Nephrology & Renal Flashcards
(110 cards)
1
Q
what is a UTI?
A
infection anywhere along the urinary tract - urethra, bladder, kidney
2
Q
what is meant by cystitis?
A
inflammation of the bladder, and can be the result of a bladder infection.
3
Q
what must be excluded when a child has a fever?
A
UTI - fever may be the only symptom
4
Q
how does a UTI present in babies?
A
- very non specific symptoms:
- Fever
- Lethargy
- Irritability
- Vomiting
- Poor feeding
- Urinary frequency
5
Q
what are some signs and symptoms for older infants and children?
A
- Fever
- Abdominal pain- suprapubic
- vomiting
- Dysuria
- Urinary frequency
- Incontinence
6
Q
what is acute pyelonephritis?
A
infection affects the tissue of the kidney. It can lead to scarring in the tissue and consequently a reduction in kidney function.
7
Q
when can a diagnosis of pyelonephritis be made?
A
Diagnosis made if either there is:
- Temp>38
- Loin pain or tenderness
8
Q
what is the ideal urine sample?
A
clean catch sample - avoiding contamination
parent may have to sit with infant without nappy on waiting to catch urine in pot
9
Q
what do nitrites indicate on a dip stick?
A
suggests bacterial infection - presence of bacteria in urine - gram negative bacteria break down nitrates (normal waste product in urine) into nitrites
better indication of infection than leukocytes
10
Q
what do leukocytes on dip stick indicate?
A
normally small number of WBC in urine but significant rise can be bc infection or other cause of inflammation
urine dipstick tests for leukocyte esterase
11
Q
when are patients treated for uti regarding nitrites and leukocytes on dip stick?
A
if both nitrites and leukocytes - treat as UTI
if only nitrites - treat as UTI
if only leukocytes - do not treat unless clinical evidence they have UTI
12
Q
when should urine be sent to the microbiology lab?
A
if nitrites or leukocytes are present
send for culture and sensitivity testing
13
Q
how is UTI managed?
A
all children under 3 months with fever - IV abx - ceftriaxone and full septic screen (cultures, bloods, lactate) also consoder lumbar puncture
oral abx in children >3 months if otherwise well
sepsis or pyelonephritis - IV abx
14
Q
name 4 abx that can be used in children with uti?
A
- Trimethoprim
- Nitrofurantoin
- Cefalexin
- Amoxicillin
15
Q
what are the guidelines of USS for children with UTI?
A
- All children <6 months with their first UTI should have an abdominal ultrasound within 6 weeks, or during the illness if there are recurrent UTIs or atypical bacteria
- Children with recurrent UTIs should have an abdominal ultrasound within 6 weeks
- Children with atypical UTIs should have an abdominal ultrasound during the illness
16
Q
what is a DMSA scan?
A
dimercaptosuccinic acid scan
used 4-6 months after illness to assess for damage from recurrent or atypical UTIs
injecting radioactive material and using a gamma camera to assess how well the material is taken up by the kidneys
where there are patches that have not taken up the material - indicated scarring from previous infection
17
Q
what is vesico-ureteric reflux
A
where urine has a tendency to flow from the bladder back into the ureters. This predisposes patients to developing upper urinary tract infections and subsequent renal scarring.
18
Q
how is VUR diagnosed?
A
micturating cystourethrogram (MCUG)
19
Q
how is VUR managed?
A
- Avoid constipation
- Avoid an excessively full bladder
- Prophylactic antibiotics
- Surgical input from paediatric urology
20
Q
what is a Micturating cystourethrogram (MCUG)?
A
Micturating cystourethrogram (MCUG) should be used to investigate atypical or recurrent UTIs in children under 6 months. It is also used where there is a family history of vesico-ureteric reflux, dilatation of the ureter on ultrasound or poor urinary flow.
It involves catheterising the child, injecting contrast into the bladder and taking a series of xray films to determine whether the contrast is refluxing into the ureters. Children are usually given prophylactic antibiotics for 3 days around the time of the investigation.
