「Testicular Pain」の編集履歴（バックアップ）一覧はこちら
「Testicular Pain」(2007/01/10 (水) 12:37:24) の最新版変更点
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<p>Case 14 testicular pain<br>
<a href=
"http://www.hmc.psu.edu/ume/fcmonline/case14/index.htm">http://www.hmc.psu.edu/ume/fcmonline/case14/index.htm</a></p>
<p>1.救急に来る陰嚢、睾丸の痛み？<br>
Acute:<br>
* acute epididymitis 精巣上体炎<br>
* orchitis 睾丸炎<br>
* testicular torsion 睾丸捻転<br>
* inguinal hernia 鼡径ヘルニア(大人は内)<br>
* trauma/testicular rupture/hematocele 外傷<br>
* folliculitis/sebaceous cyst 皮脂嚢胞<br>
Subacute:<br>
* hydrocele 陰嚢水腫<br>
* varicocele 精索静脈瘤<br>
* spermatocele 精液瘤<br>
* hematocele 陰嚢血腫<br>
* cryptorchidism 停留睾丸<br>
* atrophy/dysgenesis/endocrinopathy<br>
* testicular cancer<br>
* fibrous plaques and cysts of tunica albigunea (actually quite common and
entirely benign)<br>
* epididymal cyst<br>
Less common:<br>
* squamous cell carcinoma of scrotum<br>
* malignant melanoma/basal cell<br>
* epididymal tumor/malignancy<br>
* Fournier's gangrene (necrotizing fascitis) 壊疽性筋膜炎</p>
<p>Tips：陰嚢にできる扁平上皮癌と疫学。</p>
<p>2.ありそうなのは？<br>
急性のもの！</p>
<p>
陰部を見るときには癌のスクリーニングも忘れないようにしよう。</p>
<p>3.何を聞く？<br>
感染の原因を探る。<br>
a. sexual history? does he use condoms? has he had multiple partners? ever
had an STD? IV drug use? homosexual contact?<br>
b. contraception use? (this gives you an opportunity to reinforce the
importance of contraception and disease prevention)<br>
c. any urinary or other associated symptoms? history of urinary tract
infections?<br>
d. any history of trauma to the genitals or lower abdomen?<br>
e. any bowel problems? constipation, cramping, vomiting, diarrhea,
nausea?<br>
f. recent viral illness?<br>
g. any significant past medical/surgical history, especially related to
genitourinary tract?; history of cryptorchidism?</p>
<p>「ライター症候群」<br>
[原因]感染性下痢疾患後に発症する流行型(Shigella
Flexneri)と、性交後に発症する型(主にクラミジア)<br>
[診断基準]<br>
1. 血清反応陰性の非対称関節炎（主として下肢関節）<br>
2. 次の項目の1つまたはそれ以上を満たす<br>
a. 尿道炎<br>
b. 赤痢<br>
c. 炎症性眼疾患<br>
3. 除外項目<br>
強直性脊椎炎、乾癬性関節炎、その他のリウマチ性疾患<br>
[治療]<br>
急性期にはNSAID<br>
治療抵抗性なら免疫抑制剤<br>
[予後]<br>
3-40％では症状持続。他は半年たたずに自然治癒。</p>
<p>4.診察<br>
* general appearance<br>
* vital signs<br>
* abdominal exam<br>
* inguinal, perineum, lower extremity exam<br>
* genital exam</p>
<p>5.どこを確かめる？<br>
1. testicles<br>
2. epididymis<br>
3. spermatic cord/vas deferens<br>
4. penis<br>
5. skin of penis, scrotum, and perineum 会陰<br>
6. external/internal inguinal ring and floor of inguinal canal<br>
陰部の診察は視診と触診。<br>
視診は、感染、外傷、皮膚の変化、腫瘤、萎縮、奇形。<br>
触診は、<br>
1. testicular descent (cryptorchidism) <br>
2. testicular size (<3.5cm on long axis is small, consider
hypogonadism)<br>
3. testicular shape, lumps/masses<br>
4. symmetry (remember left testicle usually sits lower and more posterior
in relation to the right)<br>
5. testicular tenderness<br>
6. epididymis (located superior and posterior to testicle) size,
tenderness, masses<br>
7. vas deferens (check for swelling, tenderness, masses) 輸精管<br>
8. scrotal skin versus intrascrotal masses/cysts<br>
あと、Cremasteric reflex（挙睾筋反射）<br>
大腿内側面を上から下にピンでこすると同側の睾丸が挙上
