EPIDDYMO-ORCHITIS

Defintions

·         Epididymo-orchitis is an inflammation of the epididymis and the testes ,it is a combination of Epididymis(epididymitis) and orchites or testes(orchitis)

·         Epididymitis is an acute inflammatory process and is one of the common intrascrotal inflammations

·         Orchitis is commonly a complication of  Epididymitis

Causes

·         The causes of this condition are many they include :

• BACTERIA  ascending infection  via the ejaculatory ducts  to the vas deference and finally to the testes ,Epididymis,the bacteria commonly seen in laboratory tests are: Eschericha coli, Chlamydia trachomatis, Neisseria gonorrheae,Haemophilus influenza,Tubercle bacilli
• VIRUSES Paramyxovirus (the causative organism of Mumps)

Risk Factors

·         Age:  Epididymitis  common in boys less than 15 years and men over 45 years

·         Structural Malformations:  developmental insufficiencies in children may contribute to urinary reflux

·         Sexual Behaviour:  this condition is most common in men between 19to 35 years (sexually active )

Step 3: Pathophysiology and  Signs and Symptoms of Epididymo-Orchitis (10 minutes)

·        Following the invasion by the causal agents, there is accumulation of fluids in the scrotal sac as a result of the process, this fluid loss into the interstitial space leads to diminished blood flow, nerve damage, and a resultant pain and swelling

·        Inflammatory fluid can form pockets of pus (abscesses)

·        The heat generated from the inflammatory negatively affects testicular function of spermatogenesis

·        The inflammatory fluid seeps from the testicle into the serous membrane lining the epididymis and the testicle to create a unilateral or bilateral swelling

·         Scrotal swelling and painof gradual onset,urethral discharge of pus,discomfort felt when wearing restrictive clothing ,

·         Severe scrotal tenderness,fever,general body malaise,dysuria

·         The cause of orchitis is systemic and so the signs and symptoms are systemic as well and include  nausea,vomiting and pain radiating to the inguinal canal

Step 5: Diagnostic Procedures and Evaluations of epididymo-Orchitis (15 minutes)

·         Epididymitis and epididymo-orchitis are diagnosed by

• Physical examination,
• urinalysis, and sometimes
• Doppler ultrasonography, which assesses blood flow to the testes.
• clinical features,
• laboratory tests of pus culture and sensitivity

Step 6 Treatment and Nursing Care of a Patient with Epididymo- Orchitis (55 minutes)

·         Thorough assessment of the patient(physical examination)including sexual history

·         check and record vital signs

·         collect and follow up laboratory results for  urinalysis

·         Take patients history to note possibilities of sexual abuse,history of recent urinary examination or instrumentation

·         scrotal ultrasound

·         Assess the condition to see whether the pain is unilateral or bilateral

·         Assess the patients walk to see if it is of rolling nature as an attempt to  protect the scrotum(palpate the scrotum)

Treatment and Nursing Care

·         Pain management

·         medication to treat infection

·         Supportive care

·         Non steroid anti-inflammatory drugs such as Ibuprophen to decrease inflammation

·         Narcotic analgesics if pain is severe

·         Eradication of infection is usually accomplished by giving oral broad spetrum antibiotics

·         Bed rest is recommended to reduce pain

·         Patient and family education focusing on the disorder and measures to reduce the pain and prevent the disease

Step 7 Complications of Epididymo-Orchitis (10 minutes)

·         Testicular infarction

·         Chrionic pain from nerve damage

·         Abscess formation

·         Infertility