21
Q
what is vulvovaginitis?
A
inflammation and irritation of the vulva and vagina. It is a common condition often affecting girls between the ages of 3 and 10 years.
22
Q
what causes and exacerbates vulvovaginitis?
A
Caused by sensitive thin skin and mucosa around the vulva and vagina in young girls. More prone to colonisation and infection with bacteria spread from faeces. Can be exacerbated by:
- Wet nappies
- Use of chemicals or soaps cleaning the area
- Tight clothing that traps moisture or sweat in the area
- Poor toilet hygiene
- Constipation
- Threadworms
- Pressure on the area, for example horse riding
- Heavily chlorinated pools
23
Q
how does vulvovaginitis present?
A
- Soreness
- Itching
- Erythema around labia
- Vaginal discharge
- Dysuria
- Constipation
Urine dip may show leukocytes but no nitrites. Often misdiagnosed UTI
24
Q
how is vulvovaginitis managed?
A
May already have been treated for UTI and thrush, usually with little improvement in symptoms. (Unusual to develop thrush before puberty)
No medical just conservative:
- Avoid washing with soap and chemicals
- Avoid perfumed or antiseptic products
- Good toilet hygiene, wipe from front to back
- Keeping the area dry
- Emollients, such as sudacrem can sooth the area
- Loose cotton clothing
- Treating constipation and worms where applicable
- Avoiding activities that exacerbate the problem
Severe cases an experienced paediatrician may be recommend oestrogen cream to improve symptoms.
25
what is nephrotic syndrome?
occurs when the ***basement membrane*** in the ***glomerulus*** becomes highly permeable to ***protein***, allowing proteins to leak from the blood into the urine.
26
what is the most common age group to develop nephrotic syndrome
between 2 and 5 years
27
how does nephrotic syndrome present?
frothy urine
generalised oedema
pallor
28
what is the triad of nephrotic syndrome?
* Low serum albumin
* High urine protein content (\>3+ protein on urine dipstick)
* Oedema
29
Aside from low serum albumin, high urine protein content (\>3+ protein on urine dipstick) and oedema what are 3 further features of nephrotic syndrome?
* ***Deranged lipid profile***, with high levels of ***cholesterol***, ***triglycerides*** and ***low density lipoproteins***
* ***High blood pressure***
* ***Hyper-coagulability***, with an increased tendency to form blood clots
30
what is the most common cause of nephrotic syndrome?
minimal change disease
31
Name 2 causes where it is secondary to intrinsic kidney disease?
* Focal segmental glomerulosclerosis
* Membranoproliferative glomerulonephritis
32
what are 3 systemic illnesses which nephrotic syndrome can be secondary to?
* Henoch schonlein purpura (HSP)
* Diabetes
* Infection, such as HIV, hepatitis and malaria
33
What is minimal change disease?
most common cause of nephrotic syndrome in children. It can occur in otherwise healthy children, without any clear risk factors or reason for developing the condition. It is not clear why it occurs in most cases.
A ***renal biopsy*** and standard ***microscopy*** in ***minimal change disease*** is usually not able to detect any abnormality. ***Urinalysis*** (analysis of the urine) will show ***small molecular weight proteins*** and ***hyaline casts***.
34
how is minimal change disease managed?
***corticosteroids*** (i.e. prednisolone). The prognosis is good and most children make a full recovery, however it may reoccur.
35
how is nephrotic syndrome managed?
* High dose steroids (i.e. prednisolone)
* Low salt diet
* Diuretics may be used to treat oedema
* Albumin infusions may be required in severe hypoalbuminaemia
* Antibiotic prophylaxis may be given in severe cases
36
high dose steroids are used to treat nephrotic syndrome - describe the responses and how steroid resistant children are managed?
* 80% of children will respond to steroids, and are referred to as ***steroid sensitive***
* 80% of steroid sensitive patients will relapse at some point and need further steroids
* Patients that struggle to wean steroids due to relapses are referred to as ***steroid dependant***
* Patients that do not respond to steroids are referred to as ***steroid resistant***
In steroid resistant children, ***ACE inhibitors*** and ***immunosuppressants*** such as cyclosporine, tacrolimus or rituximab may be used.
