12
Q

when does torsion of appendage usually occur

A

7-12 years

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13
Q

epididymo-orchitis

A

inflammation of the epidydmis ± testis

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14
Q

who does epididymo-orchitis tend to occur in

A
  • younger patients due to STI eg chlamydia
  • older catheterised patients
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15
Q

aetiology of epididymo-orchitis

A
  • STI eg chlamydia
  • catheter
  • spread from UTI
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16
Q

how does one distinguish epididymo-orchitis from testicuar torsion

A
  • the patients are older
  • there may be UTI symtoms
  • there is a more gradual onset of pain
  • cremasteric reflex present
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17
Q

clinical features of epididymo-orchitis

A
  • unilateral swelling and pain
  • dysuria
  • pyrexia/sweats
  • may be pyruria
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18
Q

what is common in the history of epididymo-orchitis

A
  • UTI
  • urethritis (STI) - recent unprotected sex
  • catheterization/instrumentation
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19
Q

important DD of epididymo-orchitis

A

testicular torsion – exclude urgently to prevent ischaemia of the testicle

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20
Q

important differentiating investigations/signs between torsion and epidydmo-orchitis

A
  • Elevation of testes often relieves the pain – Prehn’s sign
  • Cremasteric reflex
  • US most important differentiating
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21
Q

investigationof epididymo-orchitis

A
  • doppler will show swollen epididymis and increased blood flow
  • raised inflammatory markers
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22
Q

further investigationof epididymo-orchitis

A
  • send urine for culture
  • self taken vaso-vaginal swab for chlamydia PCR
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23
Q

management of epididymo-orchitis

A
  • analgesia and scrotal support
  • bed rest
  • drain any abscess
  • ofloxacin 400mg/day for 14 days
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24
Q

who does idiopathic scrotal oedema occur in

A

children aged 2-10 usually

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25
Q

idiopathic scrotal oedema

A
  • self-limiting oedema of the scrotum
  • these is no fever, pain or tenderness
  • may be itchy
  • not usually erythematous
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26
Q

balanitis

A

acute inflammation of the foreskin and glans

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27
Q

who is balanitis more common in

A

diabetes - may be a presenting feature of T1DM

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28
Q

genital features of T1DM

A

balanitis and pruritus vulvae

29
Q

causes of balanitis

A
  • diabetes
  • strep or staph
  • often seen in young children with tight foreskins
30
Q

phimosis

A
  • inability to retract the foreskin
  • can occlude the meastus
  • Predisposes to recurrent urinary tract infections and urinary tract obstruction
31
Q

how does phimosis present in young children

A
  • recurrent balanitis and ballooning
32
Q

how does phimosis present in adults

A

painful intercourse, infection and ulceration

33
Q

management of phimosis

A
  • in young children the need for circumcision can be obviated by time and trials of gentle retraction
  • otherwise circumcision and dorsal slit
34
Q

which pre-malignant cutaneous lesion is phimosis assoicated with

A

BXO - BXO can cause phimosis

35
Q

paraphimosis

A
  • a urological emergency where retracted foreskin cannot be put back into natural position
  • painful swelling of foreskin distal to a phimotic ring (which forms around the foreskin after infection, is inelastic)
36
Q

what can paraphimosis progress to

A
  • prevents venous return leading to oedema
  • then ischemia
37
Q

management of paraphimosis

A
  • iced glove
  • use granulated sugar for 1-2 hours, to draw out fluid by osmosis
  • multiple punctures in oedematous skin
  • manual compression of glans with distal traction of oedematous foreskin
  • dorsal slit
38
Q

priapism

A

prolonged erection (>4 hours) that is often painful and not associated with sexual arousal

39
Q

aetiology of Priapism

A
  • due to intra-corporeal injection for erectile dysfunction
  • trauma
  • haematologic dyscrasias eg sickle cell
40
Q

what can be injected into the corpus cavernosum for erectile dysfunction

A

papaverine

41
Q

ischaemic Priapism

A
  • veno-occlusive or low flow
  • vascular stasis in the penis and decreased venous outflow is a form of compartment syndrome
  • the corpora cavernosa are rigid and tender and there is pain
42
Q

non-ischaemic Priapism

A
  • arterial/high flow
  • traumatic disruption of the penile vasculature results in unregulated blood entry and filling of the corpora
43
Q

how are non/ischaemic Priapism differentiated

A
  • low flow - dark blood, low O2 and high CO2
  • high flow - normal arterial blood
44
Q

investigation of Priapism

A
  • colour duplex USS
    • low flow - minimal/absent flow in cavernosal arteries
    • high - flow: normal to high flow
45
Q

management of ischaemic Priapism

A
  • aspiration ± irrigation with saline
  • injection of alpha agonist (phenylephrine)
  • surgical shunt
  • if present for >48-72 hours, it is unlikely to respond to intracaveernosal treatment
  • for v delayed presentation, immediate replacement may be considered
46
Q

treatment of non-ischaemic Priapism

A
  • observe as may resolve spontaneously
  • less urgent as there is no ichaemia
  • selective arterial embolization
47
Q

Fournier’s Gangrene

A
  • necrotizing fasciitis that occurs about the male genitalia
  • severe pain, fever, systeic toxicity
48
Q

predisposing factors for Fournier’s Gangrene

A
  • diabetes
  • trauma
  • periurethral extravasation
  • perianal infection
49
Q

how does Fournier’s Gangrene start

A

celulitis - swollen, red and tender

50
Q

how does Fournier’s Gangrene present

A
  • marked pain, fever, systemic toxicity
  • swelling and crepitus (due to gas)
  • dark, purple areas
51
Q

management of Fournier’s Gangrene

A

ABx and radical surgical debridement

52
Q

mortality in Fournier’s Gangrene

A
  • very high
  • higher in Diabetics and alcoholics
53
Q

describe the venous drainage of the testis

A
  • testicular veins formed from the pampniform plexus
54
Q

investigation of testicular varicocele

A
  • left varicocele is associated with left renal malignancy in some cases, so do an US of kidneys, ureter and bladder
55
Q

does testicular varicocele reduce fertility?

A
  • reduces sperm count, may be linked to subfertility
56
Q

what movement causes a esticular varicocele to swell

A

standing up

57
Q

hydrocele

A
  • fluid in the testes, underlying teste is impalpable
  • common in newborns
  • primary idiopathic
  • secondary to trauma, infection and tumour
58
Q

epidydmal cyst

A
  • teste will be palpable
59
Q

investigation of lumps in the testes

A

US

60
Q

what are the dorsal and ventral sides of the penis

A
61
Q

hypospadius

A
  • congenital abnormality of the penis which is characterised by ventral urethral meatus, hooded prepuce and chordee (ventral curvature of the penis - downwards)
  • can cause urethal meatus obstruction
62
Q

what is bladder injury often associated with

A

pelvic fracture

63
Q

features of bladder injury

A
  • suprapubic/abdominal pain and inability to void
  • suprapubic tenderness, lower abdominal bruising, guarding/rigidity, diminshed bowel sounds
64
Q

imaging for bladder trauma

A
  • CT cystography
  • if there is blood at external meatus or if catheter doesnt pass easily then perform retrograde urethrogram as they may well have urethral injury
65
Q

management of bladder trauma

A
  • large bore catheter, expect gross haematuria
  • ABx
  • repeat cystogram in 14 days
66
Q
A
67
Q

bladder rupture and exxtraperitoneal injury on imaging

A

flame shaped collection of contrast in pelvis

68
Q
A

RB Y2 Renal (26 decks)

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