Transcript Atypical Adolescent Substances

December 17, 2010
Welcome Applicants!
Sudden onset of severe unilateral pain
may radiate to inguinal area or lower abdomen
+/- Nausea and vomiting (90%)
Consider as secondary event
Has been reported post-orchiopexy
 4 to 8hrs
 12hrs
20% viable
 24hrs
nonviable
 Consult urology immediately!!
 Orchiopexy: surgical detorsion and fixation of both
testes
 Orchiectomy is performed if the testicle is nonviable
 Manual Detorsion: “Open Book” rotation
 Medial to lateral
 Give appropriate sedation and analgesia
 Still need surgical exploration after manual detorsion
 Not necessary if strong clinical suspicion
 Doppler U/S (69-100% sensitive, 77-100% specific)
 Nuclear Scan measuring testicular perfusion (100%
sensitive, 97% specific)
 Most commonly caused by infection
 Sexually Active Males: CT is #1, followed by GC, E.Coli,
and viruses
 Less Common: Ureaplasma, Mycobacterium, CMV,
Cryptococcus in HIV+
 Pre-adolescents
 Infectious: Mycoplasma, Enteroviruses, Adenoviruses
 Non-infectious: may be caused by “chemical
inflammation” from reflux of sterile urine
 Risk Factors
 Structural abnormalities
 Sexual activity
 Age
 Heavy physical exertion
 Bicycle/Motorcycle riding
 UA and UCx should be obtained
 Restrospective study: only 15% of patients with
Epididymitis had a positive UA
 UCx is often negative
 When GC/CT suspected:
 Ceftriaxone 250mg IM x 1 + Doxycycline 100mg PO BID
x 14 days
 Quinolones no longer recommended
 For Enteric Organisms:
 Levofloxacin 500mg PO Qday x 10 days
 Ofloxacin 300mg PO BID x 10 days
Bacterial Causes (if they have associated UTI):
Bactrim or Cephalexin
Non-Bacterial Causes: Supportive Measures (NSAIDs,
Bed Rest, Scrotal Support, possibly Abx)