37
what are some complications of nephrotic syndrome?
* ***Hypovolaemia*** occurs as fluid leaks from the ***intravascular space*** into the ***interstitial space*** causing ***oedema*** and ***low blood pressure***.
* ***Thrombosis*** can occur because proteins that normally prevent blood clotting are lost in the kidneys, and because the liver responds to the low albumin by producing pro-thrombotic proteins.
* ***Infection*** occurs as the kidneys leak ***immunoglobulins***, weakening the capacity of the immune system to respond. This is exacerbated by treatment with medications that suppress the immune system, such as steroids.
* ***Acute*** or ***chronic renal failure***
* ***Relapse***
38
what is nephritis?
***Nephritis*** refers to ***inflammation*** within the ***nephrons*** of the kidneys
39
what does nephritic cause?
* Reduction in GFR
* Haematuria
* Proteinuria (less than nephrotic)
40
what are the 2 most common causes of nephritis in children?
Post-streptococcal glomerulonephritis
IgA nephropathy (Berger’s disease)
41
what is post-streptococcal glomerulonephritis?
Occurs 1-3 weeks after a B-haemolytic streptococcus infection, such as tonsillitis caused by strep pyogenes
Immune complexed made up of streptococcal antigens, antibodies and complement proteins get stuck in the glomeruli of the kidney and cause inflammation. Inflam= acute deterioration in renal function causing AKI.
42
when should a diagnosis Post-Streptococcal Glomerulonephritis be suspected?
when there is evidence of tonsillitis caused by strep. This could be a hx tonsillitis, positive throat swab and anti-streptolysin antibody titres found on a blood test.
43
how is Post-Streptococcal Glomerulonephritis managed?
supportive and around 80% of patients will make a full recovery.
some patients can develop a progressive worsening of their renal function.
They may need treatment with ***antihypertensive medications*** and ***diuretics*** if they develop complications such as ***hypertension*** and ***oedema***.
44
what is IgA nephroapthy?
aka Bergers disease
related to [***Henoch-Schonlein Purpura***](https://zerotofinals.com/paediatrics/rheumatology/hsp/), which is an ***IgA vasculitis***.
***IgA deposits*** in the ***nephrons*** of the kidney causes inflammation (***nephritis***).
When a renal biopsy is taken the histology will show “***IgA deposits*** and ***glomerular mesangial proliferation***”.
It usually presents in teenagers or young adults.
Management involves ***supportive treatment*** of the renal failure and ***immunosuppressant medications*** such as steroids and cyclophosphamide to slow the progression of the disease.
45
what is haemolytic uraemic syndrome?
occurs when there are thrombosis within small vessels throughout body
usually triggered by Shiga toxin (produced by e coli 0157) and leads to classic triad of:
haemolytic anaemia, AKI, thrombocytopenia
46
what increases risk of HUS development?
use of antibiotics and anti-motility medications
47
what are the symptoms of HUS?
usually presents around 5 days after onset of diarrhoea
* Reduced urine output
* Haematuria or dark brown urine
* Abdominal pain
* Lethargy and irritability
* Confusion
* Oedema
* HTN
* Bruising
48
how is HUS managed?
Medical emergency as has 10% mortality. Needs to be managed by experienced paediatricians under the guidance of a renal specialist. Condition itself is self-limiting and supportive management is the mainstay of treatment
* Urgent referral to the paediatric renal unit for dialysis is required
* Antihypertensive medication required
* Careful maintenance of fluid balance
* Blood transfusions if required
70-80% patients make a full recovery.
49
what is enuresis?
enuresis = involuntary urination
Bed wetting = ***nocturnal enuresis***
Inability to control bladder function during the day is called ***diurnal enuresis***.
Most children get control of daytime urination by 2 years and nighttime urination by 3 – 4 years.
