Epididymoorchitis inflammation of Testis and epididymis .pptx

Lecture notes for MBBS UGs

1. Tips on using my ppt. You can freely download, edit, modify and put your name etc. Don’t be concerned about number of slides. Half the slides are blanks except for the title. First show the blank slides (eg. Etiology ) > Ask students what they already know about ethology of today's topic. > Then show next slide which enumerates aetiologies. At the end rerun the show – show blank> ask questions > show next slide. This will be an ACTIVE LEARNING SESSION x three revisions. Good for self study also. Good for self study also. Display blank slide> Think what you already know about this > Read next slide. See notes for bibliography.

2. Learning Objectives At the end of this session the learner will be able to describe- Aetiology Clinical Features Management Of E pididymo-orchitis  

3. Learning Objectives Introduction & History Relevant Anatomy, Physiology Aetiology Pathophysiology Pathology Classification Clinical Features Investigations Management Controversies Prevention Guidelines Take home messages

4. Introduction & History.

5. Introduction & History. Epididymo-orchitis acute inflammation of the  epididymis and testis  due to viral or bacterial infections. Isolated  orchitis Can rarely be caused by mumps or other viruses (in nonimmune individuals).

6. Etiology Idiopathic Traumatic Infections /Infestation Neoplastic (Benign/Malignant) Congenital/ Genetic Nutritional Deficiency/excess Autoimmune Degenerative / lifestyle Iatrogenic Psychosomatic Poisoning/ Toxins/ Drug induced

7. Etiology Idiopathic Traumatic Infections /Infestation Neoplastic (Benign/Malignant) Congenital/ Genetic Nutritional Deficiency/excess Autoimmune Degenerative / lifestyle Iatrogenic Psychosomatic Poisoning/ Toxins/ Drug induced

8. Etiology Bacterial: C. trachomatis N. gonorrhoeae E. coli Pseudomonas aeruginosa Klebsiella pneumoniae Haemophilus influenzae Proteus mirabilis Ureaplasma urealyticum Mycoplasma genitalium M. tuberculosis Brucella  spp. Viral (most common cause in children): Adenovirus Enterovirus Coxsackie virus Epstein-Barr virus Cytomegalovirus Varicella zoster virus Rubella  virus Mumps  virus Fungal: Blastomycosis Histoplasmosis Coccidioidomycosis Candidiasis

9. Etiology Noninfectious causes: Bladder outlet obstruction Urinary tract surgery or instrumentation Autoimmune and inflammatory conditions: Immunoglobulin A vasculitis   Behçet disease Sarcoidosis Amiodarone : Secondary to high drug concentrations at the head of the  epididymis .  Occurs in about 3%–11% of patients 

10. Classification

11. Classification 1.Acute epididymitis  Usually lasts < 6 weeks < 35 years Chlamydia trachomatis Neisseria   gonorrhoeae   > 35 years old:  Escherichia coli Pseudomonas  related to urinary tract infection 2.Chronic epididymitis  ≥ 3 months Genitourinary trauma Mycobacterium tuberculosis 3.Isolated  orchitis Rare Mumps  or other viruses

12. Clinical Features

13. Clinical Features Demography Symptoms Signs Prognosis Complications

14. Demography

15. Demography Incidence & Prevalence Geographical distribution. Race Age Sex Socioeconomic status Temporal behaviour

16. Demography Incidence & Prevalence-

17. Demography Incidence & Prevalence- Epididymitis  and  orchitis  are the most common causes of scrotal pain  in adults (> 600,000 cases per year in the United States).

18. Symptoms

19. Symptoms Unilateral Testicular Pain, Swelling Tenderness Fever Lower urinary Symptoms- Dysuria Hematuria  Urinary frequency  Urinary urgency Discharge H/O Mumps.

20. Symptoms Chronic epididymitis - Can be unilateral or bilateral Chronic testicular pain Tuberculous   epididymitis can present as a nonresponsive acute epididymitis Persistent pain  2–4 weeks after the initial presentation Can have a hard, painless mass

21. Signs

22. Signs General Examination Systemic Examination Local Examination

23. Signs General Examination

24. Signs General Examination Fever Tachycardia Noninfectious  epididymitiscan have other clinical findings (e.g., rash in  vasculitis )

25. Signs Systemic Examination

26. Signs Systemic Examination

27. Signs Local Examination

28. Signs Local Examination Elevation of the affected hemiscrotum Testis and epididymis swollen, tender. Positive Prehn’s sign: decreased pain with elevation of testicle Reactive hydrocele .

29. Investigations Laboratory Studies Routine Special Imaging Studies Tissue diagnosis Cytology FNAC Histology Germ line Testing and Molecular Analysis Diagnostic Laparotomy.

30. Investigations Laboratory Studies Routine Special Imaging Studies Tissue diagnosis Cytology FNAC Histology Germ line Testing and Molecular Analysis Diagnostic Laparotomy.

