scrotal lumps/ hernia/ scrotal pain Flashcards
true or false: testicular pain in a man less than 25 should be considered torsion until proven otherwise
true
what investigation could be done in case of painful testis?
FBC, urine m/c/s, chlamydia, u/s, technetium 99m scan
what history and examination finding help differentiate acute epidiymo-orchitis from torsion of the testis?
epidydimoorchitis tender to start with malaise, fever, UTI. Torsion starts acutely with severe pain +/- nausea/ vomiting. Pain may be relieved with supporting and elevating testis in epidydimoorchitis and worsened in torsion
What is the cause of acute orchitis?
Mumps
True or false: all types of haematoceles require surgical exploration
True. Exclude testicular rupture or tumour
What is the critical time period for management of a testicular torsion?
4-6 hours
What are the differential diagnoses of a groin mass?
Hernia- femoral, inguinal Malgaigne bulgings Lipoma Undescended testes Spermatic cord swelling - encysted hydrocele, lipoma Lymph node Haematoma (post femoral artery puncture) Neoplasm Psoas abscess Vascular anomalies (saphenous varix, femoral aneurysm)
How do you differentiate between an inguinal hernia and a femoral hernia?
Inguinal hernias are above the mid inguinal point (between the ASIS and the pubic tubercle), and femoral are below.
What are the main symptoms of a hernia?
Lump, dragging pain that is worse after standing, expansile impulse on coughing
What are the features of a hydrocele?
Any age. May be primary or secondary to infection, torsion, tumour.
Lump confined to scrotum. Anterior. Surrounds testis except posteriorly.
Smooth, pear shaped lump
Testis impalpable, non tender
Transillumination
What are the clinical features of a cyst of the epididymis?
Asymptomatic or dragging sensation Behind and above testis Smooth and tense, multi lobular swelling Testis easily palpable Transillumination
What are the clinical features of chronic epididymoorchititis?
Sometimes associated with TB/ chlamydia Behind and above testis Firm swelling. Hard and craggy Normal testis No transillumination
What are the clinical features of a varicocele?
Dragging discomfort, usually left sided Lump along line of spermatic cord Above testis Soft like a bunch of worms Collapses when patient supine and testis elevated Testis often smaller No transillumination
What are the clinical features of testicular cancer?
Young men, 20-40 Painless lump Loss of testicular sensation Lump in body of testis, usually felt anteriorly Large, firm testis Feels heavy is large No transillumination
What is the treatment for a hydrocele?
Most congenital hydroceles will resolve by 12 months. If not then consider surgery
