Genitourinary Flashcards

Question

Discuss UTIs in children

Answer 1

Most common cause of fever in young children neonatal boys are more susceptible than girls but beyond that females have a much high risk Vesicuoureteral reflux from the bladder into the ureter is a common cause of recurrent urinary infecitons. E.coli is the most common pathogen Enterobacter, proteus, morganella, serratia and salmonella, UTI in infants yonger than 3 months ar eassociated with baceremia in up to 50% of cases

Answer 2

Measures conversion of nitrates to nitrites by gram -ve bacteria, may not be +ve in young children who urinate frequently

Answer 3

Much high risk of sepsis. Formely reccomended that all infants under 2 months with UTI should have full septic screen and admission for IVABS. Some recent studies have suggested that is may be safe in a subset of patient to be treated in OPD setting 2 months -2 years Can be treated as an OPD UTI in this age group are considered to be upper tract disease process 7-14 day courses should be used Older than 2 years simple cystitis should have a 3 day course of ABs

Answer 4

``` INfection -UTI -Vaginitis (gardnerella, trichomonas, or STI) Pinworms -balanitis ``` Irritation - Bubble bath, new soups - foreing body Trauma - Sexual or physical abuse - Strddle injury - self stimulation or masturation Other - labial adhesions ' - stones

Answer 5

Extra-renal - Trauma - Meatal stenosis or posteiror urethral valves - exercise - menstraution or rectal bleeding - foreign bodies - cystitis, urethritis, epididymitis Renal - Pyelo - Renal or bladder stones or tumorus - Post strep or idiopathic GMN - AIN - ATN - Basement membrane glomerula disease - renal vein or artery thrombosis - recurrent familial haeaturia - PCKD Systemic - Alport syndrome neprhitis (recessive X-linked disorder that is typically seen in males and is often accompanied by high-frequency sensorineural hearing loss (SNHL), ocular abnormalities including anterior lenticonus, and, over time, progressive renal failure) - HSP - SLE - Haemolytic ureamic syndrome - EBV (MONO) - sickle cell disease or other haemoglobinopathies - Bacterial endocarditis - bleeding disorders - drugs

Answer 6

5 RBC or more incidcates haematuria THe presence of WBC, nitrates or leukocyte esterase indicates infection RBC casts, large p[roteinuria, HTN or renal insufficency may indicate glomberula pathology ESR and ANA for SLE If well and no cause found the child should follow-up with primary care provider for a 24 hours urine collection

Answer 7

Trace to mild proteinuria (1+ to 2+) is a common laboratory finding in young children and can represent many benign conditions such as exercise or dehydration. If the amount is significnat such as in nephrotic syndrome the resultant hypoalbumineamia may cause generalised oedema Disposition - Children with significant oedema and ascitis, significant HTN or makred renal impariment should be hoispitalized - otherwise can be managed as OPD with close follow-up

Answer 8

Can be glomerula or tubular Glomerular - nephrotic syndrome - glumeruloneprhitits - posttransplantation rejection Tubular - heavy metal poisoning - UTI - diabetes

Answer 9

``` Mild proteinuria (<=2+ or <100mg/dl) requires no further IX. Evidence of UTI such as WBC or positive luekocyte exterase or nitrate level should be treated ``` Moderate proteinuria (3+ or >300mg/dl) should have additional investigation - Serum protein and albumin - electrolytes - BUN - creatinine levels - urine culture Random PCR (protein creatine ratio) corrleates well with 24 hours urine collection - normal is less than 0.2mg/gl - urine PCR more than 3mg/dl corrleates with nephrotic syndrome ASO can be used to identify previous strep infections

Answer 10

PSGN is the most common glumerulonephritide Sequalae of streptococcal pharyngitis and less commonly skin infection PSGN is believed to reuslt from the deposition of circulating immune complexes on the kidney. Typically occurs in children 3-7 years of age usually with a history of pharyngitis with fever 2 weeks before the onset of nephritis. Symptoms can be loclaised to the urinary tract manifest as -haematuria -f;lank pain -lethargy -generalised oedema Renal failure is found in 2% of cases