31. Investigations Laboratory Studies

32. Laboratory Studies Urinalysis pyuria and/or  bacteriuria Gram stain and culture of urine or urethral discharge STD screening Urine nucleic acid amplification test (NAAT) for  N. gonorrhoeae and  C. trachomatis If  Mycoplasma genitalium is suspected → NAAT: If tuberculosis is suspected: 3 sequential early-morning urine samples for acid-fast bacilli  culture NAAT for  Mycobacterium tuberculosis   DNA/RNA If mumps  is suspected: Serology for  IgM antibodies Acute and convalescent  IgG serology leukocytosis

33. Diagnostic Studies Imaging Studies X-Ray USG CT Angiography MRI Endoscopy Nuclear scan

34. Diagnostic Studies Imaging Studies X-Ray USG CT Angiography MRI Endoscopy Nuclear scan

35. Diagnostic Studies Scrotal color Doppler ultrasonography Typical findings: Increased blood flow and inflammation of  epididymis or testis Also detects complications: Abscess Hydrocele Infarction Helps to rule out: Testicular torsion- with decreased testicular blood flow. Epididymal  mass or cysts (in cases of chronic epididymitis )

36. Differential Diagnosis

37. Differential Diagnosis Testicular Torsion Pain is sudden,severe . No signs of UTI No fever Negative Prehn’s sign: increased pain with elevation of testicle. Negative  cremasteric reflex May have nausea and vomiting. Cannot differentiate clinically. Must do doppler USG or exploration if comes within 6 hours of onset of pain.

38. Non Operative Therapy

39. Non Operative Therapy Antibiotics Bed rest Cold compresses Scrotal support/elevation NSAIDs Other analgesics may also be used.

40. Antibiotics Levofloxacin or  ofloxacin Trimethoprim–sulfamethoxazole  if unable to tolerate  fluoroquinolones . Chlamydia and/or gonorrhea- Ceftriaxone 500 mg once, PLUS Doxycycline 100 mg orally twice a day for 10 days

41. Take home messages Diagnosis is based on clinical findings and urinalysis with culture. Scrotal ultrasound may show increased blood flow to the affected epididymis or testicle. Treatment is with empiric gram-negative coverage antibiotics and culture-directed therapy. Supportive care includes scrotal support and non-steroidal anti-inflammatory drugs.

42. Take home messages Epididymitis and orchitis are characterized by acute inflammation of the epididymis and the testicle, respectively, due to viral or bacterial infections. Patients typically present with gradually worsening testicular pain and scrotal swelling along with systemic symptoms such as fever, depending on severity. Patients with concomitant sexually transmitted diseases (STDs) may present with lower urinary tract symptoms.

43. Guidelines

44. Bibliography

45. MCQs What is the most common presenting symptom of epididymo-orchitis ? A. Scrotal swelling, B. Penile discharge, C. High fever D. Abdominal pain. 

46. MCQs What is the most common presenting symptom of epididymo-orchitis ? A. Scrotal swelling, B. Penile discharge, C. High fever D. Abdominal pain. 

47. MCQs Which of the following is the most likely causative organism for epididymo-orchitis in a sexually active young male? A. Staphylococcus aureus , B. Escherichia coli C. Neisseria gonorrhoeae D. Streptococcus pneumoniae

48. MCQs Which of the following is the most likely causative organism for epididymo-orchitis in a sexually active young male? A. Staphylococcus aureus , B. Escherichia coli C. Neisseria gonorrhoeae D. Streptococcus pneumoniae

49. MCQs What is the primary diagnostic tool for epididymo-orchitis ? A. Scrotal ultrasound, B. Urine culture, C. Blood culture D. Testicular biopsy. 

50. MCQs What is the primary diagnostic tool for epididymo-orchitis ? A. Scrotal ultrasound , B. Urine culture, C. Blood culture D. Testicular biopsy. 

51. MCQs Which of the following conditions is most likely to be confused with epididymo-orchitis ? A. Testicular torsion, B. Inguinal hernia C. Prostatitis D. Varicocele . 

52. MCQs Which of the following conditions is most likely to be confused with epididymo-orchitis ? A. Testicular torsion, B. Inguinal hernia C. Prostatitis D. Varicocele . 

53. MCQs What is the mainstay treatment for epididymo-orchitis caused by a sexually transmitted infection? A. Oral antibiotics B. Steroids C. Surgery D. Observation only.

54. MCQs What is the mainstay treatment for epididymo-orchitis caused by a sexually transmitted infection? A. Oral antibiotics B. Steroids C. Surgery D. Observation only.

55. MCQs What is the typical presentation of a patient with epididymo-orchitis ? A. Unilateral scrotal pain, swelling, and tenderness  B. Bilateral scrotal pain with fever C. Sudden onset of severe scrotal pain  D. Asymptomatic scrotal mass

56. MCQs What is the typical presentation of a patient with epididymo-orchitis ? A. Unilateral scrotal pain, swelling, and tenderness   B. Bilateral scrotal pain with fever C. Sudden onset of severe scrotal pain  D. Asymptomatic scrotal mass

57. MCQs What is the typical presentation of a patient with epididymo-orchitis ? A. Unilateral scrotal pain, swelling, and tenderness   B. Bilateral scrotal pain with fever C. Sudden onset of severe scrotal pain  D. Asymptomatic scrotal mass

58. MCQs Epididymitis and epididymo-orchitis are usually caused by which of the following?   A bacterial infection    Erectile dysfunction    A fungal infection   A viral infection 

59. MCQs Epididymitis and epididymo-orchitis are usually caused by which of the following?   A bacterial infection    Erectile dysfunction    A fungal infection   A viral infection 

60. MCQs Which of the following symptoms suggests that a sexually transmitted disease is the cause of epididymitis or epididymo-orchitis ?   A.A discharge    B.Fever     C.Fluid around the testes    D.Swelling  

61. MCQs Which of the following symptoms suggests that a sexually transmitted disease is the cause of epididymitis or epididymo-orchitis ?   A.A discharge    B.Fever     C.Fluid around the testes    D.Swelling  

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