Children Flashcards by Moratwe Masima

What is primary enuresis

The child has never been dry at night before

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Nocturnal Enuresis definition

The child continues to involuntarily void beyond the age of anticipated control
For example bed wetting twice a month in a child of 5 years

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Secondary enuresis

A recurrence of incontinence after the child has been dry for 6 months

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What is the initial drug of choice in enuresis?

Desmopressin which is a vasopressin

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How long does desmopressin work for?

7-10 hours after administration

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Retractile Testis definition

Descended testis that have moved upwards by cremaster muscle spasm and can be massaged and it will drop again

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Undescended Testes definition

These are testes that have not descended down the abdomen

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Ectopic testes

This is when the testis has passed through the inguinal canal and has deviated away towards the outside of the scrotum

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What are the 2 descents of the testes?

Transabdominal descent

2. Inguinoscrotal descent

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What is orchidopexy?

A surgical procedure where they move an undescended testicle into the scrotum and permanently fix it there

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What usually happens at the 3 month mark to baby boys to help descend testes?

There is a surge of testosterone

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What is prune belly syndrome always associated with?

Bilateral undescended Testes

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What is the risk for undescended testes of becoming malignant?

5-10x more risk of malignancy

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What is the treatment for UDT?

Wait until 12-18 months
Orchidopexy
Hormone therapy(B-HCG and Gonadotropin releasing hormone)

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What is the most common organism that causes UTI’s in children?

E coli

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What ages is it common for children to have a UTI?

6 months

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What are some of the common clinical signs of UTI in children?

Fever (febrile convulsions)
irritability
Trouble feeding
Diarrhoea and vomiting
Jaundice

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How do you collect urine from a child with possible UTI?

Use a urine bag
suprapubic catheter for complications getting an uncontaminated bag specimen
Midstream urine specimen

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What are the investigations for UTI in children?

First you do a dipstick and if leucocytes and nitrites are high then it is suggestive of a UTI
Then ensure you do a Ultrasound KUB and MCUG

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What investigation is the gold standard for Vesico-ureteric Reflux?

MCUG

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What investigation cannot be done until the UTI is treated?

MCUG

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How long do you give the antibiotics for?

7-14 days

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What prophylactic Antibiotics do you give?

You can use co-trimoxazole(bactrim)
or
Nitrofurantoin

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When does the prepuce develop intra-uterinally?

12th-20th week

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Give 4 medical indications for circumcision?

1. Phimosis 2. Parphimosis 3. To reduce risk of penile cancer 4. Reduce incidence of UTI in baby boys under 6 months 5. Reduces incidence of HIV

Sensory innervation of the penis is supplied by?

Two dorsal nerves of the penis on either side of he midline

What anaesthesia do you use in infants prior to circumcision?

1. Bupivicaine (1mg/kg) which lasts for 6 hours | 2. Lignocaine (2mg/kg)

Define hypospadias

Abnormal opening of urethral meatus on the ventral aspect of the penis Chordee-The curvature of the penis towards the ventral aspect of the penis

What other congenital anomalies is hypospadias associated with?

1. Undescended testes | 2. Inguinal hernias

What is a requirement for the development of the normal urethra?

You need DHT(dihydotestosterone) convrted testosterone by 5-alpha reductase

At what age does hypospadias surgery occur?

Around the age of 2

What are the most important factors for the hypospadias surgery?

To correct the chordee and straighten the penis | To reconstruct the urethra

What is antenatal hydronephrosis?

5 mm AP diameter on ultrasound

What is the most common cause of unilateral hydronephrosis?

Pelvic-ureteric junction obstruction

What are some of the causes of bilateral hydronephrosis?

Bilateral Pelvic-ureteric junction obstruction Bilateral VUR Prune belly syndrome

What is VUR?

This is defined as when the urine back-flows from the bladder up the ureters again

What is primary VUR?

When the issue is a congenital one and is related to how the ureters enter the bladder(short submucosal tunnel)

What is VUR associated with in children?

UTI

What is the gold standard to diagnose VUR?

MCUG

What are the complications of VUR?

