GIGU Final - BHP, Prostatitis, prostate cancer, priapism, phismosis, hypo/epispadias, cryptochidism, hemorrhoids

what is a hemorrhoid

dilated veins of the hemorrhoidal plexus

what delineates between internal and external hemorrhoids

pectinate line

risk factors of hemorrhoids

cirrhosis

constipation

pregnancy

obesity

S/S of hemorrhoids

often asymptomatic

external can become painful

internal may present with blood on defecation - may cause mucus discharge and tenesmus

diagnosis of hemorroids

inspect anus

anoscopy - observe internal

how many grades internal hemorrhoids

4 grades

1- no prolapse

2- prolapse with defecation but goes back in

3- must manually reduce it

4- cannot be manually reduced

what is hypospadias

malformation of urethra that opens to the underside of the penis (ventral side)

secondary condition to hypospadias

pyroneus - curved penis

What is epispadias

malformation of urethra where it opens to dorsum of penis

is there malformation with epispadias?

no

cryptochidism is what?

when one or both testicles fail to descend\

cryptochidism is common with?

preterm babies

if you have undescended testicles, what might you get as a secondary issue?

inguinal hernia

what would we use to diagnose cryptochidism

- physical exam

- abdominal laparoscopy to confirm presence of testicle

Percentage of where testicles stay in the body

60%- high scrotal

25% - inguinal

15% - abdominal

what test would you perform for bilateral cryptochidism?

challenge test of human gonadotropin to confirm production of testosterone

when most commonly do the testicles descend if they're undescended

spontaneous descending within first 4 months of life

what is phimosis

inability to retract foreskin

phimosis could cause what secondary issue?

UTI

Balanitis - swelling of foreskin and glans

types of phimosis?

physiologic - before age 5 can't pull foreskin back

Acquired (?) - infection of foreskin

what infection of the foreskin may cause phimosis?

lichen sclerosis

what is paraphimosis?

if penis is flaccid and foreskin is pulled back and then penis gets erect, may cause swelling of the tip —> this is balanitis

symptoms of phimosis

- preputial pain

- inability to retract foreskin (paraphimosis)

- skin irritation

- local infections

- scarring of infections

-scarring of the foreskin

- ballooning of foreskin during urination

- UTI

- Painful erections

What is priapism?

persistent abnormal erection unaccompanied by sexual desire or excitation

how long before it's too long of a boner?

4 hrs

types of priapsim

ischemic and non-ischemic

what is the most type of priapism

ischemic

aka for ischemic priaprism

low flow

what is the blood flow for ischemic?

normal flow going in, low flow coming out

characteristics of penis with ischemic priapism/

rigid shaft, soft head

aka for non-ischemic

high flow

what pathologies typically causes ischemic priapism

sickle cell

leukemia

malaria

what medications typically cause ischemic priapism

antidepressants: Wellbutrin, prozac

alpha-blockers

blood thinners (warfarin, heparin)

anxiety or psychotic disorders (Risperdal, Zyprexa)

ADHD meds (strattera)

blood flow for nonischemic priapism

way too much blood going in, normal coming out

what typically cuases nonischemic priapism

trauma

what's the timeframe for nonischemic priapism

6 hrs or more

characteristics of penis from nonischemic priapism

not fully rigid shaft, no pain associated with the erection

Exam findings for priapsim?

erection lasting longer than 4 hours

draw blood —> ABG —> air blood gas

Low O2 level - ischemic

Regular O2 level - nonischemic

what elicit substances are related to priapism

cannabis

cocaine

what might the history of someone with priapism look like?

medications

drugs

alcohol abuse

spinal cord injury

syphilis

metabolic disease - goat

what usually causes prostate cancer

adenocarcinoma

median age of diagnosis for prostate cancer

72

T/F: more men die with prostate cancer than of it?

True

Symptoms of prostate cancer

- progress slowly - asympotmatic until advanced

- advanced will show

- hematuria and signs of obstruction

- difficulty peeing - due to obstruction

- sense of incomplete emptying

- bone pain due to mets

What's a DDX for elevated PSA?

Benign hypertrophic prostate and prostate cancer

PSA levels and age that it's a potential problem

50+ - over 4 ng/ml

under 50 - over 25 ng/ml

other ways to diagnose prostate cancer not via PSA levels

transurethral US

transrectal MRI

biopsy

Gleason score —> score is between 0 and 10, over 7 is advanced a lot

what is prostatitis

inflammation of prostate

what are 4 classifications of prostatitis

1- acute bacterial

2- chronic bacterial

3- chronic prostatitis

4- asymptomatic

what bacteria may cause chronic bacterial prostatitis

E coli

proteus

klebsiella

symptoms for acute bacterial prostatitis

fever

chills

malaise

myalgia

prostate pain

obstruction of urinary tract symtpoms

symptoms for chronic bacterial prostatitis

prostate pains

suprapubic pain

obstructive urinary tract symptmos

ejaculatory pain

symptoms of chronic pelvic pain

pelvic pain lasts more than 3 months of the last 6 months

- same symptoms as chronic bacterial

what would you find in a urinalysis for prostatitis

increased WBC and bacteria

methods of diagnosis for prostatitis

Urinalysis - 2 samples (1st midstream collection, 2nd digital prostate massage)

Blood culture

US

Cystoscopy

which of the following would be evident with acute bacterial prostatitis (think the graph with pre and post massage)

increased/normal WBC and bacteria for pre

positive WBC and bacteria for post

graph of diagnosis for prostatitis - WBC and bacteria

Slide 15 of BHP slide deck - i don't pay for quizlet so I can't upload the image

what is benign hypertrophic prostate (BHP)

noncancerous proliferation and enlargement of prostate

rates of BHP for the ages

30-40yo: 10%

50-60yo: 40-50%

80+: over 90%

risk factors for BHP

men over 40

family history of BHP

obesity

heart and circulatory diseases

Type 2 DM

symtpoms for BHP

increased urination frequency

urgency

nocturia

decreased size and force of stream

sensation of incomplete emptying, terminal dribbling, incontinence

what about BHP would cause hematuria

straining may cause rupture of urethral and trigone veins

diagnostic tests for BHP

digital rectal exam

PSA

transrectal ultrasonography - estimate size of gland

uroddynamic studies - measure pressure w/in bladder

what will the prostate feel like with a digital rectal exam

enlarged and rubbery with loss of median furrow