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PEDS 2- clinical disciplines > GU > Flashcards

GU Flashcards

1
Q

MC organisms involved in UTIs?

A

e coli
kelbsiella
proteus
enterococcus

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2
Q

RF for UTIs?

A 
constipation
VUR (vesicoureteral reflux) 
urinary tract obstruction
neurogenic bladder 
poor perineal hygiene
structural abnormalities 
catheterization
sexual activity
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3
Q

S/s of UTI in new borns/infants?

A

nonspecific signs: fever, hypothermia, jaundice, poor feeding, irritability, vomiting, FTT, & sepsis

+/- strong, foul-smelling or cloudy urine

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4
Q

s/s of UTIs in pre-school children?

A

abd &/or flank pain, vomiting, fever, frequency, dysuria, urgency, or enuresis

CVA tenderness is unusual in young children

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5
Q

s/s of UTI in school aged children?

A

classic s/sx of cystitis: frequency, dysuria, & urgency

possibly pylonephritits: fever, vomiting, flank pain
CVA ttp(+/-)
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6
Q

Dx of UTI?

A

screening UA

  • pyuria
  • Nitrite* (can be - in young children)

GOLD standard: urine culture of properly collected specimen

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7
Q

Tx for UTI

A

<3mo, septic, dehydrate:
ADMIT to hospital for IV abx

Older infants/children: empiric therapy

  • Amoxicillin, TMP-SMX, 1st gen cephalosporin
  • 7-10days
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8
Q

What is vesicoureteral reflux (VUR)

A

Reflux of urine from bladder into the ureter/upper urinary tract

1% of newborns
increases up to 15%

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9
Q

Epidemiology of VUR?

A

White > Black

F > M

MC <2yrs

strong fam hx

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10
Q

What is primary VUR?

A

incompetent or inadequate closure of the ureterovesical junction (UVJ)

Due to a congenitally short intravesicular ureter

MC form of reflux

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11
Q

What is secondary VUR?

A

BLOCKAGE
Due to an abnormally high voiding pressure in bladder which results in failure of the closure of UVJ during bladder contraction

Functional bladder obstruction (neurogenic bladder)

Anatomic dysfunction - Posterior urethral valves

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12
Q

s/s of VUR?

A

Prenatal: hydronephrosis on prenatal u/s

Postnatal: febrile UTI

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13
Q

Work up for prenatal VUR?

A

Prenatal hydronephrosis (on prenatal u/s):

unilateral: repeat ultrasound at 1wk of age
bilateral: repeat ultrasound + VCUG

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14
Q

work up for post natal VUR?

A

UTI: renal & bladder u/s

Febrile UTI: Voiding Cystourethrogram (VCUG)

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15
Q

Grading for VCUG reflux?

A

Grade 1 (reflex into ureter w/ no dilation) –>

Grade 4 (reflux w/ dilation of ureter & blunting of reflux calyces)

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16
Q

Tx for grade 1 and 2 VUR?

A

Monitor for spontaneous resolution (by age 5, 80% spontaneously resolve)

Consider prophylactic antibiotics

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17
Q

Tx for grade III to V VUR?

A

regardless of age antibiotic prophylaxis:
TMP-SMX (2mg/kg) or nitrofurantoin (1-2mg/kg)
DC when VUR resolves (spontaneously or surgically)

at risk for complications if left untreated

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18
Q

What is posterior urethral valves?

A

Obstructing membranous folds within the lumen of the posterior urethra

obstructs normal flow of urine

MC etiology of UT obstruction in newborn male

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19
Q

Dx of PUV?

A

Prenatal US:
Bilateral hydronephrosis, distended and thickened bladder

+/- oligohydramnios

Post natal:
Failure to thrive, distended abdomen, poor urinary stream

Older boys: straining to urinate, UTIs, daytime & nocturnal enuresis

Dx- VCUG- dilated & elongated posterior urethra during the voiding phase

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20
Q

PUV tx?

