Pediatric GU/Gi Disorders Flashcards
differentiate
pyleonephritis
cystitis
urethritis
three time periods when UTIs are common in children
Pylonephritis
- infection of the kidney
Cystitis
- infection of the bladder
Urethritis
- infection of the uretra (From outside to the bladder)
- “UTI”
UTIs in kids
- during infancy: their immune system is not functioning 100%
- during potty training: they tend to hold urine/stool and increased risk
- sexual activity: the bacteria ascend the tract after activity
- higher risk in girls > boys
Risk Factors for UTIs in Children
Anatomic Abnormalities
- VUr: vesiculoureteral reflux
- PUV: posterior Urethral Valve (boys only)
Immune System
- disruptions or defects
Habits/Bahaviors
- dysfunctional voiding: not fully emptyin
- constipation: a big RF for UTIs
Female/Male Sex
Foreskin: on males, increased risk for bacterial trapping significantly
anatomy: urethra closer to the anus in females: increased risk of infection
Pyelonephritis
symptoms
Pyeloneph. = kidney/ureter infection
Infant symptoms
- HIGH GRADE FEVER!!: #1 most commony symptom
- always be suspicious for a UTI in child under 2 months with high grade unexplaiend fever
- failure to thrive, irritabile
- vomiting & poor feeding
- fould smelling urine
Older Kids syptoms
- high grade fever
- flank pain/tenderness CVA
- vomiting
- they can usually tell you some symptoms
Cystitis
Symptoms
Cystitis: infection of the bladder
Symptoms
- dysuria: painful urination
- frequency and urgecy complaints
- malordorus
- enuresis: previous potty trained but now wetting the bed
- suprapubic pain
- can see gross hematuria
How can a UTI be diagnosed in children
- ways to collect specimen
UTI diagnosis = relies on a proper urine collection to get urinalysis and culutre
Infants & non-toilet trained = catheterization perferred
- bagged specimens not sutablie in febrile pt. need to ahve a clean sample
Toilet trained kids
- clean catch midstream specimen usually can be obtained
- girls: watch contamination from skin and vaginal
- boys: uncircumsized: need to retract foreskin to ensure proper collection
UTI in kids
- urinalysis results
- urine culutre
- pathogens
Urinalysis
- nitrites +
- leuk. esterase +
- > 5 WBCs
not all bacteria produce nitrites
Urine Culture: necessary for dx. you CANNOT dx. UTI on a urinalysis alone
- GOLD STANDARD: urine culutre…
- CFU > 100,000 in a clean catch
- CFU > 50,000 in a catheterized catch
you cannoy dx. a UTI on dipstick or urinalysis alone OR on prusumed symptoms !!!! need the culutre
pathogens
- E. coli!! = most common
- klebsiella
- proteus
- enterococcus
- citrobacter
- serratia
- pseudomonas
Treating Pyleonephritis
- infants under 2 months
- kids 2-24 moths + fever
Infants under 2 months
- youll be getting a fully septic workup anayway for understanding fever
- IV abx + admit begin abx. immediately after culutres then adjust sesitivity
- seems like IV abx (cefx, aminoglycoside)
- never nitrofurantoin
Kids 2-24 months + fever
- 7-10 days of oral or IV then oral
Kids with cystitis + NO FEVER (or superlow grade)
- treat after you obtain culutres; dont wait for results
- bactrum or cephalosporins
Treament Rules
- treat proptly - prevent urosepsis and renal scarring (cant increase future HTN risks)
what do you do for an infant/young kid with febrile UTI based on positive culture
FEVER
UTI
confirmed UTI with cultures
- consider prophylatic abx. for small babies: to prevent rucurrance while you infestiable any anatomical abnormalities
- radiologic stuides
- US recommended
- VCUG
- DMSA Renal scan (looking for scarring)
Imaging Studies for pediatric UTIs
Imaging
Renal Bladder US
- least invasive test: visualize kidneys and bladder to r/o major anatomical abd.
- however, not sensitive enough to find VUR or renal scarring
VCUG: voiding cystourethrogram
- with a febrile UTI looking for evidence of reflux to the kidneys (since fever = pyleo. more than jusy cystiti)
- VCUG: can rule out a VUR
- VUR: retrograde flow from the bladder up to the kidneys because ureter doesnt tunnel into the bladder properly
-VCUG: done via catheter in the bladder; contrast and watch when they pee what happens
what is VUR
primary due to what
dx how
treament options
vesiculourter reflex disease
dx. via VCUG
- a retrograde flow of urine back from the bladder into the kidneys (1 or both)
- graded from 1-5 ( 5= blunted calyces)
Primary Reflux = rerograde flow of urine up the urteters to kidney : due to congenital defect at utertovesical junction
VUR = increse pyleno. risk
assocaited with renal dysplasia (insufficiency leading to dyplasia)
Treatment
- prophlactic antibiotics: low dose prevention to decrease lieklihood of infection
- restaging reflux with growth
- preserve renal function and prevent UTIs and scarring
- surgical correction: ureteral reimplantation if recurrent UTIs
what is PUV
how is it diagnosed
symptoms (if found later)
results: what can happens
PUV = posterior urethral valves
can only occur in men
what is it
- an obsturction of the lower urinary tract via a valve leaflets in the posterior urethra
- “peeing aginist resistance”
- results in : significant bilateral hydrourteronephritis
- classic keyhole sign
Symptoms (if not in utero dx.)
- weak stream
- enuresis
- UTIs
Diagnosis
- can be made prerenally (due to evidence on US of dilated bladder)
- renal US
- VCUG to see full voiding phases
Results: if not managed
- obstructive uropathy
- renal dysfunction: obstruction, renal dysplasia
- bladder dysfunction
- associated VUR possible
Treament
- Surgical: valave ablation
- long term monitoring of the renal function
- usually, the damange is already done to the kidneys, need to monitor
what is a DMSA Renal Scan
a scan which shows the kidenys: detects renal scarring
happy kidneys: take up the dye and contrast easily
sacrred kidneys: dont take up the dye well
non-congential anatomical reasons for UTIs in children
UTIs in kids: non anatomical
Poor Voiding!
- constipation!
- infrequent emptying or incomplete emptying
Goals of UTI care overall
- prompt identification of the infection from symptoms/sins
- accurate dx. : culutres
- prevent renal damange and hyptensions
- avoid overuse of abx. and uncessary testing
Nocturnal Enuresis
what is it: defined
frequency for dx.
primary v non-primary
Noctural Enuresis: bed wetting
Definition
- repeated urination into clothing into the bed at night by a child who is chronolgoically and developmentally older than 5
Timeline
- must be occuring 2+ times a week for at least 3 months
Monosymptomatic : primary
- never dry at night for more thant 6 months, with no daytime accidents
- maturational disorder, no underlying organic problem
non-monosymptomatic: non-primary
- there is nighttime and daytime wetting
high % of wetters: those age 5-6 years old (15-20%) thne drops ovver
Nocturnal Enuresis
- why is it occuring: pathological/physiologically
Whats Happening
- there is an increased level of urine production; to teh point where the bladder cannot hold it all
- this occurs during sleep when the brain cannot respond
History Components
- family history: possibel genetic
- voiding history: # of times, timing and amount
- bowel patterns: constipation?
- sleep patterns: snoring, apnea
- those holding urine at daytime = increased risk
Possible Treatments
- decreasing fluids; esp. at night
- taking child to bathroom at night
- medication
- bed wetting alarm
