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Urogenital Y2 > L7 - Scrotum and foreskin conditions > Flashcards

L7 - Scrotum and foreskin conditions Flashcards

1
Q

Hydrocele

A

Accumulation of fluid within tunica vaginalis.

Transilluminable!

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2
Q

Primary hydrocele

A

Most common
Idiopathic
Can be caused by increase serous fluid production.

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3
Q

Secondary hydrocele

A

As result of tumour or infection

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4
Q

Management of hydrocele

A

Aspiration if unfit for surgery.

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5
Q

Aspiration of hydrocele

A

Needle inserted into scrotum, directly into hydrocele.

Suction applied to remove the straw coloured fluid as much as possible.

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6
Q

Surgical management of hydrocele

A

Tunica vaginalis opened.
Fluid released.
Sac sewn onto itself, hence fluid cannot reaccumulate.

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7
Q

Complications of hydrocele

A

Haematoma formation, can occasionally become more painful than original hydrocele.

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8
Q

What is a varicocele?

A

Dilation of veins of pampiniform plexus within the spermatic cord.

Males may become subfertile. Trying to conceive takes longer than what is expected.

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9
Q

Why are most varicocele’s found on the left?

A
  1. Increased pressure in left testicular vein.
  2. As it drains perpendicular into left renal vein.
  3. Hence turbulent flow
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10
Q

Compare pressure in the left and right testicular vein.

A

Right testicular vein drains at a lesser angle directly into IVC.
Hence lower venous pressure than left testicular vein.

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11
Q

What does a varicocele feel like?

A

A bag of worms.

Disappears when patient is lying down.

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12
Q

Management of a varicocele

A

Conservative, reassurance

Surgery if heavy or aching variocele

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13
Q

Describe surgical intervention on a variocele

A

Affected testicular veins are divided and embolised.

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14
Q

Describe epididymal cyst

A

Transilluminable lumps.

1 or multiple swellings felt in scrotum behind testis.

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15
Q

Spermatocele

A

Not transilluminable as it contains sperm.

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16
Q

Describe a hernia

A

Indirect inguinal hernia
Has cough impulse.
Can’t feel above it.

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17
Q

Cough impulse

A

Patient coughs.
If swelling expands upon coughing then positive.
Movement without expansion IS NOT a cough impulse.

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18
Q

Tumour in testes

A

often 20-40 y/o men
Painless lump.
Often not separate from testis.

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19
Q

Describe testicular torsion

A

most common 20-40 y/o

Testes rotates around its vascular base leading to acute pain.

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20
Q

What is testicular torsion characterised by?

A
  • Sudden onset severe testicular pain
  • Abdominal pain
  • vomiting
  • retraction of testes ‘bell clapper’ position
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21
Q

What may be done to confirm a testicular torsion?

A

Doppler

Requires urgent surgical exploration !

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22
Q

Surgical management of testicular torsion?

A

Both testes sutured to tunica vaginalis to prevent further torsion.
Known as orchidopexy.

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23
Q

Epididimitis

A 
Infection of epididymis. 
Scrotal discomfort 
Pain during micturition 
Due to chlamydia. 
- 2 week course of doxycycline may be given
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24
Q

Orchitis

A

Infection of testis.
Commonly has viral cause
- MUMPS

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25
Q

Epididymo-orchitis

A

If epididimitis spreads to testes

  • gradual onset
  • dull ache or pain
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26
Q

State some causes of groin lumps

A 
Lymphocele 
Ectopic testes 
Saphena Varix 
Psoas Abscess 
Femoral aneurysm 
Lipoma 
Lymph node
Inguinal and femoral hernia
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27
Q

Describe how a lymphocele may form?

A

Following femoral artery surgery in groin.
Disruption of local lymphatics.
Local collection of lymphatic fluid forms lump.
Can be aspirated.

28
Q

Ectopic testes

A

Testes is absent from scrotum

29
Q

How may you diagnose an ectopic testes?

A

Feel alongside line of inguinal canal ligament.

Should detect and undescended testes.

30
Q

Saphena varix

A

Bluish tinge.
Has cough impulse.
Disappears when lying down.
Varicose veins may be present.

31
Q

Psoas abscess

A

In psoas muscle
Caused by Crohn’s or Tb
Causes fixed flexion of hip

32
Q

What would you inspect a scrotum for?

A

Lumps
Scars
Swelling
Get patient to cough

33
Q

How would you palpate the scrotum / testes?

