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Flashcards in GU Deck (63)
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1

MC organisms involved in UTIs?

e coli
kelbsiella
proteus
enterococcus

2

RF for UTIs?

constipation
VUR (vesicoureteral reflux)
urinary tract obstruction
neurogenic bladder
poor perineal hygiene
structural abnormalities
catheterization
sexual activity

3

S/s of UTI in new borns/infants?

nonspecific signs: fever, hypothermia, jaundice, poor feeding, irritability, vomiting, FTT, & sepsis

+/- strong, foul-smelling or cloudy urine

4

s/s of UTIs in pre-school children?

abd &/or flank pain, vomiting, fever, frequency, dysuria, urgency, or enuresis

CVA tenderness is unusual in young children

5

s/s of UTI in school aged children?

classic s/sx of cystitis: frequency, dysuria, & urgency

possibly pylonephritits: fever, vomiting, flank pain
CVA ttp(+/-)

6

Dx of UTI?

screening UA
-pyuria
-Nitrite* (can be - in young children)

GOLD standard: urine culture of properly collected specimen

7

Tx for UTI

<3mo, septic, dehydrate:
ADMIT to hospital for IV abx

Older infants/children: empiric therapy
-Amoxicillin, TMP-SMX, 1st gen cephalosporin
-7-10days

8

What is vesicoureteral reflux (VUR)

Reflux of urine from bladder into the ureter/upper urinary tract

1% of newborns
increases up to 15%

9

Epidemiology of VUR?

White > Black

F > M

MC <2yrs

strong fam hx

10

What is primary VUR?

incompetent or inadequate closure of the ureterovesical junction (UVJ)

Due to a congenitally short intravesicular ureter

MC form of reflux

11

What is secondary VUR?

BLOCKAGE
Due to an abnormally high voiding pressure in bladder which results in failure of the closure of UVJ during bladder contraction

Functional bladder obstruction (neurogenic bladder)

Anatomic dysfunction - Posterior urethral valves

12

s/s of VUR?

Prenatal: hydronephrosis on prenatal u/s

Postnatal: febrile UTI

13

Work up for prenatal VUR?

Prenatal hydronephrosis (on prenatal u/s):

unilateral: repeat ultrasound at 1wk of age

bilateral: repeat ultrasound + VCUG

14

work up for post natal VUR?

UTI: renal & bladder u/s

Febrile UTI: Voiding Cystourethrogram (VCUG)

15

Grading for VCUG reflux?

Grade 1 (reflex into ureter w/ no dilation) -->

Grade 4 (reflux w/ dilation of ureter & blunting of reflux calyces)

16

Tx for grade 1 and 2 VUR?

Monitor for spontaneous resolution (by age 5, 80% spontaneously resolve)

Consider prophylactic antibiotics

17

Tx for grade III to V VUR?

regardless of age antibiotic prophylaxis:
TMP-SMX (2mg/kg) or nitrofurantoin (1-2mg/kg)
DC when VUR resolves (spontaneously or surgically)

at risk for complications if left untreated

18

What is posterior urethral valves?

Obstructing membranous folds within the lumen of the posterior urethra

obstructs normal flow of urine

MC etiology of UT obstruction in newborn male

19

Dx of PUV?

Prenatal US:
Bilateral hydronephrosis, distended and thickened bladder

+/- oligohydramnios

Post natal:
Failure to thrive, distended abdomen, poor urinary stream

Older boys: straining to urinate, UTIs, daytime & nocturnal enuresis

Dx- VCUG- dilated & elongated posterior urethra during the voiding phase

20

PUV tx?

prenatal: experimental surg

post natal: correct electrolyte abn, foley cath, surg correction

21

FU post PUV tx?

Bladder dysfunction may require clean intermittent catheterization

Monitor for renal failure- significant risk despite early intervention: Renal transplant

Monitor for UTIs

22

What is considered daytime freq?

voiding >8x/day

23

What is enuresis?

Repeated urination into clothing (day & nighttime) by a child > than 5y/o

diurnal enuresis = wetting while awake

24

Primary v. secondary nocturnal enuresis?

Primary = occurring in children who have NEVER been consistently dry though the night

Secondary = resumption of wetting after at least 6mo of dryness

25

s/s of enuresis?

child > 5yr (developmentally & chronologically)

at least 2x per week for 3 months

26

RF for nocturnal enuresis?

often associated w/ underlying constipation

runs in families

sleep apnea

psychological

27

dx of nocturnal enuresis?

H&P: r/o anatomical abn, constipation

UA +/- culture

28

Tx of nocturnal enuresis?

pt ed

limit liquids before sleep

awaken the child at night to bathroom

Bedwetting alarms

meds if others fail

29

What meds can be used for nocturnal enuresis?

Desmopressin Acetate (DDAVP)- synthetic analogue of the antidiuretic hormone (ADH) vasopressin
-can be Rx for short term periods

Imipramine- high risk ADEs

30

What is considered daytime urinary incontinence?

Wetting accident at least once every 2 weeks

Incidence decreases w/ age

when continence NOT achieved by 6yrs of age, need to consider underlying cause