Answer 11

Urinarlysis shows significant haematuria andprotein with RBC cast in 60% of cases Other finding include pyuria with granular or hylar cast BUN elevated hyponatraemia and hyperkalaemia ASO tirtre and IGG elevation C3 and C4 decreased

Answer 12

``` IGA nephropathy (GIT and respiratory infection) Goodpastures Wegeners granulomatosis Alport HSP HUS ```

Answer 13

Fluid and Na restriction Diuretics in consult with paeds (thiazides 1st line followed by loop for more signifiacnt disease) AB not indicated Antihypertensives if needed (CA or B blocakde) THose with CCF, uremia or significant HTN should be admitted otherwise can be managed as OPD after talkking to the friendly paeds chaps.

Answer 14

Characterised b significant proteinuria, hypoproteinemia and oedema. +loss of clotting proteins and immunoglobulins Primarly commonly occur in children younger than 5 the majority of which are minimal change Secondary neprhotic syndrome is usually seen in older children from systemic illness such as PSGN or SLE

Answer 15

Onset of oedema may be insidious beginning with periorbital oedema. Children are not usually ill unless there is pulmonary oedema or ascites HTN, haematuriaor oliguira can also be present Nephrotic children are at increased risk of thrmobosis with 2% developing thromboembolic complications

Answer 16

Nephrotic range proteinuria is more than 3.5g of proetin or more than 50mg/kg Complement is reduced in nephrotic syndrome hyperlipidaemai occurs in neprhotic syndrome for not completley understood reason

Answer 17

Despirte oedema children with signs of hypovolaemai should be treated with cyrstalloids Patients with presumptive diagnosis of primary neprhotic syndrome can be treaeted with steroids If signs of ascites or pulmonary or pleural odema should have loop diuretics and may need fluid and salth restriction As children with neprhotic syndrome are relatively immunodepressed due to loss of IG any fever should be treated in hosiptal with IVIABs

Answer 18

Pre-renal - Decreased intravascular volume or dehydaration - -burns - -third spacing - - sepsis - Decreased CO - -Caridiogenic shock - Decreased renal artery blood flow Intrarenal - Glomerula disease - -PSGN and orthers - -Pyelo - Systemic casues - -HUS - -HSP - -SLE - -Sepsis - Toxins - -heavy metals - -myoglobin or haemoglobin deposits - -ABs such as aminoglycosides - -anticonvulsants - - radiocontrast dyes Post renal - obstructive lesions - nephrolithiasis or tumor - post urehtral valves - intrabadominal tumor obstructing urinary flow - infection - renal vein thrombosis

Answer 19

Defined as a systolic or diastolic blood pressure higher than 2 standard deviations above the mena for the age ``` Blood pressure upper limit for age 0-2: 110/65 3-6: 120/70 7-10: 130/75 10-15: 140/80 ```

Answer 20

Renal - Nephritic or nephrotic syndromes - HSP - Pyelo - Obsturctive or reflux - PCKD - diabetic nephrtopathy - trauma - renal transplant - tuberous sclerosis - SLE Endocrine - Phae - Cushings - congenitial adrenal hyperpalsia - corticosteroids treatment - hyperthyroduism - neuroblastoma - ovarian tumor Cardiac - CCF - coarctation of the aorta Vascular - HUS - Kawasaki syndrome - Rneal artery thrmobosis or stenosis Neurolgoic - CNS tumor or infection - CNS trauma or abuse - Rasied ICP - Guillian Barre syndrome Neoplastic - neuroblastoma - Wilms tumor - Phae - Adrenal carcinoma Drgus - Corticosteroids - cocaine - sympathomimetics - OCP - Phecyclidine - B blockade or clonidine withdrawlal

Answer 21

Is an immunoglobulin A mediated systemic vasculitis involving the small blood vessels of the skin, GIT and joitns The peak incidence for HSP is between 4-7 years of age 50% of affected children have a history of previous upper respiraotry tract infection and as many as 75% have group A beta haemolytic strep

Answer 22

