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GI Problems Flashcards

1
Q

What are the sxs of a UTI in children aged 0-2 months?

A
  1. Jaundice*
  2. Fever
  3. Failure to thrive
  4. Poor feeding
  5. Vomiting
  6. Irritability
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2
Q

What are the sxs of a UTI in children aged 2 months - 2 years?

A
  1. Poor feeding
  2. Fever
  3. Vomiting
  4. Strong-smelling* urine
  5. Abdominal pain* may be reproducible
  6. Irritability
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3
Q

What are the sxs of a UTI in children aged 2-6 years?

A
  1. Vomiting
  2. Abdominal pain
  3. Fever
  4. Strong-smelling urine
  5. Enuresis*
  6. Urinary symptoms*(dysuria, urgency, frequency)
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4
Q

What are the sxs of a UTI in children aged greater than 6 years?

A
  1. Fever
  2. Vomiting, abdominal pain
  3. Flank/back pain*
  4. Strong-smelling urine
  5. Urinary symptoms (dysuria, urgency, frequency)
  6. Enuresis
  7. Incontinence*
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5
Q

How is a urine specimen collected from continent children?

A

A midstream, clean-catch specimen may be obtained from children who have urinary control

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6
Q

How is a urine specimen collected from incontinent children?

A

Suprapubic aspirationor urethral catheterization should be used in the infant or child unable to void on request

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7
Q

What are the indications for a renal and bladder USN?

A
  1. Febrile UTI in infants aged 2-24 months
  2. Delayed or unsatisfactory response to Tx of a 1st febrile UTI
  3. Abdominal mass or abnormal voiding (dribbling)
  4. Recurrence of febrile UTI after response to Tx
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8
Q

How is a 2 mo-2yr old with their 1st febrile UTI treated?

A
  1. Start Abx based on Hx & UA result
    A. Urine C&S pending
  2. 4-day course of oral Abx recommended
    A. 2nd - or 3rd -generation cephalosporin
    B. Amoxicillin/clavulanate, or sulfamethoxazole-trimethoprim
    C. Nitrofurantoin
  3. If the clinical response is not satisfactory after 2-3 days, alter Tx per C&S result
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9
Q

What dx studies are needed for suspected pyelonephritis?

A
  1. UA w/micro to r/o casts
  2. Urine C & S
  3. CBC
  4. BMP
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10
Q

What dx studies are needed for suspected bacteremia or urosepsis?

A
  1. UA w/micro
  2. Urine C &S
  3. Blood cultures x 2
  4. BMP
  5. CBC
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11
Q

When is hospitalization necessary for a UTI?

A
  1. Necessary if UTI with any of the following:
A. Toxemia or sepsis
B.  Signs of urinary obstruction
C. Significant underlying Dz
D. Unable to tolerate adequate oral fluids or med
E.
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12
Q

What are the IV abx of choice for UTI?

A
  1. Ceftriaxone
  2. Cefotaxime
  3. Ampicillin
  4. Gentamicin
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13
Q

What is the difference between epispadias and hypospadias? How is it treated?

A
  1. Epispadias: urethral opening on top of penile shaft
  2. Hypospadias: urethral opening on bottom of penile shaft
  3. Referral and surgery
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14
Q

What is cryptorchidism and how is it treated?

A
  1. Undescended testicle

2. Surgical treatment at 6 mo

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15
Q

Define phimosis. How is it treated?

A
  1. Foreskin cannot be retracted
  2. Steroid ointments w/ gentle retraction
  3. Rarely surgical repair
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16
Q

Define paraphimosis. How is it treated?

A
  1. Foreskin cannot be reduced

2. Emergent surgery (circ) to prevent necrosis

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17
Q

What is vesicoureteral reflux?

A

incompetent valves allow urine to reflux up the ureters to the kidneys, may cause scarring and UTIs

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18
Q

What are the complications of vesicoureteral reflux?

A
  1. Recurrent UTI’s
  2. Reflux nephropathy: protein in urine
  3. Primary
    A. Congenital anomaly of UV junction
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19
Q

What are the grades of vesicoureter reflux?

A
  1. Grades 1-V

Kids can sometimes outgrow it

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20
Q

What is grade I vesicoureter reflux?

A

Into non-dilated ureter

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21
Q

What is grade II vesicoureter reflux?

A

Into pelvis and calyses without dilation

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22
Q

What is grade III vesicoureter reflux?

A

Mild to moderate dilatation of ureter and pelvis

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23
Q

What is grade IV vesicoureter reflux?

