I struggled to find PEM resources for my CT3 year, despite the variety of excellent resources out there. I hope this website will help point you in the right direction. I'm not a PEM expert, but am following the guidance CEM have issued (in the form of a syllabus) to put together this page. This page is not endorsed by CEM, and any mistakes are mine.

Please comment with corrections, additions and further suggestions.

All the information here is collected from the internet, and it might be out of date or inaccurate, so please use your judgement and adhere to your hospital's protocols. If you do notice any errors or omissions please comment so we can put them right!

To navigate, decide whether you want to start with a PMP or a PAP. You can then select which PMP or PAP you want to look at. You will then be taken to the summary page for that PMP, with links expanded topic collections. If you know what topic you want to look at already, click on the link on the right hand side.

Friday, 8 May 2015

Non Torsion Scrotum

Idiopathic Scrotal Oedema
"Cellulitis of the scrotum"
- Unknown cause
- Hypothesized that it represents a hypersensitivity reaction, similar to angioneurotic oedema

- May have a small scrotal scratch or insect bite 
- Pre-schoolers
- Starts as a small spot, then extends to cover half of the scrotum.
- No testicular tenderness - examine through unaffected skin

- Self resolving
- NSAIDs and antibiotics have been used. 

- Affects very young or very old.

- Infants - exclude urinary tract abnormalities - renal USS + urine culture
- Post pubertal - consider sexual contact

Hydrocele of the cord
This often presents as a “third ball”. For elective management. 

Undescended Testes
4% incidence at birth (higher in premature babies), falling to 1% at age 1. 

Thought of as “varicose veins” of the testicular veins.
More common at puberty

Classically feels like a “bag of worms”.
More commonly on the left, as testicular vein drains into higher-pressured left renal vein with a 90 degree turn 
Dullness/ heaviness / scrotal discomfort
Varices more prominent with standing or Valsalva
Does not trans-illuminate

Need to exclude any other causes of obstruction at this level (e.g. renal tumour, renal vein thrombosis) --> especially if happens suddenly 
Treat surgically for symptomatic relief

Happens if there is a patent processus vaginalis. 

Often asymptomatic bilateral scrotal swellings
Sometimes have a blueish discoloration

Most resolve spontaneously 
Surgery if persist beyond 18 - 24 months
If acute, check no inflammatory process 

And references on testicular torsion page

1 comment:

  1. Pretty good post. I just stumbled upon your blog and wanted to say that I have really enjoyed reading your blog posts. Any way I'll be subscribing to your feed and I hope you post again soon. Big thanks for the useful info.Jogos online
    friv free Games
    play Games friv 2020