start exam 1 epididymitis

this is testicular inflammation secondary to infection list 2 main causes

orchitis viral- MUMPS bacterial- epidiymitis

name 2 PE signs that help support epididymitits

phrehn's sign- lifting testicle relieves pain cremasteric reflex- stroke inner thigh, and ipsilateral tests should rise 0.5 cm

how serious are the following right sided varicoceles left sided varicoceles bilateral varicoceles

right side- THINK MASS pushing on inferior vena cava left- no big deal bilateral- no big deal

what 3 supportive tx can u educate pt with epididymitits (when would you use this and when wouldn't you)

*use this til antibiotics kick in ice rest NSAIDs- will make renal insufficiency WORSE

name 3 factors that epididymitits occurs most in

1. acute prostatitis 2. recent catheter 3. uti in men with BPH these pts will not be subtle!

who is a surgical candidate for varicoceles

1. if they are young with testicular volume low on affected side- (can lead to low sperm count) 2. have painful symtoms 3. bilateral varoceles

list grades 1,2,3 of testicluar varicoceles

1. small- palp only with valsalva 2. moderate- non visible, palp upon standing 3. large- visible on gross inspection

what are the 2 leading issues leading to testicular loss from torsion

1. time seeking tx 2. elapsed time to referral

what is the tx for epididymitis in pts who practice insertive anal sex

250mg rocephin IM injection + levofloxacin 500mg QD 10 days

pts that have mumps orchitis will follow after the development of what clinical feature

4-7 days after parotitis (chipmunk cheeks)

what age and pt presents with Fournier's Gangrene

60-70 y.o male with diabetes (60% of cases) alcoholism/cirrhosis

what is the tx for epididymitis in pts <35 and pts >35

<35 tx to cover chlamydia and gonorrhea 1g azithromycin PO 1x 250mg rocephin IM injection >35 cipro 500mg BID 10 days

pt has severe abdominal pain that radiates to gluteal muscles, scrotum, and penis, has subcutaneous gas and crepitus of the testicle, with possible blisters or bulla

Fournier's Gangrene

this is necrotizing fasciitis of the perineum which often involves the scrotum (flesh eating bacteria)

Fournier's Gangrene

what side are varicoceles more common on and why

LEFT SIDE the left spermatic cord is bigger and enters the renal vein @ 90 degree angle

65% of cases of testicular torsion occur in what age group

PUBERTY 12-18 years old

what diabetic drug can be associated with Fournier's Gangrene

SGLT2- inhibitor

how do you diagnose a hydrocele

Transillumination- will light up the fluid and you can r/o hernia or mass

what 2 diagnotic tests should be done for epididymitis

U/A- will be negative (may show pyuria) must do NAAT test for chlamydia and gonorrhea- dirty catch first 10ml

this with acute epididymitits will also likely present with what

a fever

how long have symptoms been present in acute and chronic epididymitits

acute <6 weeks chronic >6weeks

what is the classical finding in testicular torsion

asymmetric high riding transverse lying testicle

what is the most common congenital abnormality noted in testicular torsion

bell clapper deformity (90% cases) the tunica vaginalis joins high on the spermatic cord allowing the testis to freely rotate usually see a transverse testicle

a hydrocele is the collection of fluids between what 2 layers in the scrotum

between parental and visceral layers of the tunica vaginalis

how can you diagnose testicular torsion and what is the definitive diagnosis

can be clinical Doppler ultrasound shows no blood flow definitive- surgical exploration

what is the most common cause of epididymitis in men <35y.o. what about in homosexuals

chlamydia especially in sexually active ecoli- homosexuals

how do you diagnose testicular varicoceles

clinical dx or Doppler ultrasound

what are 3 common causes of epididymitis in men >35y.o.

e coli pseudomonas proteus

what is the most common cause of scrotal pain in men 20-59 in the outpt setting

epididymitis

how do you manually detorsion

give them ketamine or propofol twist testical laterally (outward like opening a book) ** 1/3 are the opposite will twist medially

pt has cystic scrotal mass, with heaviness, and pain as it increases in size

hydrocele

this is sudden onset of acute persistent testicular pain and scrotal swelling with rapid resolution within seconds to minutes

intermittent torsion

upon PE of epididymitits what will the testis look like

it will feel thick have swelling and TTP

if you have an older pt passed having kids who has asymptomatic varicoceles what is the tx

just conservative observation

what is a drug that may cause epididymitis

men taking >200mg of amiodarone

what are the most symptoms present with varicoceles

most asymptomatic may have dull ache especially with standing or heaviness in scrotum

in a peds pt with testicular torsion this has a 96% positive predicted value

nausea and vomiting

what 2 PE signs are negative in testicular torsion *****and which one is MOST ACURATE, 100% sensitive for torsion

negative phrehns sign- pain has NO relief no cremasteric reflex ** most accurate

what is the tx for mumps

no tx its viral

imbalance of secretions and reabsorption of fluids from the tunica vaginalis or defective lymph drainage will lead to what in adults?

non communicating hydrocele

how soon do symptoms of epididymitits usually present

sub acute develops over several days subtle dull ache

whats is the tx for hydrocele

surgical excisions the hydrocele sac *aspiration is usually unsuccessful and will cause fluid to reaccumulate

how many degrees does torsion usually occur at

testicle rotates between 90-180 degrees

if a 10 year old little boy comes in with scrotal pain what is this until proven otherwise

testicular torsion prepubertal epidiymitis is RARE

what is the #1 differential you need to rule out if you suspect epididymitits and why?

testicular torsion must be ruled out only have 6 hrs, after that viability is in question

how do you tx Fournier's Gangrene

the infected area must be derided

where is the epididymis located

the posterior part of the testis

what malformation causes hydrocele in newborns how is this fixed

they have a patent processes vaginalis that stays open allowing fluid to enter it *COMMUNICATING hydrocele usually resolves by 1st birthday

this is a blue or black discoloration visible beneath the skin of the scrotum and what is the tx

this is testicular appendage torsion a small little appendage on the testis that is a remnant of the embryonic duct has spun around and is causing pain NOT A medical emergency and no tx required

what is the anchor that attaches the testis to the scrotal wall

tunica vaginalis

what happens to the blood supply in testicular torsion

twisting of the spermatic cord cuts off arterial INFLOW and venous OUTFLOW

what is the treatment for testicular torsion based on the hours of onset

tx: orchiopexy surgery to detorsion, and can fix bell clapper deformity <6hr- 100% viable >12hrs: 20-50% viable 24hrs: 0% viable will need orchiectomy to remove testicle

what diagnostic test can help confirm epididymitis and r/o testicular torsion

ultra sound will show increased blood flow to epidiymis testicular torsion would have reduced blood flow

pt with an STD and epididymitits will usually present with this symptom

urethritis- frequency, dysuria, discharge

on physical exam of the testicle you feel a bag of worms what is this

varicoceles

this is a collection of dilated veins in the pampiniform plexus surrounding the spermatic cord

varicoceles