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Urology Flashcards

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1
Q

Symptoms of UTI in infants

A

Fever
Lethargy
Irritability
Vomiting
Poor feeding

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2
Q

Symptoms of UTI in older infants and children

A

Fever
Abdominal pain - suprapubic
Vomiting
Dysuria
Urinary frequency
Incontinence

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3
Q

How would you diagnose pyelonephritis?

A

Temperature >38
Loin pain or tenderness

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4
Q

Investigations for UTI

A

Urine dip - positive for leukocytes and nitrites
MSU - send to lab for culture and sensitivity
If under 6 months - abdominal ultrasound within 6 weeks or during illness if recurrent UTIs or atypical bacteria

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5
Q

Management of UTI

A

All children under 3 - start IV antibiotics e.g. Ceftriaxone and start septic screen

Children over 3 and stable - oral antibiotics

Children with features of sepsis or pyelonephritis - IV antibiotics - trimethoprim, nitro, cefalexin

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6
Q

Investigating recurrent UTIs

A

USS - Abdominal USS within 6 weeks
DMSA - used 4-6 months after illness to assess damage from recurrent UTI or atypical UTI. Radioactive material used to assess uptake by the kidneys. Areas of no uptake indicate scarring.
MCUG - VUR (Vesico-ureteric reflux) - where the urine has a tendency to flow from the bladder back into the ureters. This predisposes patients to developing upper UTIs - diagnosed using MCUG (micturating cystourethrogram) FOR CHILDREN UNDER 6 MONTHS

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7
Q

When should children children with atypical UTI have an USS?

A

USS during illness

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8
Q

What is vulvovaginitis?

A

Inflammation and irritation of the vulva and vagina. Commonly affects girls between 3-10 years.

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9
Q

What can exacerbate vulvovaginitis?

A

Wet nappies
Use of chemical or soaps in cleaning the area
Tight clothing that traps moisture or sweat
Poor toilet hygiene
Heavily chlorinated pools

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10
Q

How does puberty affect vulvovaginitis and why?

A

Puberty improves symptoms as oestrogen helps keep the skin and vaginal mucosa healthy and resistant to infection

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11
Q

How would vulvovaginitis present?

A

Soreness
Itching
Erythema around the labia
Vaginal discharge
Dysuria
Constipation

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12
Q

Management of vulvovaginitis

A

No medical treatment. Advise:

Avoid washing with soap and chemicals
Good toilet hygiene - wipe front to back
Keeping the area dry
Loss cotton clothing

In severe cases - paediatrician may recommend oestrogen cream to improve symptoms

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13
Q

What is nephrotic syndrome?

A

Occurs when the basement membrane becomes highly permeable to protein - allowing them to leak into the urine. Common between ages of 2-5

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14
Q

How does nephrotic syndrome present?

A

Triad:
Low serum albumin
High urine protein content - +++ protein on urine dip
Oedema

Other features:
- Deranged lipids
- High blood pressure
- Hypercoagulability

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15
Q

Causes of nephrotic syndrome

A

Minimal change disease (most common in children)

Focal segmental glomerulonephritis
Membranoproliferative glomerulonephritis

HSP
Diabetes
Infection - HIV, hepatitis, malaria
NSAIDs, rifampicin

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16
Q

Diagnosis of minimal change disease

A

Renal biopsy and standard microscopy - usually no abnormalities
Urinalysis - small molecular weight proteins and hyaline casts

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17
Q

Management of nephrotic syndrome

A

High dose steroids
Low salt diet
Diuretics - treat oedema
Albumin infusions may be required in severe hypoalbuminaemia
Antibiotic prophylaxis in severe cases

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18
Q

What is nephritic syndrome?

A

Inflammation within the nephrons which causes reduction in kidney function, haematuria and proteinuria

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19
Q

What are the two most common causes of nephritic syndrome in children?

A

Post-streptococcal glomerulonephritis
IgA nephropathy (Berger’s disease)

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20
Q

What is post-streptococcal glomerulonephritis?

A

Occurs 1-3 weeks after beta-haemolytic strep infection e.g. tonsillitis. Immune complexes made up of strep antigens, antibodies and complement proteins get stuck in the glomerulus and cause infections - resulting in AKI

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21
Q

What would you find on blood test in a child with post-streptococcal glomerulonephritis?

A

Low C3
Anti-streptolysin antibodies

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22
Q

Management of post-streptococcal glomerulonephritis?

A

Anti-hypertensives, diuretics

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23
Q

What is Berger’s disease?

A

IgA nephropathy. IgA deposits in the nephrons causing nephritis.

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24
Q

What would you find on biopsy in a child with Berger’s disease?

