Varicocele Presentation Finalbb

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    XYLIA SAHARA E. TOCAO

    MEDICAL CLERK

    DAVAO MEDICAL SCHOOL FOUNDATION

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    VG

    18 years old

    MaleLaverna Hills subdivision, Davaocity

    October 29, 20137:05 AM

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    SCROTAL PAIN

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    6 months PTA

    scrotal pain (left); 6/10

    Lifting heavy objects

    Not associated with fever, nausea, vomiting

    No consultation and no medications taken

    Tolerated the condition

    1 month

    PTA

    1 month PTA-persistence of pain (10/10)

    Consultation with AP

    Sperm count done normal

    Advised for surgery

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    (-) Hypertension

    (-) Diabetes Mellitus

    (-) Bronchial asthma

    (-) Previous hospitalization

    (-) Surgical operation

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    Maternal side :Hypertension and

    DM

    Paternal side: Bronchial asthma

    (-) Cancer, Heart disease

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    May 20, 1995

    Laverna Hillssubdivision,Davao city

    Freshman student

    Gym -weight liftingexercises

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    GENERAL (-) easy fatigability

    ENDOCRINE SYSTEM (-) thyroid problems,(-) neck surgery,(-) heat and cold intolerance

    SKIN (-) pruritus HEAD (-) dizziness, (-) headache EYE (-) pain,

    (-) excessive lacrimation

    EAR (-) tinnitus NOSE (-) persistent stuffiness,

    (-) nasal congestion(-) postnasal drip

    MOUTH (-) bleeding gums, (-) dyspnea

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    THROAT (-) odynophagia,(-) hoarseness

    NECK (-) neck surgery,

    (-) nuchal rigidity,(-) limited motion

    BREAST (-) breast pain,(-) abnormal discharge

    CARDIAC (-) nocturnal dyspnea,(-) murmurs

    PERIPHERAL VASCULAR (-) claudication GASTROINTESTINAL (-) change in bowel habits PULMONARY (-) hemoptysis, (-) asthma GENITO-URINARY (-) dysuria, (-) flank pain HEMATOPOIETIC (-) easy brusing

    MUSCULAR (-) limited ROM NEUROLOGIC (-) change in orientation

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    GENERAL:

    awake, not in respiratory distress, oriented toperson,/ place and time.

    VITAL SIGNS:

    Temperature:36.3 oC Blood pressure:110/70mmHg

    Pulse rate: 65 bpm Respiratory rate: 20 cpm

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    SKIN: Inspection : no rash, lesions noted Palpation: good skin turgor,moist skin

    HEAD: Inspection: normocephalic, no lice & nits

    noted Palpation: (-) mass

    EYES: Inspection: anicteric sclerae, pinkish palpebral

    conjunctivae

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    EARS:

    Inspection: non erythematous, no cerumen

    noted Palpation: mobile,firm, non tender

    NOSE:

    Inspection: nasal septum in midline position

    Palpation: no sinus tenderness

    THROAT: Inspection: no tonsillar enlargement, non

    erythematous

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    NECK:

    Inspection: no thyromegaly

    Palpation: (-) cervical lymphadenopathy

    CHEST/LUNGS: Inspection: (-) use of accessory muscles for

    breathing

    Palpation: equal chest expansion

    Percussion: resonant

    Auscultation: clear breath sounds, nocrackles, wheezing

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    HEART:

    Inspection:adynamic precordium Palpation: no thrills /heaves

    Auscultation: good S1 and S2, no murmurs noted

    ABDOMEN: Inspection:flat

    Auscultation: normoactive bowel sounds at 15 perminute

    Percussion: tympanitic Palpation: non tender

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    SCROTAL EXAM: Inspection: no lesions

    Palpation: scrotal enlargement at the left sideafter bearing down

    EXTREMITIES

    INSPECTION: Full range of motion

    Palpation: full pulses, CRT

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    NEUROLOGIC EXAM:

    GCS: 15

    Eye opening: 4

    Verbal response:5

    Motor:6

    awake, conscious, oriented to person , placeand time.

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    CRANIAL NERVES:

    I not assessed II isocoric

    III, IV,VI pupils equally round and reactive to light andaccommodation

    V (+) corneal reflex, able to distinguish sharp andblunt stimuli

    VII able to perform facial expressions like smilingand frowning

    VIII able to hear soft and loud spoken words

    IX (+) gag reflex

    X (-) difficulty of swallowing

    XI able to raise shoulders against resistance

    XII able to protrude tongue and move it up, downand side

    MOTOR

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    MOTOR:

    R 5/5 5/5 L

    5/5 5/5

    REFLEX:

    R ++ ++ L

    ++ ++

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    SENSORY100% 100%

    100% 100%

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    Varicocele , left

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    POST OPERATIVE DIAGNOSIS: Varicocele , left

    OPERATION PERFORMED: varicocelectomy

    OPERATIVE TECHNIQUE: Operation started: 2:17 pm Operation ended: 3: 10 pm Skin preparation and draping done Aseptic technique Left inguinal incision done

    Left internal spermatic vein ligated Closure of incision in layers Bleeders cauterized Dressing applied

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    Seen and examined Venoclysis started with D5LR I liter at

    100cc /hour

    Medications started

    Omeprazole 40 mg 1 amp IVTT now may havebreakfast now then NPO

    Laboratory test done:

    10/29/13

    hemoglobin: 156 PT: 12.3 sechematocrit: 0.45 APTT: 30.5 sec

    platelet count : 245

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    Chest x-ray: normal findings

    Varicocelectomy , L at 1 pm

    10/30/13

    May go home

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    SALIENT FEATURES 18 years old, male

    Scrotal pain

    Gym weight lifting exercises

    Pertinent physical exam finding

    includes scrotal swelling on theleft side after bearing down

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    SwellingDragging /aching pain in the groin

    and scrotum bag of worms feeling

    Scrotum on the affected side hangsdown

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    Male and female reproductive systemsdevelop from similar embryonic tissue.

    First few weeks of development, male andfemale embryos are indistinguishable.

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    Ovoid structures about5 cm long and 3 cmwide.

    Located within thescrotal sac (scrotum)

    During fetaldevelopment they arenear the kidneys andslowly move inferiorly

    in the abdominal cavity. During the 7thmonth

    they descend throughthe inguinal canals

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    Sac of skin and superficial fascia thathangs outside the abdominopelvic cavityat the root of the penis

    Contains paired testicles separated by amidline septum

    Its external positioning keeps the testes3C lower than core body temperature

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    In the dermis, there isa thin layer of smoothmuscle known as thedartos muscle.Contractions of this

    muscle causeswrinkling of the skin. The cremaster muscle

    is a thicker layer ofskeletal muscle that

    lowers and raises thetestes based ontemperature.

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    Each testes isenclosed by thetunicavaginalis, acontinuation of the

    peritoneum that linesthe abdominopelviccavity.

    A fibrous capsule

    covers each testiscalled the tunicaalbuginea.

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    The tunica albugineagives rise to septa(partitions) thatdivide the testis intolobules (about 250)

    Each lobule contains3 or 4 highly coiledseminiferous tubules

    These converge to

    become rete testiswhich transportsperm to theepididymis

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    Contains thestructures runningfrom the testicles tothe pelvic cavity. Passes through the

    inguinal canal

    Contents: Vas Deferens

    Nerves Blood Vessels

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    Lie on the posterior wall of the bladder andsecrete 60% of the volume of semen Seminal fluid:

    Fructose: provides ene