GU Tract Disorders

Question 1

What are the three kinds of UTIs in children?

Answer 1

#1. asymptomatic bacteria 
#2 cystitis 
#3 pyelonephritis.
Young children may have limited or unusual symptoms therefore a high degree of suspicion must be maintained to diagnose UTI

Question 2

What is asymptomatic bacteriuria?

Answer 2

Bacteria in urine without other symptoms that is benign and does not cause renal injury

Question 3

What is cystitis

Answer 3

An infection of the bladder that produces lower tract symptoms but does not cause fever or renal injury

Question 4

What is pyelonephritis?

Answer 4

It is the most severe type of UTI involving their renal parenchyma or kidneys and must be readily identified and treated because of the potential for irreversible kidney damage.

Question 5

Symptoms consistent with pyelonephritis:

Answer 5

• fever
• Irritability
• Vomiting in an infant
• Urinary symptoms associated with fever, bacteria, vomiting, and renal tenderness in older children.

Question 6

What is the most common cause of serious bacterial infection in infants younger than 24 months with a fever without a focus?

Answer 6

UTI

Question 7

What is complicated UTI?

Answer 7

A UTI with fever, toxicity, and dehydration or a UTI occurring in children younger than 3-6 months.

Question 8

Additional classification of UTI’s can be based on their association with other structural or functional abnormalities which are?

Answer 8

VUR, obstruction, dysfunctional voiding, or pregnancy

Question 9

VUR, obstruction, dysfunctional voiding, or pregnancy

Answer 9

First occurrence, reoccurrence (within 2 weeks of the same Organism or a reinfection with a different Organism) or chronic (ongoing unresolved often caused by structural abnormality or resistant Organism)

Question 10

What is the most common bacteria associated with UTI?

Answer 10

E. coli is 70%, other organisms include enterobacter, klebsiella, pseudomonas, and proteus.
UTI secondary to Group B streptococcus is more common in neonates

Question 11

What is the most important risk factor for the development of pyelonephritis in children?

Answer 11

VUR, which can be detected in 10-45% of young children who have asymptomatic UTIs.

Question 12

Host resistance factors in bacterial virulence factors are important for the UTI etiology of UTIs? What are host resistance factors?

Answer 12

Presence of a structural abnormality or dysplasia (such as VUR, obstruction or other anatomic defect) Or the presence of functional abnormalities (such as dysfunctional voiding or Constipation) Female gender (having a short urethra), poor hygiene, irritation, sexual activity or abuse, and pinworms.

Question 13

Host resistance factors in bacterial virulence factors are important for the UTI etiology of UTIs? What are bacterial factors?

Answer 13

The 2 most important bacterial factors are adherence and bacterial virulence. Bacteria that have fimbriae or pili are able to adhere to the bladder mucosa and are not flushed out with urine. Virulence refers to the toxicity of substances released by the bacteria

Question 14

What are risk factors for UTI

Answer 14

• 2 to 24 months old
• Females twice that of males
• Uncircumcised boys 40 to 20 times more than circumsized
• Premature and low birth weight infants

Question 15

What are important clinical findings & risk factors for UTI?

Answer 15

• Female: white race, < 12 months old, temperature 102.2 degrees Fahrenheit (39 degrees Celsius) or higher, fever for two days or more and the absence of another source of infection.
• Male: non black race, temperature 102.2 degrees Fahrenheit (39 degrees Celsius) or higher, fever for more than 24 hours. and absence of another source of infection

Question 16

What are diagnostic studies for a UTI?

Answer 16

• urine culture is essential to confirm the diagnosis
• UA should be used only to raise or lower suspicions. Suspicious findings include foul order, cloudiness, nitrates, leucocytes, alkaline pH, proteinuria, hematuria, pyuria, and bacteria.
• CBC, ESR, CRP, BUN, creatinine should be done in <1yo, appears ill, or if pyelonephritis is suspected

Question 17

What are the differential dose diagnosis for UTI?

Answer 17

• Urethritis
• Vaginitis
• viral cystitis
• foreign body
• sexual abuse
• dysfunctional voiding
• appendicitis
• pelvic Abscess
• pelvic inflammatory disease

Question 18

What are the goals of treatment for UTI?

Answer 18

• quickly identify the extent and level of infection
• eradicate infection
• provide symptomatic relief
• to find and correct anatomic or functional abnormalities
• prevent recurrence and renal damage