A

prenatal: experimental surg

post natal: correct electrolyte abn, foley cath, surg correction

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21
Q

FU post PUV tx?

A

Bladder dysfunction may require clean intermittent catheterization

Monitor for renal failure- significant risk despite early intervention: Renal transplant

Monitor for UTIs

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22
Q

What is considered daytime freq?

A

voiding >8x/day

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23
Q

What is enuresis?

A

Repeated urination into clothing (day & nighttime) by a child > than 5y/o

diurnal enuresis = wetting while awake

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24
Q

Primary v. secondary nocturnal enuresis?

A

Primary = occurring in children who have NEVER been consistently dry though the night

Secondary = resumption of wetting after at least 6mo of dryness

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25
Q

s/s of enuresis?

A

child > 5yr (developmentally & chronologically)

at least 2x per week for 3 months

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26
Q

RF for nocturnal enuresis?

A

often associated w/ underlying constipation

runs in families

sleep apnea

psychological

27
Q

dx of nocturnal enuresis?

A

H&P: r/o anatomical abn, constipation

UA +/- culture

28
Q

Tx of nocturnal enuresis?

A

pt ed

limit liquids before sleep

awaken the child at night to bathroom

Bedwetting alarms

meds if others fail

29
Q

What meds can be used for nocturnal enuresis?

A 
Desmopressin Acetate (DDAVP)- synthetic analogue of the antidiuretic hormone (ADH) vasopressin
-can be Rx for short term periods

Imipramine- high risk ADEs

30
Q

What is considered daytime urinary incontinence?

A

Wetting accident at least once every 2 weeks

Incidence decreases w/ age

when continence NOT achieved by 6yrs of age, need to consider underlying cause

31
Q

RF for daytime urinary incontinence?

A

females

hx of nocturnal enuresis

UTI

encopresis (soiling in underwear)

32
Q

What are some disease assoc. with daytime urinary incontinence?

A

OAB -urinary urgency is hallmark

Voiding postponement & under active bladder

Dysfunctional voiding

33
Q

Dx work up for daytime urinary incontinence?

A 
Voiding diary 
VCUG
US
MRI spine
Abd  xray
Referral to: urology, nephrology, neurosurgery
34
Q

Tx of daytime urinary incontinence?

A

tx underlying path: (i.e. cystitis, DI, DM, seizures, neurogenic bladder, anatomical abn., constipation, psych)

Behavioral therapy

Anticholinergics – oxybutynin

TCAs do not appear to work

35
Q

What is exstrophy of the bladder?

A

Complex congenital anomaly involving the musculoskeletal system & the urinary, reproductive, and intestinal tracts

Open, inside-out bladder - the inner surface is exposed

rare! But MC in M >F, white infants, 1st born

36
Q

S/s of exstrophy of the bladder?

A

Open bladder plate & exposed urethra

low set umbilicus

diastasis of the symphysis pubis - outward malrotation of pelvic bones (at risk of hip dysplasia)

anteriorly displaced anus

inguinal hernias

genital defects

37
Q

Dx of exstropy of the bladder?

A

prenatal US- confirmed w/ MRI (sometimes)

if missed previously, diagnosed at birth

38
Q

Tx of exstrophy of the bladder?

A

Prenatal ed
and counseling of parents

Induced vaginal delivery or planned C-section and surgery within 72 hours of delivery

Surgical repair after stabilization

39
Q

What is hypospadias?

A

Congenital anomaly of male urethra

Results in abn ventral placement of the urethral opening

The urethral folds fail to completely or partially close

40
Q

Hypospadias can be assoc. with?

A

chordee (ventral curvature of penis)

10% have cryptorchidism

increased risk of inguinal hernia

Do not circumcise at birth!

41
Q

Dx of hypospadias?

A

New born PE:
-abdnormal foreskin (dorsal hooded)

Abdnormal penile curvature

the “presence” of 2 urrethral openings

42
Q

Tx of hypospadias?

