NRNP 6541 Week 8 Assignment and Answers

Testicular Torsion; Testicular torsion is the spontaneous twisting of the spermatic cord. This twisting leads to compromise of testicular blood flow. Testicular torsion occurs in 1:4000 males age 18 and younger. The risk/early diagnosis of testicular torsion can be assessed with the TWIST (Testicular Workup for Ischemia and Suspected Torsion) score. Scoring is: testicular swelling (2 points), hard testis (2 points), absent cremasteric reflex (1 point), nausea and vomiting (1 point), and high-riding testis (1 point). A score of 0 is predictive of non torsion, and a score of 6 or 7 is highly predictive of testicular torsion. Testicular torsion is a surgical emergency (Keays & Rosenberg, 2019). 7 Differential Diagnoses: 1. Torsion of testicular appendage – It is the twisting of a small piece of tissue above a testicle. The appendage does not have a function in the body, however it can become twisted and cause pain and swelling that gets worse over time. The pain is generally gradual onset. A positive blue dot sign, which is a tender nodule with blue discoloration on the upper pole of the testis, is often an indicator of torsion of the testicular appendage (Pomajzl & Leslie, 2021). 2. Epididymitis - Inflammation or infection of the epididymis. Pain and swelling typically develops gradually over the course of a few days, unlike testicular torsion, which is usually of sudden onset. 3. Urolithiasis - It is calculi or stones that form the urinary tract. They are likely related to diet. Generally, presents with abdominal and flank pain with UA often showing blood in the urine (Maaks, et al., 2020). 4. Appendicitis - Is the obstruction of the lumen of the appendix is the main cause of acute appendicitis. It typically occurs in adolescence or early adulthood and presents with RLQ pain, anorexia, diminished bowel sounds, fever, nausea, tachycardia, and a positive Rovsing, psoas, and obturator signs (Jones, Lopez, & Deppen, 2021). 5. Inguinal hernia - Often there is a history of heavy lifting or previous surgery. There may detect a mass in the inguinal canal that may be nonreducible. Physical exam may be a normal lie and a normal cremasteric reflex (Tiemstra,& Kapoor, 2008). Additional laboratory and diagnostic tests: Scrotal Ultrasound – A scrotal US should be ordered as soon as possible. The hallmark sign of testicular torsion on ultrasonography is absence of testicular blood flow or whirlpool sign which is the twisting of the spermatic cord (Keays & Rosenberg, 2019). He should also have a urinalysis, CBC, CMP, and UA.