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Pediatric Primary Care Exam 4 > GU Problems of Infancy > Flashcards

Flashcards in GU Problems of Infancy Deck (17):
1

Etiology and History of Hernias

Etiology: Patent process vaginalis
*Associated with pre-term infants or family history

History: ‘lump’ with straining or crying, subsides at rest (waxes and wanes)

2

PE of Hernia (4)

1. Palpate testes first
2. Extend arms over head, crying- visible
3. Reduce it
4. If cannot reduce call surgery!

3

Hydrocele Etiology

Intra-abdominal fluid leakage through a patent inguinal ring (water bubble)

4

Hydrocele Presentation (4)

1. Appears like a “water balloon” - bulging scrotum
2. Testes not palpable
3. Soft, nontender
4. Transilluminate (this is the key finding; it will light up with transillumination)

5

Hernia and Hydrocele Differentials (4)

1. Undescended/retractile testicle
2. Varicocele
3. Epididymitis
4. Tumor, soft tissue swelling

6

Hernia vs. Hydrocele

Hydroceles are soft non-tender and non-reducible; feel and look like water balloon and will light up with transillumination

Hernias are firm and reducible

7

Hernia management (2)

1. Incarcerated inguinal hernia needs surgical repair; if it does not reduce then it needs to go to surgery otherwise risk of peritonitis

2. Can be accompanied by a hydrocele

8

Hydrocele Management (2)

1. Spontaneous resolution by 1 year

2. If not, surgical repair

9

Undescended Testes (3)

1. AKA - Cryptorchidism

2. One of the most common conditions of the male endocrine glands

3. Most common genital condition at birth

10

Undescended Testes Evaluation (5)

1. Obtain gestational history at initial evaluation; earlier gestational age=increased risk

2. Palpate testes for quality and position at each well child visit

3. Refer infants with cryptorchidism, present at birth, who do not have spontaneous descent by 6 months to surgery (URO/PEDIATRIC)

4. Bilateral undescended testes, non-palpable should be referred for genetic testing

5. Endocrine/genetics for sexual development if bilateral with severe hypospadias

11

Ambiguous Genitalia Evaluation (2)

1. Do not perform ultrasound or other imaging prior to referral – these do not assist in decision making

2. Do not use hormonal therapy to induce testicular descent – low response rates and lack of evidence to support

12

Undescended Testes Treatment (3)

1. In absence of spontaneous descent by 6 months surgery should be performed within the next year

2. Providers should counsel boys with a history of cryptorchidism (neither testicle descended) or monorchidism (only 1 testicle within the scrotum) and parents on long-term risks

3. Educate about infertility and cancer risks due to increased risk of these things with undescended testes

13

Hypospadias (6)

1. Opening of the urethra is on the underside of the penis

2. 1 in 300 males

3. Grading

4. Refer to urology

5. Surgical repair

6. No circumcision clearance

14

Epispadias (5)

1. Defect in the urethra

2. Often occurs with bladder exstrophy

3. Shorter than normal urethra with opening on the dorsal aspect

4. Short and flat penis that may curve upward

5. Bladder control problems

15

Ambiguous Genitalia (7)

1. Not obvious

2. 1 in 4,500 newborns

3. Associated with disorders of sexual development (DSD)

4. Do not differentiate until clear

5. May need hormones or surgery

6. Controversial and evolving management
-Parents choice
-Child’s choice

7. Healthy baby but can’t identify the sex; need to do work-up of sending in chromosomes
-Make decision and parents will decide if the baby will have surgery to look physically like a female or look physically like a male

16

Ambiguous genitalia referral (2)

1. Genetics

2. Get ultrasound to look at renal and bladder area; want to identify what structures are present

17

Tests for Ambiguous Genitalia

1. Ultrasound imaging

2. Chromosomal analysis

3. 21 hydroxy level due to increased risk of congenital adrenal hyperplasia (which can be caused by deficiency of things such as 21 hydroxy or cortisol)