A

IgA deposits
Glomerular mesangial proliferation

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25
How would you manage Berger's disease?
Initial treatment with ACE inhibitors Supportive treatment of renal failure and immunosuppressant medications - steroids and cyclophosphamide
26
What is haemolytic uraemia syndrome?
Occurs when there is thrombosis within the small vessels of the body. Caused by shiga toxin. Triad of: Haemolytic anaemia AKI Thrombocytopenia (low platelet count)
27
What is the most common cause of HUS?
E.coli 0157
28
How would HUS present?
Reduced urine output Haematuria Abdominal pain Oedema HTN Bruising
29
Management of HUS
Supportive management Urgent referral to paediatrics renal unit for renal dialysis if required Antihypertensives if required Careful maintenance of fluid balance Blood transfusions if required
30
What is enuresis?
Involuntary urination
31
What is nocturnal enuresis?
Bed wetting
32
What is diurnal enuresis?
Inability to control bladder function during the day
33
What is primary nocturnal enuresis?
Where the child has never managed to be consistently dry at night
34
Causes of primary nocturnal enuresis
Family history of delayed dry nights Overactive bladder Fluid intake Failure to wake Psychological distress Secondary causes - UTI, learning disability or cerebral palsy
35
Management of primary nocturnal enuresis
2 week diary of toileting, fluid intake and bedwetting episodes - helps identify patterns and areas that may need to be changed i.e. fluid intake before bed Encouragement and positive reinforcement - avoid blame or shame Treat any underlying causes - UTI Enuresis alarm Pharmacological treatment
36
What is secondary nocturnal enuresis?
Where a child begins wetting the bed when they have been previously dry for at least 6 months
37
Causes of secondary nocturnal enuresis
UTI Constipation T1DM New psychosocial problems - stress in family or school life Maltreatment
38
Types of diurnal enuresis
Urge incontinence Stress incontinence
39
Pharmacological treatment for enuresis
Desmopressin - antidiuretic hormone - reduces the volume of urine produced by the kidneys Oxybutinin - helps reduce the contractility of the bladder. Used for urge incontinence Imipramine - TCA - relaxes the bladder and lighten sleep
40
What mutation causes PKD in children?
PKHD1 on chromosome 6
41
Features of PKD
Cystic enlargement Oligohydraminos Pulmonary hypoplasia Potter syndrome Congenital liver fibrosis
42
Complications of PKD
Liver failure due to liver fibrosis Portal hypertension leading to oesophageal varices Progressive renal failure Hypertension due to renal failure Chronic lung disease
43
Presentation of Wilm's tumour
Abdominal pain Haematuria Lethargy Fever HTN Weight loss Usually in children under the age of 5 with an abdominal mass
44
Diagnosis of Wilm's tumour
Initial USS CT and MRI for staging Biopsy for definitive diagnosis
45
Management of Wilm's tumour
Treatment involves surgical excision of tumour and affected kidney (nephrectomy) Adjuvant chemo and radiotherapy
46
What is a posterior urethral valve?
Where the tissue at the proximal end of the urethra causes obstruction of urine output - this creates back pressure into the bladder, ureters and kidneys causing hydronephrosis. Occurs in newborn boys. Increases risk of UTIs
47
How would posterior urethral valve present?
Difficulty urinating Weak urinary stream Chronic urinary retention Palpable bladder Recurrent UTIs Impaired kidney function Severe cases - bilateral hydronephrosis and oligohydraminos
48
Investigations for posterior urethral valves
Severe cases - picked up on antenatal scans as oligohydraminos and hydronephrosis Abdominal USS MCUG Cystoscopy
49
Management of posterior urethral valves
Mild cases - observation and monitoring If required temporary urinary catheter can be inserted to bypass the valve whilst awaiting definitive management Definitive management - ablation or removal of exert urethral tissue - usually during cystoscopy.
50
Risks of cryptorchidism in older children
Testicular torsion Infertility Testicular cancer
51
Risk factors for crytorchidism
Family history Low birth weight Small for gestational age Prematurity Maternal smoking during pregnancy
52
Management of crytorchidism
Watch and wait in newborns If undescended by 6 months - orchidopexy between 6-12 months of age
53
What is hypospadias?
Where the urethral meatus is displaced to the ventral side of the penis (underside).
54
What is epispadias?
When the meatus is displaced to the dorsal side of the penis
55
Management of hypospadias
Mild cases - may not require treatment Surgery usually performed after 3-4 months of age - to correct the position of the meatus and straighten penis Do not circumcise infant until a urologist indicates it's okay.
56
Complications of hypospadias
Difficulty directing urination Cosmetic and psychological concerns Sexual dysfunction
57
What is a hydrocele?
Collection of fluid within the tunica vaginalis.
58
What is a simple hydrocele?
Common in newborn males Fluid trapped in the tunica vaginalis Fluid gets absorbed over time and the hydrocele disappears
59
What is a communicating hydrocele?
When the tunica vaginalis is connected to the peritoneal cavity via a pathway called the processes vaginalis. Fluid from the peritoneal cavity can travel into the tunica vaginalis freely.
60
Examination of a hydrocele
Transluminates with light.
61
Management for hydrocele
USS - confirm diagnosis Simple hydrocele - routine follow up Communicating hydrocele - surgical operation to remove or ligate the processes vaginalis

Paediatrics (17 decks)

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