Scrotal Symptoms

Age: ‍ years old

Gender: male



HISTORY:

Presents with a ‍-‍day history of scrotal symptoms

Symptoms include:

‍testicular pain

‍swelling

‍redness

‍heat

‍lump

‍change in size

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍fever, up to ‍°, over ‍ ‍hoursdays

‍nausea

‍vomiting, ‍ episodes ‍per day, ‍, ‍hematemesis

‍dysuria

‍frequency



Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Contributing factors:

‍recent trauma

‍recent sexual activity

‍unprotected sex

no history of: ‍sexually transmitted infections, ‍testicular cancer, ‍varicocele, ‍hydrocele, ‍inguinal hernia, ‍scrotal surgeries

no use of: ‍testosterone replacement therapy





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Genital: penis ‍normal, testes and epididymis ‍normal, ‍inguinal hernia

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍





ASSESSMENT:

‍Epididymitis ‍likelysuspectedpossible

DDx: epididymitis, testicular torsion, hydrocele, varicocele, inguinal hernia, orchitis, scrotal abscess, scrotal dermatitis, contact dermatitis, sexually transmitted infections, fournier's gangrene, testicular cancer, spermatocele, trauma, inguinal lymphadenopathy, scrotal eczema, cryptorchidism, scrotal hematoma, scrotal cyst





PLAN:

Investigations:

- Urinalysis

- Urine culture

- STI testing for chlamydia and gonorrhea

- Blood work: ‍CBC, ‍CRP, ‍creatinine

- Scrotal ultrasound

- Testicular doppler if torsion suspected

Treatments:

- ‍Analgesics

- ‍Antibiotics

- Ice packs

Further care:

- Referral to urologist

- Follow-up in ‍ ‍daysweeks

- Return if pain worsens, if new symptoms develop such as fever or swelling, or if symptoms do not improve with treatment

- Referral to ER if severe pain or sudden onset of symptoms occurs