A

Moderate dilatation and/or tortuosity of ureter

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24
Q

What is grade V vesicoureter reflux?

A

Severe dilatation and tortuosity of ureter, renal pelvis, and calyces

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25
Q

How is vesicoureter reflux treated?

A
  1. Prophylactic Abx in grades I-II to prevent damage to kidneys for 1-2 yrs
    A. Amoxicillin if under 6wks old
    B. Bactrim if over 6wks old
    C. Annual sonogram
  2. Surgery in grades III-V if persistent reflux despite Abx
    A. Uretero-vesical reimplantation
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26
Q

What is the most frequent urinary anomaly in children?

A

Duplicate collecting system/double ureter

27
Q

What are the general characteristics of a double ureter?

A
  1. Female: male = 2:1
  2. Seen on pre-natal USN
  3. Usually asymptomatic
    A. May develop UTI
  4. If ureterocele present, accumulated urine may need surgical draining
  5. If UV reflux, the 2nd ureter may need to be removed
28
Q

Define congenital ureterocele

A

Distal ureter balloons at opening into bladder, forming a sac-like pouch

29
Q

What are complications of congenital ureterocele?

A

Can lead to obstruction, UTI’s, stones

30
Q

What are the types of congenital ureterocele?

A 
1. Intravesical
A. Confined w/in bladder
2. Ectopic
A. Part extends to bladder neck or urethra
B. Assoc w/duplicated ureter
31
Q

What is the first choice for treatment of candidal diaper dermatitis? 2nd choice?

A
  1. Nystatin Cream (Mycostatin)
    A. 1st line Tx in cutaneous candidiasis
    B Can be used with hydrocortisone cream as well
  2. Clotrimazole 1% Cream (Lotrimin, Mycelex)
    A. 2nd choice in Tx
32
Q

What causes of an indirect inguinal hernia?

A
  1. Due to persistence of patent processus vaginalis

2. Bowel & peritoneal protrusion don’t herniate directly thru a weakness in abdominal muscle

33
Q

What leads to glomerulonephritis?

A

Recent Hx of streptococcal throat infection

34
Q

What are the sxs of glomerulonephritis?

A
  1. Hematuria assoc. w/oliguria
  2. HTN in 70% of cases
  3. Edema
    A. Starts as puffy eye lids & may progress to edema of limbs
35
Q

What complications can arise from glomerulonephritis?

A
  1. Electrolyte disturbances
  2. Hypertensive encephalopathy
  3. Heart failure
36
Q

What are the dx for glomerulonephritis?

A
  1. UA-
    A. RBC’s TNTC
    B. May have RBC casts - diagnostic if (+)
    C. Proteinuria
  2. ↑ ASO titer
  3. BMP: BUN/electrolytes
  4. Renal Bx if renal function deteriorates after Tx
37
Q

How is glomerulonephritis treated?

A
  1. PCN only if infection persists
  2. Close monitor of renal function & BP: refer to nephrologist
  3. Corticosteroids may help
  4. Sx’s resolve in 2-3 weeks
  5. Microscopic hematuria can last up to 1 year
  6. 85% of children recovery completely
38
Q

define henoch-schonlein purpura. What are the sxs?

A
  1. “Anaphylactoid Purpura”
    A. Purpuric blanching cutaneous rash (2-4 weeks), may be slightly itchy
    B. Migratory polyarthritis/polyarthralgias (ankles, knees)
    C. Intermittent sharp abdominal pain
    D. Nephritis
  2. Small vessel vasculitis (skin, GI tract, kidneys)
  3. URI or ST precedes Dx
  4. Highest occurrence spring & fall
39
Q

What are the labs for henoch-S pupura?

A 
1. Normal CBC
A. May have ↑ platelets
2. UA 
A. RBC’s 
B. May have proteinuria
3. May have guaiac (+) stools
4. Usually has ↑ ASO titer
4. May have (+) throat culture
40
Q

What is the treatment for henoch-Schonlein purpura?

A
  1. Supportive
  2. NSAIDs prn
  3. Prednisone for GI/joint sx’s
    A. Does not affect skin or renal manifestations
  4. Penicillin if (+) ASO titer
  5. Sx’s can recur for several months & microscopic hematuria can last years
    6.
41
Q

What causes medullary cystic dz?

A

Congenital-autosomal recessive Dz

42
Q

What is medullary cystic dz (juvenile nephronophthisis)?