50
what is primary nocturnal enuresis? and what is the most common cause?
never been dry at night
## Footnote
variation on normal development, particularly if the child is younger than 5y/o.
Often pt will have FH of delayed dry nights. In this situation reassurance is important, and there is no need to jump to further investigations or management.
51
what are some other causes of primary nocturnal enuresis?
* ***Overactive bladder***. Frequent small volume urination prevents the development of ***bladder capacity***.
* ***Fluid intake*** prior to bedtime, particularly fizzy drinks, juice and caffeine, which can have a diuretic effect
* ***Failure to wake*** due to particularly deep sleep and underdeveloped bladder signals
* ***Psychological distress***, for example low self esteem, too much pressure or stress at home or school
* ***Secondary causes*** such as ***chronic constipation***, ***urinary tract infection***, ***learning disability*** or ***cerebral palsy***
52
how is primary nocturnal enuresis managed?
2-week diary of toileting, fluid intake and bedwetting episodes.
Helps establish any patterns and identifies areas that may be changed, such as fluid intake before bed.
It is important to take a hx and examination to exclude underlying physical or psychological causes.
53
how is primary nocturnal enuresis managed?
* Reassure parents of children under 5 years that it is likely to resolve without any treatment
* Lifestyle changes: reduced fluid intake in the evenings, pass urine before bed and ensure easy access to a toilet
* Encouragement and positive reinforcement. Avoid blame or shame. Punishment should very much be avoided.
* Treat any underlying causes or exacerbating factors, such as constipation
* Enuresis alarms
* Pharmacological treatment
54
what is secondary nocturnal enuresis?
child begins wetting the bed when they have previously been dry for at ***least 6 months***. This is more indicative of an underlying illness than primary enuresis
55
what are some causes of secondary nocturnal enuresis?
* Urinary tract infection - most common
* Constipation - most common
* Type 1 diabetes
* New psychosocial problems (e.g. stress in family or school life)
* Maltreatment
\*think abuse/safeguarding
56
what is Diurnal Enuresis?
daytime incontinence
occurs when the person has become dry at night but still has episodes of urinary incontinence during the day.
more common in girls
Incontinence comes in two main types:
* ***Urge incontinence*** is an overactive bladder that gives little warning before emptying
* ***Stress incontinence*** describes leakage of urine during physical exertion, coughing or laughing.
Other causes of diurnal enuresis include
* ***Recurrent urinary tract infections***
* ***Psychosocial problems***
* ***Constipation***
57
what is an enuresis alarm?
An enuresis alarm is a device that makes a noise at the first sign of bed wetting, waking the child and stopping them from urinating. It requires quite a high level of training and commitment and needs to be used consistently for a prolonged period (i.e. at least 3 months). Some families may find them very helpful, whereas others may find they add to the burden and frustration and are counter productive.
58
what is the pharmacological management of enuresis?
Medication for nocturnal enuresis is usually initiated by a specialist.
***Desmopressin*** is an analogue of ***vasopressin*** (also known as ***anti-diuretic hormone***). It reduces the volume of urine produced by the kidneys. It is taken at bedtime with the intention of reducing ***nocturnal enuresis***.
***Oxybutinin*** is an ***anticholinergic*** medication that reduces the contractility of the bladder. It can be helpful where there is an overactive bladder causing urge incontinence.
***Imipramine*** is a ***tricyclic antidepressant***. It is not clear how it works, but it may relax the bladder and lighten sleep.
59
what is wilms tumour?
aka nephroblastoma
Wilms’ tumour is a specific type of tumour affecting the kidney in children, typically under the age of 5 years.
60
how does wilms tumour present?
may have mass in abdomen
* Abdominal pain
* Haematuria
* Lethargy
* Fever
* HTN
* Weight loss
61
how is wilms tumour investigated?
USS of the abdomen to visualise the kidneys.
CT or MRI scan can be used to stage the tumour.
Biopsy to identify the histology is required to make definite diagnosis.
62
how is wilms tumour managed?
