Male Genital Problems

Male Genital Problems
PResentation by: Eric Quimbo

Anatomy
* Penis
o 3 cylindrical bodies
+ Corpus Cavernosum (2)
+ Corpus Spongiosum (1)
o Tunica albuginea
o Buck’s Fascia
* Testes
o Tunica albuginea
o Epididymis
o Tunica vaginalis
+ Torsion risk
# Lack of posterior fixation
+ Parietal portion
# Hydrocele

Physical Examination

* Well-lit, warm room
* Visual inspection
* Penis
* Scrotum
o Mass?
+ If present, carcinoma until proven otherwise
o Lie of the testes?
* Inguinal canal
* Prostate

Scrotum

* Scrotal Edema
* Scrotal Abscess
o Must differentiate if phlegmon in scrotal wall vs. intrascrotal organs
* Fournier Gangrene
o Polymicrobial, necrotizing infection of the perineal subcutaneous fascia.
o Painful, erythematous/edematous scrotum
o DM is risk factor
o Tx – aggressive fluid resus, broad spectrum antibiotic coverage, HBO
o Mortality 20 %

Penis

* Balanoposthitis
o Inflammation of glans and foreskin
o Recurrence – can be sole presenting sign of DM
o Treat type of infection, good hygeine, topical antifungals
* Phimosis
o Inability to retract foreskin
o Emergent if inability to void
o Tx - Definitive – circumcision, Consider topical steroids at tip QD x 4-6 weeks
* Paraphimosis
o Inability to reduce proximal edematous foreskin back to position
o True urologic emergency
o Tx – compress glans several mins, tight wrapping of glans with 2 inch bandage x 5 mins, small needle punctures, or dorsal incision of the band.
* Entrapment Injuries
o String, metal rings, wire
o Human hair
+ 2 – 5 y/o
+ Check with retrograde urethrogram (urethral integrity) and doppler (blood supply)
+ Not a sign of child abuse
* Fracture
o Tear/rupture of corpus caverosa/tunica albuginea
o Hx trauma during sexual activity
o “snapping sound”
o Check retrograde urethrogram
o Surgical indication
o Check XR….
Priaprism

* Urologic emergency
* Complications – urinary retention, impotence 35%
* Causes – anti-impotence meds (papaverine, PGE), anti-hypertensives (hydralazine, prazosin, CCB), psych (chlorpromazine, trazodone, thioridazine), sickle cell in children
* 2 types
o High flow (rare)– nonischemic, nonpainful, traumatic fistula between cavernosal artery & corpus cavernosum, dx with doppler, and treated with embolization
o Low flow – more common, more painful, dx by aspiration dark acidic intracavernosal blood
* Treatment
o Pain control
o Terbutaline 0.25 – 0.5 mg SC q20-30 mins as needed
o Pseudoephedrine 60 – 120 mg PO if within 4 hours
o If sickle cell – exchange transfusion
o Corporal aspiration

Testes and Epididymis
Prostate

* Acute prostatitis
Urethra

* Urethritis
* Urethral Structure
Urinary Retention
* H&P important
* Voiding history
o Problems with holding/initiating?
o Manner of the stream, complete or interrupted?
o Feeling of bladder emptiness afterwards?

Quiz Answers
Male Genital Problems.ppt

Read more...

Gastrointestinal Imaging

Gastrointestinal Imaging
Presentation by:Rajneesh Mathur D.O.