A
  1. Fibrosis & cysts at the cortico-medullary junction
  2. Kidneys are small to normal in size
  3. Unable to concentrate urine
43
Q

What are the general sxs of medullary cystic dz?

A
  1. Polydipsia & polyuria
  2. Sodium wasting
  3. Anemia
  4. May present w/renal failure
44
Q

How is medullary cystic dz treated?

A

Supportive→ dialysis →transplant

45
Q

What is the prognosis for medullary cystic dz?

A
  1. Poor prognosis
    A. ESRD during childhood
    B. No cure
46
Q

What are the early sxs of medullary cystic dz?

A
  1. Polyuria
  2. Salt cravings
  3. Nocturia
  4. Weakness
47
Q

What are the later sxs of medullary cystic dz?

A 
Coma
Confusion
Decreased alertness
Easy bruising or bleeding
Fatigue
Frequent hiccups
Headache
Increased skin color (skin may appear yellow or brown)
Itching
Malaise
Muscle twitching or cramps
Nausea
Pale skin
Paresthesia of  hands & feet
Seizures
Hematemesis or hematochezia
Weight loss
Weakness
48
Q

What are the dx studies for medullary cystic dz?

A
  1. 24-hour urine volume & electrolytes
  2. BUN & Creatinine
  3. CBC
  4. Creatinine clearance
  5. Serum uric acid
  6. Urine specific gravity
  7. Renal sono
  8. Genetic testing
49
Q

What causes polycystic kidney dz?

A

Autosomal dominant Dz

50
Q

What are the general characteristics of polycystic kidney dz?

A
  1. Large kidneys
  2. Genetic counseling to family
  3. Usually diagnosed by prenatal USN
  4. HTN early
  5. Requires close monitoring
  6. Eventual renal failure
  7. Will require dialysis & renal transplant at some point in life
51
Q

What causes and ectopic kidney?

A

Congenital defect

52
Q

What are the general characteristics of an ectopic kidney?

A
  1. Kidney is located below, above, or on the opposite side of its usual position
  2. May compromise drainage of urine → hydronephrosis
53
Q

What is renal agenesis?

A
  1. Absent kidney(s)
    A. Bilat.: Rare → death
    B. Unilateral: Abnormal development of
    female reproductive tract → infertility
54
Q

What is renal agenesis asst with?

A 
1. Often assoc. w/gene mutations 
A. Widely set eyes w/skin folds over  upper  lids
B. Low set ears
C. Flat, broad nose 
D. Limb defects
E. Receding chin
55
Q

What are the sxs of renal agenesis?

A
  1. Asymptomatic
  2. +/- Hematuria
  3. Swelling in the face, hands, or legs
  4. Developmental defects in the inner ear, genital tract, head, & vertebrae
  5. Foamy urine
  6. HTN in adults
56
Q

What is prune belly syndrome?

A 
1. AKA 
A. Abdominal muscle deficiency syndrome
B. Congenital absence of the abdominal muscles 
C. Eagle-Barrett syndrome
D. Obrinsky syndrome 
E. Fröhlich syndrome
57
Q

How is prune belly syndrome diagnosed?

A
  1. 1 in 40,000 births
  2. 97% of cases are male
  3. Dx’d w/prenatal USN
    A. May f/u w/voiding cystourethrogram
58
Q

What is the triad asst. w/ prune belly syndrome?

A 
Triad of symptoms
1. Partial or complete lack of abdominal wall muscles
A. Wrinkly folds of skin covering abdomen 
2. Cryptorchidism 
3. Urinary tract abnormality 
A. Large ureters
B. Distended bladder
C. Vesicoureteral reflux
59
Q

What are the sxs of prune belly syndrome?

A
  1. Frequent UTI’s
  2. VSD
  3. Malrotation of the gut
  4. ↑ incidence of MSK abnormalities:
  5. Pectus excavatum
  6. Scoliosis
  7. Congenital hip dislocation
  8. Club foot
  9. Later in life: post-ejaculatory discomfort
  10. Bladder spasm lasting up to 2 hr
60
Q

How is prune belly syndrome treated?

A
  1. Depends on the severity of the symptoms
    A. Orchiopexy
    B. Self catheterization
    C. Vesicostomy
    -Allows the bladder to drain via stoma in abdomen
    D. Surgical “remodeling” of abdominal wall & urinary tract
61
Q

What is the number 1 infectious process in infants?

62
Q

What is the treatment for labial fusion?

A

Refer for surgery

63
Q

what does a horseshoe kidney increase the risk of?

A

kidney stones

Peds: Growth and Development (13 decks)

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