Radical Nephrectomy
Adjuvant treatment refers to treatment that is given after the initial management with surgery. This depends on the stage of the disease, the histology and whether it has spread.
Main options are:
* Adjuvant chemotherapy
* Adjuvant radiotherapy
63
what is the prognosis for pt with wilms tumour?
early tumours with favourable histology hold a good chance of cure (upto 90%). Metastatic higher prognosis.
64
what is a posterior urethral valve?
A ***posterior urethral valve*** is where there is tissue at the proximal end of the ***urethra*** (closest to the bladder) that causes obstruction of urine output. It occurs in newborn boys. The obstruction to the outflow of urine creates a back pressure into the bladder, ureters and up to the kidneys, causing ***hydronephrosis***. A restriction in the outflow of urine prevents the bladder from fully emptying, leading to a reservoir of urine that increases the risk of urinary tract infections.
65
how does a posterior urethral valve present?
* Difficulty urinating
* Weak urinary stream
* Chronic urinary retention
* Palpable bladder
* Recurrent UTI
* Impaired kidney function
Severe cases cause obstruction to urine outflow in the developing fetus resulting in bilateral hydronephrosis and oligohydramnios. oligohydramnios = pulmonary hypoplasia w/ resp failure shortly after birth
66
what investigations can be done for posterior urethral valvue?
severe cases picked up on antenatal scans = oligohydramnios and hydronephrosis
To investigate cases presenting after birth, for example young boys presenting with UTIs:
* ***Abdominal ultrasound*** may show an enlarged, thickened bladder and bilateral hydronephrosis
* ***Micturating cystourethrogram*** (***MCUG***) shows the location of the extra urethral tissue and reflux of urine back into the bladder
* ***Cystoscopy*** involves a camera inserted into the urethra to get a detailed view of the extra tissue. Cystoscopy can be used to ***ablate*** or remove the extra tissue.
67
how is a posterior urethral valve managed?
Mild cases simply be observed and monitored. If required a temporary urinary catheter can be inserted to bypass the valve whilst awaiting definite management.
Definite= ablation or removal extra urethral tissue, usually during cystoscopy.
68
what is the normal development/progression of the testes in a fetus?
The testes develop in the abdomen and then gradually migrate down, through the inguinal canal and into the scrotum. They have normally reached the scrotum prior to birth.
69
what is considered to be undescended testes?
In about 5% of boys the testes have not made it out of the abdomen by birth. At this point they are called ***undescended testes***. This can also be referred to as ***cryptorchidism.***
They might be palpable in the inguinal canal (in the inguinal region), which is not technically classed as undescended testes, although they have not fully descended at that point.
70
The longer the testes take to descend, the less likely it is this will happen spontaneously. Undescended testes in older children or after puberty hold a higher risk of what?
* testicular torsion
* testicular cancer
* infertility
71
what are risk factors for undescended testes?
* Family history of undescended testes
* Low birth weight
* Small for gestational age
* Prematurity
* Maternal smoking during pregnancy
72
how is undescended testes managed?
Watch and wait is appropriate in new-borns.
Most cases the testes will descend in the first 3-6months.
If not by 6months they should be seen by paediatric urologist.
Orchidopexy should be carried out age 6-12 months.
Intrabdominal- Fowler- Stephens
Atrophic testis= laparoscopic removal
73
what is retractile testicles?
Normal in boys that have not reached puberty for the testes to move out of the scrotum and into the inguinal canal when it is cold or the cremasteric reflex is activated.
Usually resolves as go through puberty and the testes settle in the scrotum.
Occasionally may fully retract or fail to descend and require surgical correction with orchidopexy.
74
what is hypospadias?
condition affecting males, where the ***urethral meatus*** (the opening of the urethra) is abnormally displaced to the ***ventral side*** (underside) of the penis, towards the scrotum. This might be further towards the bottom of the ***glans*** (in 90% of cases), halfway down the shaft or even at the base of the shaft.