Renal failure Hypertension due to renal scarring Reflux nephropathy or chronic pyelonephritis

What is secondary VUR?

This caused by some sort of obstruction | Bladder outflow obstruction or posterior urethral valve or neuropathic bladder

What is the DMSA used to detect?

Renal scarring

When do you do a post natal ultrasound when dealing with VUR?

At 1 and 6 weeks

When do you do do a DMSA/MAG3 when dealing with VUR?

At 6 and 12 weeks

What is the medical Rx of VUR?

We give low dose chemo-prophylaxis-nitrofurantoin or nalidixic acid

What is the definition of a PUJ?

The obstruction at the junction between the ureter and the renal pelvis which results in restriction of urinary flow

Which kidney is usually affected with PUJ?

The left kidney

What is neonatal anuria?

The inability of the child to pass urine before the first 24 hrs of life

If the baby has not passed urine within 24 hours what could be the cause?

Urinary retention or anuria

What are the causes of anuria?

Bilateral renal agenesis or renal venous thrombosis | Or renal arterial thrombosis

Causes of urinary retention include:

Bladder outlet obstruction Posterior urethral valves Magnesium sulphate in pregnancy to help with pre-eclampsia

What is cloacal exstrophy?

Involves the bladder and the bowel

What is bladder exstrophy?

It involves the bladder and the urethra exposed

What is epispadias?

It involves the urethra being open on the dorsal aspect

What are the clinical features of exstrophy?

``` Undescended testes Epispadias Bifid clitoris in girls Diastasis of pubic symphysis Penis is usually short and stubby ```

Management of a child with bladder exstrophy

Urological emergency Cover with plastic and transfer immediately for bladder closure+ orchidopexy+ urethral reconstruction and iliac osteomies

What are the triad of abnormalities associated with prune belly syndrome?

Undesecended testes Abnormal abdominal wall Anomalies of the urogenital tract

Babies with prune belly syndrome often present with:

Pulmonary hypoplasia- respiratory distress

What are some of the special investigations associated with prune belly syndrome?

Ultrasound MCUG Urine culture and Urine MCS because of the high occurrence of UTI

Management of babies with prune belly syndrome:

Treat with AB because of the UTI | Elective bilateral orchidopexy for the UDT

What are the clinical features of posterior urethral valves on ultrasound?

* oligohydroamnios * bilateral hydronephrosis * thickened bladder wall

What is the surgical Rx for VUR?

ureterneocystostomy which has a 90% success rate

What are the primary causes of PUJ obstruction?

Abberant development of ureteric/pelvic circular muscle Abberant insertion of the ureter into the renal pelvis(higher than normal) Abnoemal collagen folds Extrinsic vessels occluding the ureters

What is the best investigation for PUJ?

Ulrasound then MAG3/DMSA followed by IVP

What are the clinical signs of PUJ?

Haematuria UTI Loin pain

What are the complications of PUJ

Renal failure Pyelonephritis Calculi Hypertension

Mx of PUJ obstruction:

Conservative with AB and watch with U/S If surgery is indicated then do: pyeloplasty, balloon dilataion or nephrectomy

What is the ratio of the ureter and the ureteric diameter/

5:1

What is simple multicystic dysplastic kidney disease?

This is when it affects only one side of the kidney

What is complex multicystic dysplastic kidney disease?

This is when it affects both kidneys

Unilateral disease of MCDKD is associated with:

contralateral PUJ or VUR of the contralateral kidney

In autosomal recessive polycystic kidney disease, the child dies from:

Respiratory distress

What genes are associated with Polycystic Kidney Disease?

PKD1 and PKD2

What is the incidence of nephroblastoma in children?

About 10-20%

At what age does Wilms Tumour occur?

2-3 years old

What do children with Wilms tumour present with?

AbdomInal mass, haematuria, hypospadias, UDT

What is the treatment of Wilms tumour?

Nephrectomy, chemotherapy and radiotherapy

What are the clinical presentations of children with neuroblastoma?

``` systemically unwell fever abdominal mass loss of weight anaemia ```

Children Flashcards

(78 cards)