CALEB MERTZ CASE WEEK#10 A 13-YEAR-OLD BOY: TESTICULAR PAIN IHUMAN CASE STUDY LATEST 2025, Exams of Nursing

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CALEB MERTZ CASE WEEK#10 A 13-YEAR-OLD BOY: TESTICULAR PAIN IHUMAN CASE STUDY LATEST 2025 Caleb Metz 13 ylo 5'5" (165 cm) 120.0 Ib (54.5 kg) Chief complaint testicular pain distinct muscular tube extends cephalad in spermatic cord from tail of epididymis passes through inguinal canal and joins seminal vesicles to form paired ejacultaroy dycts in prostatic urethra testicular PE examine penis, retract skin if uncircumcised visualize glands, urethral meatus, shaft inspect for ulcerations, cysts, absessesses, plaques check urethra for d/c, anatomical placement, erosion scrotum may be contracted and testicles high riding if room is cold adult testicles should be 4-5 cm in length 3 cm wide and depth smooth, soft, squishy never firm epididymis PE posterolaterally to each testis may vary in alignment head (globus major), body, tail (globus minor) may elicit discomfort with palpation examining spermatic cord, vas deferens, inguinal canals best done upright, standing position look for varicoceles cremasteric reflex absent consider testicular torsion epididymitis definition inflammation of epididymis epididymitis etiology sexually transmitted or non sexually trasnmitted sexually transmitted epididymitis commonly occurs in men under 35 and is result of chlamydia or gonorrhea DNA test gram stain urinalysis urine cultures CBC - epididymitis leukocytosis with left shift DNA testing - epididymitis for chlamydia and gonorrhea if urethral discharge is present (<35) gram stain - epididymitis in sexually transmitted variety smear of urethral d/c may be diagnostic of gram - intracellular diplococci (gonorrhea) urinalysis - epididymitis non sexually transmitted variety urine reveals pyuria, bacteriuria, varying degrees of hematuria urine cultures - epididymitis diagnostic for offending pathogen epididymitis treatment antibiotics sexually transmitted epididymitis tx 10-21 days with abx (oral and IM) tx partner accordingly non sexually transmitted epididymitis tx 10-14 days with approp abx TMP/SMZ (bactrim); fluoroquinolones supportive care - epididymitis sx could last for 6 weeks +/- sitz bath analgesics best rest with scrotal elevation condom usage epididymitis recommendations (for sexually transmitted) negative prehn sign = still pain if scrotum is elevated diagnostic studies for testicular torsion CBC urinalysis US CBC and urinalysis for testicular torsion normal WBC count distinguishes torsion from epididymitis color flow duplex doppler US - testicular torsion useful but routine clinical use limited by timely availability and operator experience positive for torsion if demonstrates absent or decreased blood flow to painful testicle treatment of testicular torsion emergent urology conssult tx should not be delayed by getting a film rate of salvaging testicular torsion <6 hr = 85-95% 6-12 hr = 55-85% 12-24 hr = 20-80% >24 hr = <10 % manual detorsion for testicular torsion most causes occur from lateral to medial this occurs by moving testicle from medial to lateral (back to neutral position) if testicular torsion is indicated or unable to be detrosed in ER urgent scrotal exploration is indicated orchiopexy is procedure of choice orchitis inflammation of the testes orchitis etiology isolated orchitis is rare and usually occurs in junction with other systemic infections mumps or other viral illness (EBC or coxsackie) left spermatic vein empties into left renal right empties into inf vena cava varicocele signs / sx exam should be performed standing bag of worms typically dimininsh in size/disappear when supine varicocele treatment urologic referral for surgical repair (varicocelectomy) if painful, bilateral, significant in size if untreated, can lead to testicular atrophy or infertility hydrocele definition collection of serous fluid surrounding testis btw two layers of tunica vaginialis hydrocele etiology fluid or blood blockage in spermatic cord inflammation or injury of testicle or epididymis malignancy (10% of testicular tumors associated with hydrocele) patho of hydrocele fluid filled remnant of vaginallis that surrounds testis during development, they descend down tube from abdomen into scrotum hydrocele occurs when this tube doesn't close hydrocele signs and sx painless, swollen testicle diagnosis can be made via transillumination (if clear fluid filled = they will light up) hydrocele diagnosis US confirms it hydrocele treatment not usually dangerous only treated when causing embarrassment or pain surgical repair with hydrocelectomy cremasteric contraction tunica albuginea (tough and fibrous) all are protective hematocele accumulation of blood around the testicles management of conservative testicular trauma NSAIDs/ opioids ice elevation scrotal support urology follow up management of severe testicular trauma emergent urology consult surgical exploration - evacuation of hematocele blood clots - repair of testicular rupture testicular salvage following penetrating trauma 35% scrotal hernia occurs when bowel, omentum, or other intra abdominal organs pass through internal inguinal ring lateral to epigastric vessel indirect bc it doesn't produce directly through wall to leave the abdominal cavity travels through inguinal canal scrotal hernia - congenital defect pass through continuity of processus vaginalis if it doesnt remain patent, indrect hernia cant develop hydroceles related to patient processes vaginalis as it allows passage of perioteal fluids to varying degrees presentation of scrotal hernia bulge in groin, result of inc intraabdominal pressure MOA due to lifting heavy or coughing violently inquire abt COPD, difficulty urinating, constipation(can inc the pressure) males, typically on the right side bc delayed descent of right testicle) reduction - scrotal hernias manual can provide temp management no attempt if its strangulated (can result in gangrenous bowel) treatment of current conditions - scrotal hernia associated abnormalities that inc pressure cough, bladder outlet obstruction, constipation need to be fixed penile cancer epidemiology less than 1% of all male cancers risk factor for penile cancer HPV, HIV 50+ (average is 68) phimosis/poor hygiene/uncircumcised tobacco products Up to 50% of these cases are said to have either unilateral or bilateral cryptorchidism Relative risk for cancer in cryptorchidism is higher among intraabdominal (1:20) and lower for intrainguinal (1:80) testicles descending the testicle into the scrotum does NOT signs of penile cancer growth or sore on glans or foreskin of penis (or shaft) color changes skin thickening urethral discharge, or under foreskin hematuria from meatus or under foreskin pain in shaft or glans irregular or blue brown lesions or marks below foreskin or on penis (warts) reddish, velvety rash crusty bumps swollen nodes irregular swelling at head of penis dx of penile cancer punch bx of lesion signs of testicular cancer enlargement of tsticle without pain only 1/3 have pain heaviness 10% will maifest metastatic disease sx - back pain - cough - lower extremity edema slightly more common on right than left labs for testicular cancer hCG alpha fetoprotein LDH LFT scrotal US hCG - testicular CA elevated in nonseminomas elevated in seminomas but not as high alpha fetoprotein - testicular CA never going to be elevated in seminomas LDH - testicular CA may be elevated in either type LFT - testicular CA to rule out metastasis scrotal US - testicular CA readily makes diagnosis tx of testicular CA refer to urology radical orchiectomy - high rates of cure when tx with retroperitoneal irradiation seminomas tx 60-65% of all germ cell tumors