Flashcards in Pediatrics: UTI and Pyelonephritis in Children Deck (85)
Are pediatric UTI common in children?
Who does pediatric UTI affect more often?
Can pediatric UTI occur with normal anatomy?
What 2 situations increase incidence of pediatric UTI?
1. Incidence increases in obstructive conditions: Anatomic or neurogenic (neurodysfunction...cerebral palsy)
What is generally the source of pediatric UTI?
What roles does the urethra play with regard to UTI?
-Mechanical role: The laminar flow of urine washes out bacterial
*Urethral caliber plays little role if any (how wide it is)
What plays a significant role in UTI with regard to the bladder?
-Frequent and complete bladder empyting
What happens in the bladder from infancy into childhood?
There are changes in storage and emptying patterns
How does the bladder work in an infant?
The bladder reflexively empties when filled to its functional capacity
What are the steps of maturation of bladder control?
1. Increase in bladder capacity (holds more urine)
2. Perception of bladder fullness while awake
3. Perception of bladder fullness while asleep
4. Ability to initiate micturition at less than full capacity (2-2.5 years)
5. Inhibition of micturition despite a full bladder
What are some normal bladder defenses against infection?
1. Frequent and complete emptying (stagnant urine collects bacteria)
2. Antibacterial chemical constituents of urine
3. Mucous coating of the uroepithelium (blocks bacteria from attaching)
4. Laminar flow of urine (clears out bacteria)
What does frequent and complete empyting of the bladder result in?
1. Absence of over-distention
2. Maintenance of low pressure in the bladder: Increased pressure results in more strain at the vesicoureteral junction
What are some risks of UTI you must consider?
-Significant residual urine
-High intravesical pressure
-Infrequent bladder emptying
-Retrograde passage of urine (reflux)
-Fistulae from the GI tract
-Foreign bodies in the urinary tract
Why does constipation significantly correlate with UTI?
It is based on increased bacterial contamination
-Mechanical voiding factors
-Relation between infrequent voiding and constipation: Constipation predisposes to bladder instability
What is encopresis?
Inability to control the elimination of stool
-Multiple etiologies...treat underlying cases
What can mimic symptoms of UTI?
Vaginal or urethral irritation
What are some things that can cause vaginal or uretheral irritation?
1. Pinworms: Anal itching
2. Bubble baths
3. Allergens: Sitting in a bubble bath... can hit the mucous membranes
What are environmental influences that can lead to UTI?
-Holding of urine
-Urologic instrumentation or surgery
*General: Anything decrease immune system
What causes 85% of bacterial UTI?
What are other gram-negative bacterial pathogens that can cause UTI?
What are some gram-positive bacterial pathogens that can cause UTI?
What are 2 other categories of agents that can cause UTI?
Viral and fungal
What are some pathogens that can cause UTI due to intstrumentation/catheter?
-Staphylococcus saprophyticus: Coagulase-negative
What can cause UTI in immune compromised patients?
A broad range of organisms
What are clinical features of UTI in neonates?
-Irritability: Can't console
-Failure to gain weight
-Diarrhea: Cross contamination from diaper
What are clinical features of UTI in children?
-Urgency: Going often, nothing coming out
-Enuresis: Bed wetting (from being previously potty-trained
-Fever: No other source
-Failure to toilet train at expected age
What is part of the PE for UTI?
3. Growth paramteres
4. Abdominal exam: Suprapubic tenderness or costovertebral angle tenderness
5. Genitals: Diaper, allergies, ect.
6. Other sources of fever
How must urine sample be collected?
-In a sterile containter: Must be processed within 2 hours
-If refrigerated, processed within 24 hours
Can you give drugs before doing a urine culture?
NO...the drugs with skew the results