A
  1. Place hand over lump, get patient to repeat cough reflex, in order to feel movement.
  2. Check both sides for less obvious bilateral hernia
  3. Start on unaffected side
  4. Palpate along line of inguinal ligament to identify an undescended testes
34
Q

What is a reducible hernia?

A

A hernia with a bulge that flattens out when you lie down or push against it gently.

35
Q

How may you distinguish between a direct and indirect hernia?

A
  1. Ask patient to reduce lump
  2. Cover deep inguinal ring covered with 2 fingers.
  3. Ask patient to cough
    IF
    - Lump comes out (direct)
    - Stays in place (Indirect)
36
Q

What would be observed is you trans-illuminated a hernia?

A

Nothing.

Hernia’s do not trans-illuminate

37
Q

What is the surgical difference between direct and indirect hernias?

A

Direct hernia arises laterally to inferior epigastric artery.

Arises through deep ring.

38
Q

How would you identify an undescended testes?

A

Palpate along the line of inguinal ligament to identify an undescended testis.
Use the cough impulse.

39
Q

You are inspecting a patient.
You can feel above the lump.
What could it be?

A

Hydrocele
Tumor
Varicocele
Epididymal cyst

40
Q

On inspection of a patient you realise you can’t feel above the lump, this could indicate…

A

Presence of hydrocele of cord

Indirect inguinal hernia

41
Q

What kind of lumps are transilluminable?

A

Hydrocele
Epididymal cyst
Hydrocele of cord

42
Q

What kind of lumps are definitely not transilluminable?

A

Tumour

Indirect inguinal hernia

43
Q

What is schistosomiasis

A

Water bourne parasite

- gives rise to squamous cell carcinoma

44
Q

Uraemia

A

Characteristic fishy smell on tongue

45
Q

Bruit

A

Abnormal sound heard over upper abdomen

46
Q

Possible causes of bruit

A

Renal artery stenosis
Aneurysm of renal artery
Arteriovenous fistula

47
Q

Describe scrotal pain

A

May be referred to groin or abdomen

Result of stretching of albuginea

48
Q

Strangury

A

Repeated desire to pass urine but with little to show for it other than pain related to urethra or penile tip.

49
Q

What is renal agenesis?

A

Kidney either absent or underveloped

50
Q

Renal dysplasia

A

One kidney in newborn is multicystic, irregularly lobulated mass of cysts.

Usually absent ureter.

51
Q

Potter’s syndrome

A

Bilateral renal agenesis

- can also occur due to infantile polycystic kidney disease, renal hypoplasia and obstructive neuropathy

52
Q

Renal hypoplasia

A

One small kidney with one larger than normal

53
Q

How might renal hypoplasia differ from renal dysplasia?

A

Kidney otherwise morphologically normal.
Normal residual parenchyma.
Smaller calyces, lobule, papillae

54
Q

Supernumerary kidney

A

3rd kidney

55
Q

Describe common position of horseshoe kidney?

A

Often fixed at lower pole.
Positioned lower.
Central part just below inferior mesenteric artery

56
Q

Ectopic kidney

A

Kidney does not ascend properly, found in pelvis

57
Q

Ureteral atresia

A

Ureter maybe absent or fail to extend to bladder

58
Q

Epispadia

A

Rare, congenital abnormality involving the opening of urethra.

Urethra opens on top of penis as oppose to tip.

59
Q

Lymphatic drainage of scrotum

A

Inguinal nodes

60
Q

Where do the right and left testicular veins drain into?

A

LEFT: Pampiniform plexus drain into renal vein on the left.

RIGHT: IVC on right

61
Q

State some conditions affecting foreskin

A

Balanoposthitis
Phimosis
Paraphimosis

62
Q

Balanoposthitis

A

Inflammation of the head of the penis and the foreskin

63
Q

Symptoms of balanoposthitis

A

Redness, swelling and soreness around head of penis or foreskin.

Thick discharge under foreskin.

Rash on the penis

Itchiness

Unpleasant odour

Pain when urinating

64
Q

Causes of balanoposthitis

A

Irritation caused by smegma,
Thrush.
Bacterial infection caused by streptococcal bacteria.

65
Q

Phimosis

A

Condition where foreskin is too tight to be pulled back over head of penis.

66
Q

Paraphimosis

A

When foreskin cannot be returned to its original position after being retracted.

  • in extreme cases penile head may become gangrenous
  • emergency reduction is indicated
67
Q

Difference between Epispadias and Hypospadias

A

Epispadias: congenital absence of upper wall of urethra, results in urethral meatus on dorsum of penis.

Hypospadias: urethral opening appearing on underside of penile shaft or on the perineum

Urogenital Y2 (16 decks)

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