75
what is hypospadias?
condition affecting males, where the ***urethral meatus*** (the opening of the urethra) is abnormally displaced to the ***ventral side*** (underside) of the penis, towards the scrotum. This might be further towards the bottom of the ***glans*** (in 90% of cases), halfway down the shaft or even at the base of the shaft.
76
what is Epispadias?
***Epispadias*** is where the meatus is displaced to the ***dorsal side*** (top side) of the penis
77
what are the clinical features of hypospadias?
1. Ventral opening of urethral meatus
2. Ventral curvature of penis or Chordee
3. Dorsal hooded foreskin
78
how is hypospadias investigated?
diagnosed on examination of newborn
important to eliminate underlying disorder of sex development - detailed hx and exam, karyotype, pelvic uss, u&e, endocrine hormones - testosterone, 17 alpha-hydroxyprogesterone, LH, FSH, ACTH, renin, aldosterone
79
how is hypospadias managed?
Referral to a paediatric specialist urologist for ongoing management.
It is important to warn parents not to circumcise the infant until urologist deems ok.
* Mild cases= no management
* Surgery is usually performed after 3-4months
* Surgery aims to correct the position of the meatus and straighten the penis
80
what are some complications of hypospadias?
Difficulty during urination
Cosmetic and psychological concerns
Sexual dysfunction
81
what is a hydrocele?
collection of fluid in tunica vaginalis that surrounds the teste.
tunica vaginalis is a sealed pouch of membrane that surrounds the testes.
Originally the tunica vaginalis is part of the ***peritoneal membrane***, but during development of the fetus it becomes separated from the peritoneal membrane and remains in the scrotum, partially covering each testicle.
82
what is a simple hydrocele?
common in newborn males. They occurs where fluid is trapped in the ***tunica vaginalis***. Usually this fluid gets reabsorbed over time and the hydrocele disappears.
83
what is a communicating hydrocele?
Communicating hydroceles occur where the ***tunica vaginalis*** around the testicle is connected with the ***peritoneal cavity*** via a pathway called the ***processus vaginalis***. This allows fluid to travel from the peritoneal cavity into the hydrocele, allowing the hydrocele to fluctuate in size.
84
what is seen on examination of a hydrocele?
soft, smooth, non-tender swelling around one of the testes. The swelling will be in front of and below the testicle. Simple hydroceles remain one size, whereas communicating hydroceles can fluctuating in size depending on the volume of fluid from the peritoneal cavity.
***transilluminate with light***. To ***transilluminate*** the hydrocele, hold a pen torch flat against the skin and watch as the whole thing lights up like a bulb.
85
what are some differential diagnosis for scrotal or inguinal swelling in a neonate?
* Hydrocele
* Partially descended testes
* Inguinal hernia
* Testicular torsion
* Haematoma
* Tumours (rare)
86
how are hydroceles managed?
***Ultrasound*** is a useful investigation for confirming the diagnosis and excluding other causes.
***Simple hydroceles*** will usually resolve within 2 years without having any lasting negative effects. Parents can be reassured and followed up routinely. They may require surgery if they are associated with other problems, such as a hernia.
***Communicating hydroceles*** can be treated with a surgical operation to remove or ligate the connection between the peritoneal cavity and the hydrocele (the ***processus vaginalis***).
87
what is balanitis xerotica obliterans?
Adhesions between the prepuce and the glans of the penis. Over time these gradually breakdown. Pathological phimosis ad keratisation at the top of the foreskin causes scarring and the prepuce remains non-retractile.
88
what is the peak incidence of BXO?
9-11 years
89
what are the clinical features of BXO?
* Ballooning of the foreskin in micturition is common but is a normal phenomenona non-retractile foreskin aged 2-4yrs.
* Scarring urethral meatus
* Irritation
* Dysuria
* Haematuria and local infection
EXAM= White, fibrotic and scarred preputial tip.
90
how is BXO managed?
Circumcision
Send off histopathology to confirm diagnosis
91
what are the complications of BXO?
Bleed and infection (prophylactic topical abx)
Degree swelling and serous discharge 1 week post op.
