Hello, this work is on Advanced Pathophysiology, it must have a minimum of 300 words and a bibliographic reference. The bibliography used on the topic is McCance, K. L. & Huether, S. E. (2019). Pathophysiology: the biological basis of diseases in adults and children. But you can use another one in addition to this one.
A 23-year-old healthy man has been unable to father a child. He and his wife have a workup for infertility. His wife’s reproductive function is normal. On physical examination both his testes are palpable in the scrotum and the testes and scrotum are normal in size, with no masses palpable. However, the spermatic cord on the left has the feel of a ‘bag of worms’. Laboratory studies show oligospermia. Which of the following conditions is this man most likely to have? Explain your answer.
A Hydrocele
B Testicular torsion
C Spermatocele
D Varicocele
E Seminoma
The most likely condition that the 23-year-old man in this case has is D) Varicocele. A varicocele is a condition characterized by the enlargement of the veins within the scrotum, specifically the pampiniform plexus, which drains the testicles. It often presents as a “bag of worms” feel in the spermatic cord, which is a result of the dilated and tortuous veins.
Here’s an explanation for this choice:
Varicocele: A varicocele occurs when the veins in the spermatic cord become enlarged, leading to blood flow disruption and an increase in scrotal temperature. Elevated scrotal temperature can negatively affect sperm production, leading to oligospermia (reduced sperm count) and infertility. Varicoceles are more common on the left side, which is consistent with the description of the left spermatic cord having a “bag of worms” feel in this case. The increased blood flow and pressure in the veins can impair sperm production and function. It’s important to note that varicoceles are often asymptomatic and can be discovered during an evaluation for infertility.
The other options can be ruled out for the following reasons:
A) Hydrocele: A hydrocele is a collection of fluid around the testicle, which would result in swelling but not necessarily oligospermia or the “bag of worms” feeling in the spermatic cord.
B) Testicular torsion: Testicular torsion is a surgical emergency that involves the twisting of the spermatic cord, leading to a sudden and severe pain in the scrotum. It doesn’t typically present with oligospermia or the characteristic “bag of worms” feeling.
C) Spermatocele: A spermatocele is a cyst that forms in the epididymis, which is a different structure from the spermatic cord. It doesn’t usually cause a “bag of worms” sensation or oligospermia.
E) Seminoma: Seminoma is a type of testicular cancer, and while it can affect fertility, it usually presents with a painless testicular mass rather than a “bag of worms” feeling.
In conclusion, given the clinical presentation of a “bag of worms” sensation in the spermatic cord, along with oligospermia, the most likely condition is a varicocele, which is a common cause of male infertility and can be managed with surgical intervention if needed.
Reference: McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The Biological Basis of Diseases in Adults and Children.