Peer Response – Dannielle
Relate to another journal reading
- When developing a thorough history of present illness (HPI) for a patient with acute testicular pain, it’s important to ask specific questions to gather relevant information. Here are some questions to consider:
- When did the pain start?
Can you describe the pain (sharp, dull, constant, intermittent)?
- Is the pain localized to one testicle or both?
Have you experienced any recent trauma to the genital area?
- Have you noticed any swelling or changes in the appearance of the scrotum?
- Do you have any associated symptoms such as nausea, vomiting, fever, or difficulty urinating?
- Have you had any recent sexual activity?
- Have you experienced similar episodes of testicular pain in the past?
- Differential diagnosis:
- The top three differential diagnoses for acute testicular pain include:
- Testicular Torsion: This is a surgical emergency characterized by the twisting of the spermatic cord, leading to compromised blood flow to the testicle. It typically presents with sudden onset severe pain, swelling, and tenderness of the affected testicle (Laher et al., 2020).
- Epididymitis: This is the inflammation of the epididymis, commonly caused by bacterial infection or sexually transmitted infections. Patients often present with gradual onset of pain, swelling, and tenderness localized to the posterior aspect of the testicle (Rupp et al., 2023).
Inguinal Hernia: Although less common, an inguinal hernia can present with testicular pain, particularly if there is strangulation of the herniated contents (Fitzgibbons et al., 2022). Patients may report a history of groin pain or swelling that worsens with physical activity.
Assessment:
Conducting a physical assessment is crucial in evaluating a patient with acute testicular pain. The physical examination should include inspection, palpation, and assessment for signs of inflammation, swelling, tenderness, and changes in the scrotal contents. The cremasteric reflex should be assessed by gently stroking the inner thigh to observe for elevation of the testicle, which is typically absent in testicular torsion. Ultrasound to r/o testicular torsion as it is an emergent condition.
Plan:
If the cremasteric reflex is absent and u/s finds a testicular torsion. In that case, immediate referral to the ER is warranted, and emergent surgical exploration and detorsion of the affected testicle to restore blood flow. This should be done promptly to salvage the testicle and prevent irreversible damage. Analgesia should be provided to alleviate pain, and arrangements for surgical intervention should be made urgently.
Fitzgibbons, R. J., McBee, P., & Walters, R. (2022). Current status of inguinal hernia management: A review. International Journal of Abdominal Wall and Hernia Surgery, 5(4), 159. https://doi.org/10.4103/ijawhs.ijawhs_36_22
Laher, A., Ragavan, S., Mehta, P., & Adam, A. (2020). Testicular Torsion in the Emergency Room: A Review of Detection and Management Strategies. Open Access Emergency Medicine : OAEM, 12, 237-246. https://doi.org/10.2147/OAEM.S236767
Rupp, T. J., & Leslie, S. W. (2023, July 17). Epididymitis. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK430814/
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