GU Flashcards
Bladder exstrophy Definition
Posterior bladder wall
extrudes through lower
abdominal wall
Bladder exstrophy Sx
-Bladder mucosa appears as mass of bright-red tissue
-urine leaks from ureters onto
the skin
Bladder exstrophy Tx
- bladder tissue is covered w/ plastic until surgery
- closure within 24-48 hours after birth
Epispadias Definition
- Males: meatal opening located on dorsal surface of penile shaft
-Females: cleft of ventral urethra that extends to bladder neck
Hypospadias Definition
Urethral meatus located anywhere along the course of urethra on ventral surface of penile shaft
Hypospadias Post-op care
-No tub baths until stent/catheter removed
-Double diapering
-No ride-on toys, no hip straddle position x 2 weeks
-Infection sx
-ABX if ordered
-Hydration status
-Blood in urine is normal at first but only pink tinged
Obstructive Uropathy Definition
Structural/functional abnormalities of urinary system
that interfere with urine flow
Obstructive Uropathy Complications
-Pressure by urine backup causes hydronephrosis
-Cessation of glomerular filtration
-Metabolic acidosis
-Impairment of kidney’s ability to concentrate urine
-Urinary stasis
-Restriction of urinary outflow
Obstructive Uropathy Tx
-Surgical correction
Prune Belly Syndrome Defintion
-AKA Eagle-Barrett syndrome
-Failure of ABD
musculature to develop
Prune Belly Syndrome Sx
-Skin covering ABD wall is thin and resembles a wrinkled prune
- urinary tract anomalies
-poor ureteral peristalsis
-enlarged bladder
-increased UTI
Prune Belly Syndrome Tx
-ABD wall reconstruction and correction of GU defects
Enuresis Definition
-Repeated involuntary voiding by a child old enough to have expected bladder control
-Primary: never had a dry night
-Secondary: was dry for 6 months then started wetting self
Enuresis Tx
-Fluid restriction
-Bladder training
-Enuresis alarms (last resort)
-Double-voiding
-Medications (DDAVP, TCAs, Oxybutynin Chloride)
-Meds SE:
UTI Definition
-Bacterial, viral or fungal origin
-Upper UTI (Pyelonephritis): ureters, renal pelvis, renal
parenchyma
-Lower UTI (Cystitis): Urethra and bladder
UTI Causes
-Urinary stasis
-Poor hygiene
-Inadequate cleansing
-Constipation
-Sexual activity
-Vesicoureteral reflux
UTI Sx
-Infants: irritability, unexplained fever, hypothermia, failure to thrive, poor feeding, vomiting
and diarrhea
-Older children: mimic more “classic” sx (cloudy, painful, bloody urine)
UTI Tx
-Fluids
-ABX (Bactrim (SJS), then cephalosporin)
-Follow up cultures
-Dx: midstream, clean-catch urine culture > 100,000 colony forming units (cfu) of a single bacteria or > 50,000 cfu of single bacteria cultures from sterile specimen
Dx: Radiologic studies
-Education: no bubble bath, cotton underwear, sexual activity, diet, fluids, wipe right
UTI increases kidney dmg if:
-UTI in infant < 1 year of age
-Delay in Dx and effective ABX Tx
-Anatomic obstruction or nerve supply interruption
-Recurrent episodes of upper UT
Phimosis Definition
- Foreskin over glans penis and cannot be retracted
- Normal in uncircumcised infants and young males
Phimosis Tx
-Circumcision
-Betamethasone Cream BID for 4-8 weeks (steroids reduce swelling/inflammation)
Cryptorchidism Definition
- One or both testes fail to descend through inguinal canal into scrotum
Cryptorchidism Complications
-infertility
-malignancy
Cryptorchidism Tx
- orchiopexy if testes don’t descend on its own
Inguinal Hernia and Hydrocele Definition
- Inguinal hernia: painless swelling of variable size
that occurs when ABD tissue extends into canal - Hydrocele: Fluid filled mass in the scrotum
Inguinal Hernia and Hydrocele Tx
-outpatient surgery
Testicular Torsion Definition
- testis suddenly rotates on its spermatic cord, cutting off its blood supply leading to
vascular engorgement and ischemia
Testicular Torsion Sx
-Severe pain in scrotum
-erythema in scrotum
-testes are tender on palpation
-cremasteric reflex is absent
Testicular Torsion Tx
-Emergent surgery
-When torsion is reduced within 6hrs, 90% of saving testis
Nephrotic Syndrome Definition
Alteration in kidney function
secondary to increased
glomerular basement
membrane permeability to
plasma protein
Nephrotic Syndrome Sx
- Edema over several weeks
-Snug fit of clothing/shoes
-Pallor
-HTN
-Irritability
Nephrotic Syndrome Labs
-Urine: Proteinuria, RBCs
-Blood: GFR- normal to high, Hypoalbuminemia, Potential hyponatremia, Elevated Hgb, Hct, platelets
Nephrotic Syndrome Tx
-albumin
-prednisone (steroid)
-diuretics
Nephrotic Syndrome Care
- skin breakdown
-ABD girth
-nutrition (limit NaCl)
-Manual BP
Acute Postinfectious
Glomerulonephritis (APIGN) Definition
-inflammation of glomeruli of kidneys from strep
Acute Postinfectious
Glomerulonephritis (APIGN) Sx
-Edema
-Oliguria
-Flank/Mid-abdominal pain
-Irritability
-Malaise
-Fever
Hemolytic-uremic Syndrome (HUS) Definition
-caused by E.coli
Hemolytic-uremic Syndrome (HUS) Sx
-Hemolytic Anemia
-Thrombocytopenia
-Acute Renal Failure
Hemolytic-uremic Syndrome (HUS) Tx
-Fluid Restrictions
-High-calorie, high-carb
-Low protein, Na, K and P
-Transfusions
-Medications
-May require hemo or peritoneal dialysis
Polycystic Kidney Disease Definition
-Cellular hyperplasia of
collecting ducts causes dilation
of ducts.
-Fluid secreted into ducts
enables cyst sacs to form
-Cysts replace kidney’s mass
and reduce kidney function
Polycystic Kidney Disease Sx
-Potter facies
-HTN
-Osteodystrophy
Polycystic Kidney Disease Tx
-Supportive care
-Diuretics
Acute Renal Failure Definition
Sudden loss of adequate renal function in which kidneys are unable to clear metabolic wastes and to regulate ECF volume, sodium balance, and acid-base homeostasis
Acute Renal Failure Sx
-Healthy child becomes ill with nonspecific symptoms such
as N/V, lethargy, edema, hematuria
-Usually due to electrolyte imbalances
Acute Renal Failure Complications
-Hyperkalemia
-Uremia
-Azotemia
-Treat underlying cause
Chronic Renal Failure Definition
-Progressive, irreversible reduction in kidney function
Chronic Renal Failure Sx
- Minimal renal function
-Uremic Syndrome
-Anemia
-Abnormal blood values
-Polyuria
-Pallor
-Headache
-Nausea
-Decreased mental alertness
Chronic Renal Failure Tx
-Irreversible but course of
disease is variable
-Diet
-Meds
-Renal Replacement Therapy
(Dialysis)
Peritoneal Dialysis
-Dialysate instilled via catheter
-Remains in peritoneal cavity for dwell time
-Emptied and exchanged with
fresh dialysate (room temp)
-May preserve kidney
function
-Risks of infection
