Pediatrics: UTI and Pyelonephritis in Children Flashcards Preview

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Flashcards in Pediatrics: UTI and Pyelonephritis in Children Deck (85)
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1

Are pediatric UTI common in children?

Yes

2

Who does pediatric UTI affect more often?

Females...shorter urethra

3

Can pediatric UTI occur with normal anatomy?

Yes

4

What 2 situations increase incidence of pediatric UTI?

1. Incidence increases in obstructive conditions: Anatomic or neurogenic (neurodysfunction...cerebral palsy)
2. VUR

5

What is generally the source of pediatric UTI?

Urethral

6

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)

7

What plays a significant role in UTI with regard to the bladder?

-Frequent and complete bladder empyting

8

What happens in the bladder from infancy into childhood?

There are changes in storage and emptying patterns

9

How does the bladder work in an infant?

The bladder reflexively empties when filled to its functional capacity

10

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

11

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)

12

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

13

What are some risks of UTI you must consider?

-Significant residual urine
-High intravesical pressure
-Bladder overdistension
-Infrequent bladder emptying
-Retrograde passage of urine (reflux)
-Fistulae from the GI tract
-Foreign bodies in the urinary tract

14

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

15

What is encopresis?

Inability to control the elimination of stool
-Multiple etiologies...treat underlying cases

16

What can mimic symptoms of UTI?

Vaginal or urethral irritation

17

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
4. Yeast

18

What are environmental influences that can lead to UTI?

-Holding of urine
-Psychosocial factors
-Indwelling catheters
-Neurogenic bladder
-Urologic instrumentation or surgery
-Renal transplantation
-Diabetes mellitus
-Elevated BP
-Poor growth
-HIV
*General: Anything decrease immune system

19

What causes 85% of bacterial UTI?

E. COLI

20

What are other gram-negative bacterial pathogens that can cause UTI?

-Klebsiella
-Proteus
-Pseudomonas
-Enterobacter
-Citrobacter

21

What are some gram-positive bacterial pathogens that can cause UTI?

-Stapylococcus saprophyticus
-Enterococcus

22

What are 2 other categories of agents that can cause UTI?

Viral and fungal

23

What are some pathogens that can cause UTI due to intstrumentation/catheter?

-Pseudomonas species
-Enterococcus species
-Staphylococcus aureus
-Staphylococcus saprophyticus: Coagulase-negative
-Enterobacter species
-Yeast
-Proteus

24

What can cause UTI in immune compromised patients?

A broad range of organisms

25

What are clinical features of UTI in neonates?

-Irritability: Can't console
-Poor feeding
-Failure to gain weight
-Diarrhea: Cross contamination from diaper
-Fever

26

What are clinical features of UTI in children?

-Urgency: Going often, nothing coming out
-Frequency
-Enuresis: Bed wetting (from being previously potty-trained
-Dysuria
-Fever: No other source
-Failure to toilet train at expected age

27

What is part of the PE for UTI?

1. BP
2. Temperature
3. Growth paramteres
4. Abdominal exam: Suprapubic tenderness or costovertebral angle tenderness
5. Genitals: Diaper, allergies, ect.
6. Other sources of fever

28

How must urine sample be collected?

-In a sterile containter: Must be processed within 2 hours
-If refrigerated, processed within 24 hours

29

Can you give drugs before doing a urine culture?

NO...the drugs with skew the results

30

How can urine be collected?

1. Clean catch: Sterilize area then pee
2. Maybe cath if no other options