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Pediatric Surgery (Pg 68-81) - page 32 / 33

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32 / 33

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Laparoscopy – locate nonpalpable testes

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Need to bring down b/c increased frequency of cancer

Does not decrease risk of cancer, but makes it easier to detect

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Decreased fertility

Patent Processus Vaginalis – inguinal hernia

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Peritoneum extending from abd cavity

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Hernation of viscera possible ---> EMERGENCY SURGERY

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Partial closure – hydrocele, feels like silk in scrotum

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May close after birth- surgery necessary >1 y/o

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Tx: High ligation @ internal inguinal ring

Testicular Cord torsion:

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Neonates – epididymis, testicle, tunica vaginalis, twist w/in internal spermatic fascia --> infarct

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Transverse positioned testicle, anterior epididymis, loss of cremaster reflex

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Adolescents: tunica vaginalis surrounds testicle

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may follow vigorous activity but activity does not cause it

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DDx: trauma, epididymoorchitis, viral, testicular cord torsion

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Torsion of appendage – blue dot (infarct) visible through skin on scrotum

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Dx: color ultrasound

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Tx: surgery

>6 hours irreversible testicular damage

If it is bell clapper anatomy, assumed bilateral, and both sides repaired

Trauma: Ultrasound

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Tunica albuginea intact – conservative mgt.  torn – surgery

Scrotal Infections

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Cellulites (G+) or fungal

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Necrotizing Fasciitis – Sub Q gangrene spreads rapidly – Tx w/ debridement + ABx to prevent death

Malignant Dz: testicular cancer most common; males 18-35

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Eval: transilluminating – floating testicel = hydrocele:  

fluid at/below testicle = spermatocele

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mass involving testicle = likely malignant --> Ultrasound --> surgery

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surgery --> inguinal incision (don’t make test incision b/c lymph system in cancer)

remove the testicle if tumor.

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Tx:

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Germ cell:

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Nonseminoma: differentiate along extraembryonic lines or intraembryonic

obtain tumor markers before orchiectomy  (AFP diagnostic for nonsemin)

B-HCG may be elevated in both (nonsemin/semin)

Elevated AFP after surgery – nonseminomatous tumor/ or additional tuma

Staging – CT scan, lymphography, Chest X-ray/Chest CT

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Seminoma: white smooth monotonus: round/clear

Tx: radiation (I&IIa)  Bulky higher grade – platinum based chemotx

Stage I: lymph node dissection

5 yr survival = 70%

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