GU Flashcards
Infection of one or more structures of the urinary tract
UTI
Locations of UTI
Lower: cystitis urethritis
Upper: pyelonephritis; worse
Most common site for UTI
Bladder
UTI incidence
More common in girls after 1st year of life
Boys who are circumcised
Cause of a UTI
E.Coli; bacteria enter through the urethra
Who is more at risk for UTI; why?
Females due to the short urethra
UTI sx
Foul smelling urine Dysuria Freq./ enuresis Fever Vomiting Diarrhea Irritability Poor feeds / loss of appetite Hematuria
UTI diagnosis
Urine culture w/sensitivity
Back-flow of urine from the bladder up the ureter to the kidney
Vesicoureteral Reflex
Vesicoureteral Reflex incidence
Common in children who’ve had a UTI
Familial reflux common
Females
Vesicoureteral Reflex sx
Persistent UTI
Enuresis
Flank pain
Abd. pain
Vesicoureteral Reflex diagnosis
Based on cystogram or VCUG
Reflux graded on a scale of I-V
Vesicoureteral Reflex tx
Long term prophylactic antibiotics
Surgery to correct reflux
Vesicoureteral Reflex mgmt goals
Prevent UTI
^ kidney damage
^ reflux complications (scarring)
Common congenital malformation in which the urethral meatus is on the ventral surface (underside) of the penis
Hypospadias
Urethral opening on the dorsal side of the penis
Epispadias
Downward curvature of penis
Chordee
Hypospadias incidence
Btwn the 5th and 8th month of gestation
Hypospadias tx
Surgery before the child is 18 month; prior to toilet training
An acute or sudden inflammation of the glomeruli within the kidney
Acute glomerulonephritis
When do most cases of Acute glomerulonephritis occur?
Post infection (pneumo, strep or viral) *Group A strep
What does Acute glomerulonephritis result in?
Acute renal failure
Acute glomerulonephritis incidence
Peaks at 7 years; males
How does Acute glomerulonephritis occur?
Bacterial or viral agent invades the child’s body->immune system responds-> antibodies to attach the foreign antigen->immune complexes->inflammation
What is altered by the Acute glomerulonephritis process?
Membrane permeability-> proteins able to leak into urine
What does Acute glomerulonephritis lead to?
Decreased filtration of plasma results in excessive accumulation of water and retention of sodium
Acute glomerulonephritis sx
Hematuria/ deep smoky brown urine Dependent and periorbital edema Decreased urinary output Proteinuria Hypertension Fatigue Elevated serum sodium/ potassium Anorexia
Acute glomerulonephritis diagnosis
Dependent upon the symptoms WBC with diff Urinalysis (RBCs, protein, increased Specific Gravity Normal electrolytes Throat culture
Acute glomerulonephritis tx
Depends on the degree of kidney damage
Aim is to identify the causative agent
Children with normal blood pressure/urine output managed at home
Children with edema, htn, oliguria, and gross hematuria should be hospitalized
Acute glomerulonephritis mgmt
1-3 weeks of antibiotic therapy Low sodium diet ^ lower extremities to reduce edema Frequent rest periods Maintain fluid balance Daily weights Frequent b/p measurement
Massive proteinuria and hypoalbuminemia leading to edema and hyperlipidemia
Nephrotic syndrome
Primary nephrotic syndrome
Results from glomerular disease of the kidney
Secondary nephrotic syndrome
Result of systemic disease, drugs, or toxins such as liver malfunction, lupus, lead poisoning, cancer or cancer therapy
Disturbance to the glomeruli leads to what?
^ permeability to protein, especially albumin->leaks it into the urine. This reduces the serum albumin level-> reduces colloidal osmotic pressure in the capillaries. Fluid accumulates in the interstitial spaces and body cavities.
The shift from intravascular to interstitial space causes what?
Decreased vascular fl. volume-> release ADH and aldosterone
Edema
Ascites
Hypovolemia
Nephrotic syndrome sx
Anorexia Abdominal pain/swelling b/p normal or slightly decreased Decreased urine volume Edema (generalized) Fatigue Facial puffiness History of recent respiratory infection Increased weight Irritability Proteinuria
Nephrotic syndrome diagnosis
Based on protein and serum albumin levels, which are decreased
Nephrotic syndrome tx
Goal is to reduce proteinuria, control edema and prevent infection
Sodium restricted diet
Treated w/ steroids for as long as 4-8 weeks
Gradually tapered
Nephrotic syndrome mgmt
Abdominal girths Daily weights Maintain fl. and el. balances Monitor VS especially b/p Preventing infection Prevent skin breakdown w/ careful positioning
Urine checks