Hallmark is a palpable purpuric or petehcial rash. This is seen in the vast majority of patients and is most prominent on the lower extremities starting at the lateral malleoli Arthralagia and arthritis are common usually involved knees and ankle joints Dull peri-umbilical pain resulting from bleeding into the intestinal wall occurs in at least 50% of cases Self limiting glomerulonephritis will develop in 25-50% of cases manifested by haematuria with or without RBC cast

Answer 23

Urine and urinanylysis for RBC and CAST + protein BUN and creat levels FBC Coags US of the abdomen wif significant abdom signs

Answer 24

Most cases resolve spontanesouly and do not require threapy NSAIDS for pain corticosteroids reduce time course

Answer 25

A microangiopathic haemolytic anaemia is one of the most common causes of AKi in children HUS is rare after the age of 5 years of age but recurrence is more common in older children and mortality is 30% Most common cause is Shiga toxin producing e.coli Transmission is through person to person contact or exposure to contaminated food HUS can be classified as primary cause by compliment dysregulation and secondary caused by infection Renal compromise is caused by vascular endothelium injury induced by viral or bacterial agents. RBCs are injured within the narrowed blood vessels resulting in a microangiopathic haemolytic anaemia. Platelets complement and fibrin are deposited in the glomerular lumen resulting in thrombocytopenia, decrease in the GFR and renal failure

Answer 26

Secondary HUS from STEC present with watery diarrhoea crampy abdominal pain and occasionaly fever. Within days of symptoms increasing abdominal pain with 50-85% of patient developing bloody stool. up to 10% of patients will experience the triad of sudden onset of haemolytic anaemia, thrombocytopenic and acute renal insufficiency with possible progression to renal failure. Up to 60% of diarrhoea related HUS cases require dialysis and death or ESRD occur in 12%

Answer 27

Renal - AKI - CKD GIT - toxic megacolon, - ischaemic colitis - intussusception - perforation - delayed colonic stricutre ' Systemic - Anaemia - Thrombocytopenia - HTN

Answer 28

Early peritoneal dialysis and supportive measure current mortality is less than 5% Fluid resus if dry electrolyte management (hyper K common) Do not given antimotility agents Antibiotics have not be shown to prevent HUS from STEC and may increase the release of verotoxins and worsen sytmpoms

Answer 29

1) mec ileus 2) anal anomalise (stenosis, stricter, malposition) 3) spinal anomalise 4) hirschprung's 5) hypothyroidism 6) metabolic - hypercalcium, hypokalaemia 7) coeliac disease 8) cows milk intolerance 9) lead poisoning 10) intellectual impairment 11) child abiuse 12) CF 13) dietary 14) psychogenic 15) drug releated

Answer 30

1) exclude physical treatable cuases with carful history exam and ix 2) empty rectum preferably from the top 3) esatblish a pharmacological bowel rhythm and pattern which may need support for years 4) allow the nelarged rectum to re-restablish it own inherent physiologcial bowel pattern and tone and to regain its normal sensation 5) continue maintenance for some time before considering slowly weaning off pharmaceuticalls This will involve - enthusiasm on part of managing clinicians - non punitve behaviour on part of the parents - adjunctive behavioural modification interventiojns with achievable golas including motivational praise with star and reward charts

Answer 31

If consitpation is severe the bowel may need disimpaction before maintenance treatment can be commenced 1) oral OPD faecal disimpaction is the preferred method. Macrogel 3350 sachets are tolerated better if cooled in the fridge. They are administered by esclated dose. - age 2-5 one sachet on day 1, 2 on day 2and 3, 3 on day 4 and 5 and 4 on day 6 and 7 Rectal disimpaction is avoided when possible Inpatient disimpaction -this is usually a planned admission involving the administration of bowel preparation fluid via a NGT.

Genitourinary Flashcards

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