Testicular torsion - Key points for the USMLE

Torsion is the most common cause of acute scrotal swelling and pain
-Underlying cause is a high attachment of tunica vaginalis that occurs in 12% of males
-Symptoms may include nausea and vomiting  and even fever (in addition to testicular symptoms)
-Examination may demonstrate a horizontal and elevated testis
-The cremasteric reflex is usually absent, but its presence does not rule out testicular torsion.
-Elevation of the scrotum does not relieve the pain 
-Doppler can confirm diagnosis although it is often not needed
-If surgery is done after 6 hours of onset the chances of testicular atrophy are extremely high
-During surgery the opposite (normal) testis is also fixed because the high attachment anomaly is often bilateral

Differential diagnosis:
1) Acute epididymitis and/or orchitis
-Onset is more gradual with fever and dysuria.
-Elevation of the scrotum may reduce discomfort
-Cremasteric reflex may or may not be present
-Teatment is with rest, analgesia, and antibiotics if there is concern about a bacterial infection

2) Torsion of the appendix testis
-Localized tenderness over the upper portion of the testis
-Blue dot sign
-Cremasteric reflex is present
-Treatment is analgesia

Umbilical hernia - when to treat?

Most umbilical hernias before the age of 6 mo disappear spontaneously by the first birthday. Even large hernias (5–6 cm in all dimensions) have been documented to disappear spontaneously by 5–6 yr of age. Strapping is ineffective and strangulation is very rare.

Surgery is indicated if the hernia persists to the age of 4–5 yr, causes symptoms, becomes strangulated, or becomes progressively larger after the age of 1–2 yr. Defects exceeding 2 cm are less likely to close spontaneously.

Gastroschisis vs Omphalocele

Gastroschisis (a.k.a paraomphalocele or abdominoschisis) is a congenital abdominal wall defect in which the intestines and sometimes other organs develop outside the fetal abdomen through an opening in the abdominal wall. This defect is the result of obstruction of the omphalomesenteric vessels during development.

 

Omphalocele is a similar birth defect, but it involves the umbilical cord, and the organs remain enclosed in visceral peritoneum instead of coming in contact with AF directly.

Transplant medicine

1. Autograft - donor is same as the recipient
2. Isograft - among twins.
3. Allograft - same species
4. Xenogaft - different species