Basic Imaging Techniques

* Plain Film Radiography
o Quick, Easy, Inexpensive
o “Snapshot” of a dynamic system
o Technique
+ Bones
+ Upper quadrants
+ Flanks
+ Mid-Abdomen
+ Lower Abdomen

Plain Film Radiography Continued

* Acute Abdominal Series
o Supine
+ Detects fluid/blood in peritonuem
+ Detects gas in bowel
o Upright
+ Air Fluid Levels
o Left Lateral Decubitus
o Upright CXR
+ Best for free air

Contrast Radiography

* Barium Sulfate
o Standard for contrast GI studies
o Insoluble, High viscosity
o Not absorbed by the GI tract
* Gastrograffin
o Soluble, Low viscosity
o Not absorbed by the GI tract
o Laxative Effect
+ Not recommended in Peds

Computed Tomography

* Imaging of SOLID organs
* View of RETROPERITONEUM
* Oral Contrast
o Identify bowel
* IV Contrast
o Blood Vessels
* 2 Phases


Radionuclide Scanning

* Replaced by Ultrasound in ED secondary to time

Ultrasonography

* Inexpensive
* Non-Invasive
* Air is a poor conductor
* Solid structures conduct well

Specific Gastrointestinal Conditions

* Plain Film Radiography
* Abdominal CT
* Ultrasound
* Air Contrast or Barium Enema
* Angiography
* Radionuclide Scanning
* MRI

Plain Film Radiography

* In past, every belly pain got plain films
o 10 to 40% of the time it does not change clinical management
o Get it for
+ SBO
+ Free Air
+ Ileus
+ Bowel Ischemia
+ Foreign Bodies

Abdominal Computed Tomography

* Diagnostic Tool of Choice for:
o Diverticulitis
o Pancreatitis
o Pancreatic Pseudocysts
o Aortic Aneurysm
o Blunt Trauma
o Appendicitis
* Can pinpoint a diagnosis in 95% of cases where clinical judgment fails to narrow a wide range of potential diagnoses

Ultrasonography

* Initial study for patients with
o RUQ pain
o Pelvic Pain
o Acute Appendicitis



Air Contrast or Barium Enema

* Used for
o Intussusception
o Has been replaced by CT for suspected abdominal aortic aneurysm
o May be helpful in evaluation of patients with lower GI bleed

Angiography
Radionuclide Scanning

* Can be useful as an adjunct to Ultrasound when suspicion of
o Cholecystitis
o Cystic Duct obstruction
o No Role in the imaging of the GI tract in the ED

MRI
Gastrointestinal Imaging.ppt

Read more...

Kawasaki Syndrome

Kawasaki Syndrome
Presentation by: Anna Mae Smith, MPAS, PA-C
Lock Haven University

* An acute, distinct, self-limited, febrile disease of children
o Mucocutaneous lymph node syndrome
o vasculitis of coronary blood vessels with potential dilation, aneurysms, thrombosis, rupture, or myocardial ischemia
o 25% develop cardiac sequelae
* Incidence/Prevalence in USA: Worldwide, affects all races but most prevalent in Japan
* In the US, the annual incidence rate is 0.6 cases/100,000 children under 5 years old
* Seasonal variation - increased in winter and spring.
* Increased outbreaks at 2-3 year intervals
* Predominant age: 1-5 years; 50% are < 2 years old, 80% are < 5 years old. Seldom
* seen after 8 years of age

Diagnostic Criteria

* Fever lasting greater than 5 days plus 4 of the 5 following…
o Polymorphous rash
o Bilat. Conjunctiva injection
o 1 or more mucous mb changes
+ Diffuse injection of oral/pharyngeal mucosa
+ Erythema or fissure of the lips
+ Strawberry tongue
o Acute cervical lymphadenopathy
o 1 or more extremity changes
+ Erythema of palms &/or soles
+ Indurative edema of the same
+ Membranous desquamation of the fingertips
Treatment

TAKAYASU ARTERITIS

* Asian population
* Affects young adult populations
* Affects large elastic arteries
o Aorta & major branches & renal

ALLERGIC ANGIITIS/CHURG- STRAUSS SYNDROME

* Occurs in patients with asthma
* Middle age men>women
* Eosinophilia >10% WBC
* Mono or Polyneuropathy
* Transitory Pulmonary infiltrates
* Paranasal sinus Abnormalities
* Biopsy - Extravascular eosinophils

Kawasaki Syndrome

Read more...