Ch 19 - Genitalia Flashcards Preview

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Flashcards in Ch 19 - Genitalia Deck (12):
1

Inguinal hernia: definition (direct vs indirect), features (3), management (1)

D - passing of abdo contents via a defective abdo wall (direct) or through inguinal canal (indirect) - its almost always indirect in children due to patent processus vaginalis

F - RHS; groin/testicular swelling on straining/crying

M - manual reduction > surgical repair

2

Hydrocele: defiinition, features (3), management (2)

D - tracking of peritoneal fluid via patent processus vaginalis

F - asymp, non-tender, transilluminable compressible swellings - usually bilateral

M - majority resolve spontaneously > surgery if not resolved within 2 years

3

Undescended testis (cryptorchidism): define, feature (1), classification; retractile, palpable, impalpable, Ix (3), management (1)

D - testis arrests along its normal pathway of descent

F - empty hemi-scrotum

Classification:

  • Retractile- testis can be manipulated into scrotum without tension > but subsequently retracts into inguinal region due to cremasteric muscle > resolves with age
  • Palpable - palpable but cannot be manipulated into scrotum; can be ectopic > found in perinieum/femoral triangle
  • Impalpale - cannot be felt > can be in inguinal canal/ intra-abdominal/absent

Ix: USS, IM HCG - to see if get a testosterone rise to confirm presence of tesicular tissue (in bilate impalpable testis), laparoscopy

M - Orchidopexy (mainly psychological benefit)`

4

Varicocele: definition, features (2), management (1)

D - testicular varicosities develop during puberty

F - LHS; associated with reduced fertility 'bag of worms'

M - surgical/radiological obliteration of testicular vein

5

Testicular torsion: Features (4), management (2)

Twisting of epididymis & testis

F - could be due to 'bell-clapper' testis (not anchored properly), severe pain, N & V, black horizontal testis

M - surgical exploration also fixation of contralateral testis

6

Torsion of Hydatid of Morgagni: Definition, features (1), management (2)

D - torsion of an embryological remnant on upper pole of testis; happens just prior to puberty (LH/FSH action on Hydatid)

F - Less severe pain + blue dot sign (can see/palpate hydatid)

M - analgesia > surgical excision

7

Idiopathic scrotal oedema - features (2)

painless bilat scrotal swelling + redness in preschool child

8

Hypospadias: definition, Features (3), management (1)

D - failure to completion of urethral tubularization (which normally occurs proximally to distally under influence of fetal testosterone) > leads to urethral opening more proximal to normal meatus on glans penis

F - VENTRAL URETHRAL MEATUS - urethra opens on/adjacent to glans (but can also be on shaft or perineum in severe cases) HOODED DORSAL FORESKIN - failure to fuse ventrally,

CHORDEE - ventral curvature of penile shaft

M - surgery before 2yrs (DO NOT CIRCUMSIZE - require skin for reconstructive surgery)

9

Indications for circumsion (3)

Phimosis - inability to retract foreskin - whitish scarring of foreskin due to balanitis xerotica obliterans

Recurrent balanoposthitis

Recurrent UTIs - only if they have upper UT anomalies complicated by UTIs

10

Inguinal hernias in girls

Rare Somtimes ovary can become incarcerated in hernial sac Rarely androgen insensitivity can present as a hernia in phenotypic female (with male genotype)

11

Labial adhesions management (2)

Labia minora adherence > if asymptomatic leave alone and will spontaneously lyse if perineal soreness > topical oestrogen

12

Vulvovaginitis/ vaginal discharge management (3)

hygeine avoid bubble bath/scented soaps oestrogen cream on vulva