A

Isolated hypospadias:
Repair before 18months

Hypospadias with cryptorchidism: At Increased risk for disorders of sex development (DSD) - additional workup:

  • Pelvic U/S
  • Karyotype
  • serum electrolytes
43
Q

What is cryptorchidism?

A

a hidden testis - testis not w/in the scrotum & does not descend spontaneously by 4mo of age

MC congenital abnormality of the GU tract

may be assoc. with various genetic anomalies

44
Q

pts with Cryptorchidism are at risk for…

A

At risk for infertility & testicular malignancy (5-10x greater risk)

45
Q

Dx of cryptorchidism?

A

Clinical- newborn exam

cause of most cases is unclear

2-6mo of age: measure LH, FSH,inhibin B, & testosterone (can help determine whether or not testes are present)

HCG stimulation test

46
Q

Tx of cryptorchidism?

A

Surg if descent has not occurred by 6-12mo of age

Palpable – orchiopexy

Non-palpable – exploratory surgery

47
Q

What is a testicular torsion?

A

Twisting of testes on the spermatic cord

Inadequate fixation of testis to tunica vaginalis

venous compression, edema or the testicle & cord, ischemia of the testicle

48
Q

What is the MC abnormality assoc. with testicular torsion?

A

“bell clapper” deformity
-testis lies horizontally

testicle lacks normal attachment to tunica vaginalis

49
Q

2 peak incidences of testicular torsion?

A

Neonatal period (less likely)

Puberty (65% btwn 12-18yrs)

50
Q

s/s of testicular torsion?

A

Abrupt onset of severe testicular or scrotal pain

N/V

51
Q

PE in pt with testicular torsion?

A

scrotum may be swollen and edematous

Affected testes is usually tender, swollen, slightly elevated

Doppler US/nuclear scan of the scrotum:
Decreased perfusion

Absent cremasteric reflex
negative prehn sign

52
Q

Tx of testicular torsion?

A

Immediate consult w/ an urologist

Surgical detorsion and fixation (orchiopexy) of both testes if viable

Orchiectomy if testicle nonviable

53
Q

Time frame for testicular torsion?

A

Detorsion within 4 to 6 hours-100% viability

Detorsion after 12 hours 20 percent viability

Detorsion after 24 hours 0 percent viability

54
Q

Manual detorsion of testicular torsion?

A

If the child presents before scrotal swelling develops:

Appropriate sedation and analgesia

Rotate outward toward the thigh- “open the book”

Will relieve pain

55
Q

What is a hydrocele?

A

Collection of peritoneal fluid between the parietal and visceral layers of the tunica vaginalis.

May be communicating or non-communicating

generally present as a cystic scrotal mass

56
Q

Epidemiology of a hydrocele?

A

Common in newborns
May be a sign of

concerning etiology in older children

Resolve spontaneously, by the 1st birthday

57
Q

What is a communicating hydrocele?

A

develop as a result of failure of the processus vaginalis to close during development

fluid = peritoneal fluid

58
Q

What is a non-communicating hydrocele?

A

no connection to the peritoneum

fluid comes from the mesothelial lining of the tunica vaginalis

59
Q

Dx of hydrocele?

A

Transillumination of the scrotum that demonstrates a cystic fluid collection

Doppler U/S

60
Q

Tx of Hydrocele?

A

Surgical repair

-if beyond 1 yr of age

61
Q

What is a varicocele?

A

Collection of dilated and tortuous veins surrounding the spermatic cord

MC on the left side

62
Q

s/s of varicocele?

A

May be asxs

Dull ache or fullness of the scrotum upon standing

Palpable texture of a “bag of worms”

63
Q

Tx of varicocele?

A

If varicocele persists in supine position, or is right sided, need to r/o processes that cause IVC obstruction
-doppler US

conservatively w/ observation

Repaired through surg ligation or testicular vein embolization

PEDS 2- clinical disciplines (5 decks)

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