00:02 Our topic here is varicocele. 00:04 What do varices mean to you? Engorgement of your veins. 00:08 Here we have a varicocele. 00:11 What’s happening? Dilation of veins, you must know the anatomy in greater detail here. 00:16 You must know about the pampiniform plexus due to increased venus pressure. 00:21 How does your increased pressure which is then – Well, the veins, what are they doing? That’s important for you to understand. 00:28 Are veins draining or supplying? Draining. 00:31 So if there’s increased pressure in the veins, then you’re having difficulty with the draining. 00:36 So now, what happens? Engorgement, right? Welcome to varicocele. 00:42 Concept first, then you plug in the diagnosis. 00:46 Most common cause of scrotal enlargement is varicocele. 00:50 Most common cause of scrotal enlargement, hence, know everything about varicocele. 00:57 What side? Almost always on the left side due to resistance to flow. 01:02 It’s important that you know the anatomy here. 01:05 The left testicular vein or gonadal vein drains into the left renal vein. 01:10 Can you picture that for me? Does that happen on the right side? No. 01:15 Okay, so pause. 01:18 On the left side, if the left gonadal vein or testicular vein has to drain into the left renal vein first, then it drains into your inferior vena cava. 01:26 My goodness, that’s a pretty long journey. 01:29 And so therefore, if at any point in time there is blockage, then you’re going to have engorgement and enlargement of the scrotum, left side. 01:37 Simple anatomy, clinical – Everything that you do in medicine between you and I or in general by yourself, make sure you give it a clinical tag. 01:45 If you don’t, then I don’t know, just leave it aside and come back to it. 01:50 Acute onset may indicate a thrombotic event. 01:53 Secondary to nephrotic syndrome or even renal cell carcinoma. 01:57 Keep that in mind. 01:58 Interesting? We’ve talked about this. 02:02 Nephrotic syndrome leaves you in what kind of state? Bleeding or hypercoagulable? Good, hypercoagulable. 02:10 Do you see as to how everything that you’ve learned is coming together now? Nephrotic syndrome, your losing antithrombin III. 02:17 Antithrombin III normally knocks out your? If you remember. 02:19 Thrombin. 02:21 So normally, it should control coagulation. 02:25 In nephrotic syndrome, if you remember, of all the coag factors, the one that you have memorized and, if you haven’t, do so. 02:31 Again, now, you lose antithrombin III. 02:36 And you're state of what? Hypercoagulabilty. 02:39 Where? Renal vein. 02:42 And what about renal cell carcinoma? Renal cell carcinoma, once again if it’s the left side, think about metastasis. 02:50 You’ve moved from stage one to stage two. 02:52 You’ve busted through the capsule and now you’re going to metastasize through the renal vein. 02:58 This is metastasis. 03:01 All these cancer cells, slowly moving. 03:04 It’s a gang passing through the renal vein. 03:07 And all of the sudden, on the left side, here comes gonadal. 03:10 Hey, what’s up? But the thing is, it’s a bully. 03:14 It stops the drainage of your gonadal vein So you’d stopped the drainage of your testicular vein or gonadal vein, welcome to varicocele. 03:24 Signs and symptoms that will then help you out to figure out what’s going on with your patient. 03:30 Next, well, if you’re decreasing the drainage, would you call this hyperemia or congestion? Yet another basic concept. 03:38 Congestion. 03:40 So congestion, may result in high temperatures. 03:43 What’s optimum temperature? How about 98.6 degrees Fahrenheit, 37 degrees Celsius? With all these increased heat, there’s every possibility that you may or may then become infertile. 03:56 So far so good. 03:58 Let’s keep going. 03:59 Diagnosis made by standing exam. 04:01 What? Yes, exactly right. 04:04 You can see this on gross examination with your eyes and the scrotum looks like it contains a bag of “worms”. 04:12 Why? Because the veins are engorged. 04:14 Can you picture that? Literally, the scrotum looks like a bag of worms. 04:19 Okay. 04:20 Hence, the standing exam. 04:22 Let’s keep going. 04:23 Inspect the bag of worms that are palpable and observe with? Make sure you know how to investigate properly. 04:29 A Doppler ultrasound. 04:31 It does not transilluminate. 04:33 That’s important. 04:34 It does not, because what’s in your vein? Blood. 04:38 Blood is thick and viscous, it will not transilluminate. 04:42 "Versus what, Dr. Raj?" Hydrocele. 04:46 Be careful. 04:48 They both have the suffix –cele. 04:50 Varicocele, hydrocele. 04:52 You pay attention to the prefix. 04:54 Varico-, blood. 04:56 Hydro-, fluid. 04:58 Which one of these will illuminate? Fluid, hydro-. Not varico- Are we clear? Let’s keep going. 05:05 So it does not transilluminate. 05:06 And management includes – Well, you have to – My goodness, you have to get rid of the congestion. 05:11 So there’s something called varicocelectomy or perhaps something called embolization. 05:16 On a Doppler ultrasound, you will find certain issues and with ultrasound, you would find as you see in the picture here, the bag of worms type of appearance. 05:27 Image shows several what’s known as your anechoic tubule. 05:31 What does that mean to you? Remember this doesn’t appear as being lucent and black, anechoic. 05:36 And the application they call a Doppler imaging in the same patient will show what? Bidirectional flow with anechoic tube. 05:44 Now, do you understand this is in the veins? Should the veins ever -- The fluid and the blood, should it ever move back and forth, back and forth? No. It’s always unidirectional. 05:54 Veins are always draining. 05:57 So if it’s blocked and you see bidirectional flow, that’s a pathology. 06:02 Full picture of varicocele. 06:03 Every single bullet point that I’ve gone through here, incredibly important.
The lecture Varicocele by Carlo Raj, MD is from the course Male Reproductive System Diseases.
Acute onset of a varicocele may indicate what pathology?
Which factor does NOT cause acute varicocele?
Which statement is TRUE regarding the diagnostic findings of a varicocele?
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