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Paediatric GU Flashcards

1
Q

What symptoms would children with a UTI present with?

A

Dysuria
Frequency
Loin pain

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2
Q

What symptoms would infants with a UTI present with?

A

Poor feed
Lethargy
Irritability
D&V

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3
Q

How would you diagnose a UTI?

A

History - distinguish if Upper or Lower UTI
Urine dip - leukocyte esterase and nitrate

If +ve urine dip - send for culture and microscopy

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4
Q

What general management measures would you suggest to prevent UTI’s?

A 
Correct wiping technique
Prevent constipation
Avoid bubble baths
Adequate fluid intake
Regular toileting
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5
Q

If a child is <3 months, what do you do if you suspect a UTI?

A

Immediately refer to paediatric specialist?

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6
Q

How would you manage cystitis in a child over 3 months?

A

3 days trimethoprim

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7
Q

How would you manage pyelonephritis in a child over 3 months?

A

7-10 days ciprofloxacin

Consider referral

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8
Q

What investigation must be ordered if a child with a UTI has a fever >38 degrees?

A

Urinalysis

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9
Q

Who is at risk of recurrent UTI’s?

A 
Poor flow
Renal abnormality
High BP
Vesicoureteral reflux
Constipation
Sexual abuse
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10
Q

What counts as recurrent UTI’s?

A

> =2 Upper UTI
1 Upper UTI + 1 Lower UTI
= 3 Lower UTI

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11
Q

How are recurrent UTI’s managed?

A

USS of urinary tract
Specialist referral

Can consider prophylactic Abx

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12
Q

What is vesicoureteric reflux (VUR)?

A

Retrograde flow of urine back from bladder to upper tract

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13
Q

What causes vesicoureteric reflux?

A

Ureters enter bladder perpendicularly leading to inadequate vesicoureteric junction

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14
Q

What can happen if vesicoureteric reflux is compounded by recurrent UTI’s?

A

Progressive renal scarring which can cause renal failure

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15
Q

How can vesicoureteric reflux be diagnosed?

A

Routine antenatal scans

Micturating cystourethrogram

Indirect cystogram

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16
Q

When is a micturating cystourethrogram carried out and how does it work?

A

Children <2yo - catheter insertion needed

Radiocontrast detect reflux on voiding

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17
Q

When is an indirect cystogram carried out and how does it work?

A

> 2yo children

Give MAG3 injection and void in front of special camera that detects it

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18
Q

What is a key risk factor for vesicoureteric reflux?

A

Strong family history

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19
Q

How is vesicoureteric reflux graded?

A

1 - flow back up to ureters
2 - flow back up to kidney
3 - mild dilation of ureter and renal pelvis
4 - dilation of ureter, renal pelvis and calyces
5 - severe dilation of ureter, pelvis and calyces

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20
Q

How is vesicoureteric reflux managed?

A

Can be self resolving around 2yo - prophylactic Abx to prevent UTI’s

STING procedure - make valve

Open surgery to reimplant ureters

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21
Q

What happens in testicular torsion?

A

Mobile mesentery within tunica vaginalis leads to twisting of the spermatic cord –> testicular torsion and necrosis

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22
Q

How does testicular torsion present?

A 
Acute severe scrotal pain
Referred pain to abdomen
N&amp;V
Swelling and redness of scrotum
Testis retract up
Lifting testis increase pain
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23
Q

How would you investigate testicular torsion?

A

Can do Doppler USS to show arterial flow

Don’t delay surgery to investigate!

24
Q

When is testicular torsion most common?

25
What is the management for testicular torsion?
Immediate surgical exploration with fixation of both testis
26
Why do you fix both testis in testicular torsion?
Bell clapper deformity (which causes it) is often bilateral
27
What complications are associated with testicular torsion?
Sub-fertility in 40% of patients
28
What happens in congenital torsion?
Cord twists outside tunica vaginalis resulting in an infarcted testis which presents as a hard painless scrotal mass
29
What differentials do you consider for testicular torsion?
Epididymo-orchitis - associated with UTI Trauma - swelling more gradual Hydrocoele - painless Incarcerated hernia - examine inguinal canal
30
What is typical bed wetting?
Large volume of urine in first few hours of the night
31
What is enuresis?
Bed wetting in girls >5yo and boys >6yo
32
What is primary enuresis?
Child never achieve bladder control
33
What is secondary enuresis?
Child wetting after 6 months established control
34
What are the risk factors for enuresis?
``` Boys Constipated Family history Obese Stressed Developmentally delayed ```
35
How is enuresis assessed?
Have they ever had bladder control? Bed wetting history - what time, how much, do they wake? Day time symptoms - frequency, urgency, stream How much fluid are they drinking
36
When is further investigation required for enuresis?
? Organic cause to bedwetting
37
What investigations are requested for enuresis?
Urinalysis - recent onset, UTI, diabetic symptoms, unwell Referral - severe daytime symptoms, UTI, co-morbidities, no response to treatment Safeguarding - urinating on purpose, punished for bedwetting? persistent
38
What is the normal process in children's urination control?
Children learn to recognise full bladder and overcome autonomic pattern of voiding Achieve during day before night Dry by 3-4 yo
39
What advice should you give to parents if their child is suffering from enuresis?
Reassure Fluid intake advice - normal intake, no caffeine Toilet regularly - 4-7x per day Reward for using toilet before bed
40
What can be trialled in children with enuresis?
Enuresis alarm Desmopressin - short term (sleepover) or in conjunction with alarm Both for 1 month
41
What is first line management for children >7 with enuresis?
Desmopressin
42
What should be done if the child with enuresis isn't responding to treatment?
Refer to specialist They may try drugs such as anticholinergics or tricyclics
43
How does an enuresis alarm work?
Alarm have sensor which attach to child's underwear and goes off on moisture detection so child wakes and finishes voiding in toilet
44
How common is undescended testes in children?
Around 3% of infants but more common if preterm
45
How does undescended testes normally present?
Normally unilateral 25% bilateral
46
What complications are undescended testes associated with?
Infertility Torsion Testicular cancer Psychological issues
47
If testes are palpable but undescended, what does this mean?
Testes sitting at external inguinal ring so should be brought into scrotum with orchidopexy
48
If testes are impalpable and undescended, what does this mean?
Testes could be within the inguinal canal or intra-abdominal Need to laparoscopy to investigate and then orchidopexy
49
What should be done if the testes remain undescended by 3 months?
Refer
50
What should be done if testes remain undescended by 6 months?
Child seen by surgeon
51
What should be done if testes remain undescended after 1 year?
Surgery performed
52
How can haematuria be categorised?
Macroscopic | Microscopic - asymptomatic/symptomatic
53
What examination would you do if a child has haematuria?
Abdominal exam - palpate for masses
54
What investigations would you request for haematuria?
``` Urine dip BP FBC - clotting, eGFR, PCR Cytology - examine urine Renal tract USS Cystoscopy ```
55
What do the letters stand for in the VITAMIN O model for differential diagnoses?
``` Vascular Infection Trauma Autoimmune Metabolic Inherited Neoplastic Other ```
56
Using the VITAMIN O model, list some causes for haematuria
``` V - sickle cell, coagulation, disorder I - UTI T - catheter, prolonged severe exercise A - HSP, glomerulonephritis M - Calcium calculi I - Polycystic kidneys N - Wilm's tumour O - child abuse, fabricated induced illness, beetroot, menstruation ```
57
If a child has haematuria, what must be done?
Refer to specialist!

Child Health (30 decks)

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