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Paediatrics > 1: Urology - UTIs > Flashcards

1: Urology - UTIs Flashcards

1
Q

What is an upper urinary tract infection

A

pyelonephritis

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2
Q

What is a lower urinary tract infection

A

cystitis

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3
Q

What is the difference between lower urinary tract infection and urethritis

A

lower urinary tract infections occur above the bladder neck (cystitis) whereas, urethritis is below

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4
Q

in which gender are UTIs more common before 3m

A

boys

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5
Q

in which gender are UTIs more common after 3m

A

girls (3:1)

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6
Q

what is the most common cause of UTIs in children

A

E.coli

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7
Q

if paediatric UTIs are caused by anything but E.coli what is it classed as

A

Atypical

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8
Q

What are three hypothesised causes of UTIs

A
  1. Incomplete bladder emptying
  2. Poor hygiene
  3. Vesico-ureteric reflux
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9
Q

Give 4 causes of incomplete bladder emptying

A
  1. Hurried micturition
  2. Constipation
  3. Infrequent voiding due to vulvitis
  4. Neuropathic bladder
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10
Q

What proportion of children with UTIs have vesico-ureteric reflux

A

35%

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11
Q

What are poor hygiene causes of UTIs

A

Girls - wiping back to front

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12
Q

When should UTI be suspected in infants

A

Fever of unknown origin or sepsis

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13
Q

What are three features of UTI in neonates

A
  1. Prolonged neonatal jaundice
  2. Vomiting
  3. Sepsis
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14
Q

What are 6 features of UTIs in infants

A
  1. Irritable
  2. Poor Feeding
  3. Fever
  4. Febrile Convulsions
  5. Diarrhoea
  6. FTT
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15
Q

What are 6 features of UTI in children 1-5y

A
  1. Fever
  2. Rigors
  3. Malaise
  4. Abdominal pain
  5. Dysuria
  6. Urinary frequency
  7. Enuresis
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16
Q

How will children over 5 with cystitis present

A

Dysuria
Frequency
Enuresis

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17
Q

How will children over 5 with acute pyelonephritis present

A

Abdominal pain

Fever

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18
Q

If a child has a T of >38 what does it likely indicate

A

Upper UTI (pyelonephritis)

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19
Q

What are three indicators to check urine in a child

A
  1. Symptoms UTI
  2. T > 38
  3. Fever of unknown-origin
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20
Q

What is the best method to collect urine from a child recommended by NICE

A

Clean catch urine sample

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21
Q

What is clean catch sample

A

Parent holds a pot to catch childs urine

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22
Q

What is second-line method for collecting urine

A

Urine collection pads

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23
Q

When are absorbent pads more useful

A

Children who wear nappies

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24
Q

When may invasive (supra-pubic aspiration be used)

A
  • Only if non-invasive methods are ineffective

- Child is very unwell and requires immediate diagnosis

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25
Q

What is adhesive plastic bag as urine collection method

A

A plastic-bag is attached to child’s perineum

26
Q

What is the problem with adhesive plastic bags

A

often lead to contamination

27
Q

When is mid-stream urine sample indicated

A

in continent child

28
Q

Explain investigation for infants under 3-months with UTI

A
  • All children should be referred to specialist paediatrician
  • Send urine for MC+S
  • Renal USS (All children under 6-months with first UTI)
29
Q

When should children 3m-3y be admitted with UTI

A

If acute pyelonephritis suspected

30
Q

What is used to investigate a UTI in 3m-3y

A

Urinalysis

31
Q

In a child 3m-3y if leucocytes or nitrites, or both, are positive what should be done

A

If both, or one is positive - send urine for MC+S and start antibiotics

32
Q

In a child 3m-3y if leucocytes and nitrites are negative, what should be done

A

Not a UTI

33
Q

What is first line to investigate a UTI in children over 3y

A

Urinalysis

34
Q

In a child >3y, what should be done if leucocytes and nitrites are positive

A

Start antibiotics. Do not need to send culture unless high-risk or very unwell

35
Q

In a child >3y if nitrites are positive and leucocytes negative what should be done

A

Send urine for MC+S

Start antibiotics

36
Q

In a child >3y if leucocytes are positive and nitrites negative what should be done

A

Send urine for MC+S

Do not start antibiotics

37
Q

In a child >3y if leucocytes and nitrites are negative what does this mean

A

If is not a UTI

38
Q

What is first-line imaging for UTIs in children

A

Renal US

39
Q

What are the four indications for urinary US in UTI

A
  1. Atypical Infection
  2. First UTI under 6m
  3. Recurrent UTI under 6m
  4. Recurrent UTI over 6m
40
Q

What are 6 indicatiors of atypical infection in children

A
  • Poor urine flow
  • Bladder or abdominal mass
  • Any organism but E.coli
  • Raised creatinine
  • Sepsis
  • Failure to respond to antibiotics in 48h
41
Q

If child under 6 months and first UTI how quickly should US renal tract be ordered

A

Within 6W

42
Q

If child under 6 months and recurrent UTI how quickly should US renal tract be ordered

A

During Acute infection

43
Q

If child over 6 months and recurrent UTI how quickly should US renal tract be ordered

A

Within 6W

44
Q

What does a DMSA scan look for

A

Damage to renal parenchyma

45
Q

What are the two indications for DMSA scan for UTI

A
  1. Children under 6m with atypical or recurrent UTI

2. Children over 6m with recurrent UTI

46
Q

When should a DMSA scan be performed following a UTI

A

4-6W

47
Q

If a child <6m is suspected to have vesico-ureteric reflux what is used to investigate

A

MCUG = micturating cystourethrogram

48
Q

If a child is >6m and is suspected to have vesico-ureteric reflux what is used

A

MAG3 = techniteum-99 scan

49
Q

If a infant <3m is suspected to have acute pyelonephritis how should they be managed

A
  • Refer to paediatric specialist

- IV 3rd gen cephalosporins

50
Q

In a child 3m-15y with acute pyelonephritis how should they be managed

A
  • Admit

- Oral cefalexin or co-amoxiclav

51
Q

What is used for analgesia in acute pyelonephritis in children

A

Paracetamol

52
Q

What is used for analgesia in acute pyelonephritis for children >12

A

Codiene

53
Q

How should infants under 3-months with suspected cystitis be managed

A
  • Refer to paediatric specialist

- Admit for IV 3rd gen cephalosporin

54
Q

How should child 3-15 years be managed if suspected cystitis

A
  1. Oral trimethoprim

2. If resistance to trimethoprim is high in the area and eGFR >45, give oral nitrofurantoin

55
Q

What is a complication of UTI in children

A

Can lead to renal scarring - if bilateral may result in chronic HTN

56
Q

Define a recurrent UTI

A
  1. More than two upper-UTIs (pyelonephritis)
  2. One upper-UTI (pyelonephritis) and lower-UTI (cystitis)
  3. Three or more lower UTIs (cystitis)
57
Q

What are the indications for renal US in recurrent UTIs

A
  1. Child under 6m with recurrent UTIs = arrange during infection
  2. Child over 6m with recurrent UTIs = arrange up to 6m after
58
Q

Aside from renal US, what type of imaging should be used in children with recurrent UTIs

A

DMSA within 4-6m

59
Q

If a child under 3m has recurrent UTIs how should they be managed

A

Refer to paediatrics for parental antibiotics, send urine MC+S

60
Q

How should a child over 3m with recurrent UTI be manage

A

Prophylactic antibiotics

Paediatrics (61 decks)

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