Untreated= meatal stenosis, phimosis and erosions of glans and prepuce which can be extended to the urethra.
92
what is testicular torsion
twisting of the ***spermatic cord*** with rotation of the testicle
93
typical age of testicular torsion
12-25
94
risk for development of testicular torsion?
age
previous torsion
FH
undescended testes
95
clinical features /presentation of testicular torsion
often triggered by activity
acute rapid onset of unilateral testicular pain
abdo pain and vomiting
**BEWARE** - abdo pain may be only symptom so always examine testicle
96
what are the examination findings of testicular torsion?
* Firm swollen testicle
* Elevated (retracted) testicle
* Absent cremasteric reflex
* Abnormal testicular lie (often horizontal)
* Rotation, so that epididymis is not in normal posterior position
* negative prehn's sign (positive Prehn's sign indicates relief of pain upon elevation of the scrotum and is associated with epididymitis)
97
what is a bell-clapper deformity and how is it related to torsion?
Normally, the testicle is fixed posteriorly to the tunica vaginalis. A ***bell-clapper deformity*** is where the fixation between the testicle and the tunica vaginalis is absent.
The testicle hangs in a horizontal position (like a bell-clapper) instead of the typical more vertical position. Able to rotate within the tunica vaginalis, twisting at the spermatic cord. As it rotates, it twists the vessels and cuts off the blood supply.
98
what investigations are done for testicular torsion?
clincal dx - surgical exploration within 4-6 hours as surgical emergency
uss - whirlpool sign - spiral appearance to the spermatic cord and blood vessels
99
management of testicular torsion?
* NBM, in preparation for surgery
* Analgesia as required
* Urgent senior urology assessment
* Surgical exploration of the scrotum
* **Orchiopexy** (correcting the position of the testicles and fixing them in place)
* **Orchidectomy** (removing the testicle) if the surgery is delayed or there is necrosis
100
what is epididymitis?
inflammation of the epididymis
101
what is orchitis?
inflammation of the testicle
102
what is epididymo-orchitis?
result of infection in the epididymis and testicle on one side
103
what are some causes of ***Epididymo-orchitis?***
* **Escherichia coli (E. coli)**
* **Chlamydia trachomatis**
* **Neisseria gonorrhoea**
* **Mumps** - think mumps when parotid swelling (usually only affects the testes)
104
how does epididymo-orchitis present?
gradual onset, over minutes to hours, with unilateral:
* Testicular pain
* Dragging or heavy sensation
* Swelling of testicle and epididymis
* Tenderness on palpation, particularly over epididymis
* Urethral discharge (should make you think of chlamydia or gonorrhoea)
* Systemic symptoms such as fever and potentially sepsis
105
what is an important differential for epididymo-orchitis?
torsion - if any doubt, treat as torsion
106
what features make epididymo-orchitis more likely to be due to a STI?
* Age under 35
* Increased number of sexual partners in the last 12 months
* Discharge from the urethra
107
what are some investigations that may be done?
* ***Urine microscopy***, ***culture and sensitivity*** (MC&S)
* ***Chlamydia and gonorrhoea NAAT testing*** on a first pass urine
* ***Charcoal swab*** of purulent urethral discharge for gonorrhoea culture and sensitivities
* ***Saliva swap*** for PCR testing for mumps, if suspected
* ***Serum antibodies*** for mumps, if suspected (IgM – acute infection, IgG – previous infection or vaccination)
* ***Ultrasound*** may be used to assess for torsion or tumours
108
how is **Epididymo-orchitis managed?**
acutely unwell/septic - admitted to hospital for IV abx
STI risk - GUM
local guidelines for abx - low risk for STI = Ofloxacin (tendon damage/rupture, lower seizure threshold)
analgesia, supportive underwear, reduce physical activity, abstain from sex
109
what are some complications of epididymo-orchitis?
* Chronic pain
* Chronic epididymitis
* Testicular atrophy
* Sub-fertility or infertility
* Scrotal abscess
110
CKD, PCKD
