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Child Health > Paediatric GU > Flashcards

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?

A

12 yo

25
Q

What is the management for testicular torsion?

A

Immediate surgical exploration with fixation of both testis

26
Q

Why do you fix both testis in testicular torsion?

A

Bell clapper deformity (which causes it) is often bilateral

27
Q

What complications are associated with testicular torsion?

A

Sub-fertility in 40% of patients

28
Q

What happens in congenital torsion?

A

Cord twists outside tunica vaginalis resulting in an infarcted testis which presents as a hard painless scrotal mass

29
Q

What differentials do you consider for testicular torsion?

A

Epididymo-orchitis - associated with UTI
Trauma - swelling more gradual
Hydrocoele - painless
Incarcerated hernia - examine inguinal canal

30
Q

What is typical bed wetting?

A

Large volume of urine in first few hours of the night

31
Q

What is enuresis?

A

Bed wetting in girls >5yo and boys >6yo

32
Q

What is primary enuresis?

A

Child never achieve bladder control

33
Q

What is secondary enuresis?

A

Child wetting after 6 months established control

34
Q

What are the risk factors for enuresis?

A 
Boys
Constipated
Family history
Obese
Stressed
Developmentally delayed
35
Q

How is enuresis assessed?

A

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
Q

When is further investigation required for enuresis?

A

? Organic cause to bedwetting

37
Q

What investigations are requested for enuresis?

A

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
Q

What is the normal process in children’s urination control?

A

Children learn to recognise full bladder and overcome autonomic pattern of voiding

Achieve during day before night

Dry by 3-4 yo

39
Q

What advice should you give to parents if their child is suffering from enuresis?

A

Reassure
Fluid intake advice - normal intake, no caffeine
Toilet regularly - 4-7x per day
Reward for using toilet before bed

40
Q

What can be trialled in children with enuresis?

A

Enuresis alarm
Desmopressin - short term (sleepover) or in conjunction with alarm

Both for 1 month

41
Q

What is first line management for children >7 with enuresis?

A

Desmopressin

42
Q

What should be done if the child with enuresis isn’t responding to treatment?

A

Refer to specialist

They may try drugs such as anticholinergics or tricyclics

43
Q

How does an enuresis alarm work?

A

Alarm have sensor which attach to child’s underwear and goes off on moisture detection so child wakes and finishes voiding in toilet

44
Q

How common is undescended testes in children?

A

Around 3% of infants but more common if preterm

45
Q

How does undescended testes normally present?

A

Normally unilateral

25% bilateral

46
Q

What complications are undescended testes associated with?

A

Infertility
Torsion
Testicular cancer
Psychological issues

47
Q

If testes are palpable but undescended, what does this mean?

A

Testes sitting at external inguinal ring so should be brought into scrotum with orchidopexy

48
Q

If testes are impalpable and undescended, what does this mean?

A

Testes could be within the inguinal canal or intra-abdominal

Need to laparoscopy to investigate and then orchidopexy

49
Q

What should be done if the testes remain undescended by 3 months?

A

Refer

50
Q

What should be done if testes remain undescended by 6 months?

A

Child seen by surgeon

51
Q

What should be done if testes remain undescended after 1 year?

A

Surgery performed

52
Q

How can haematuria be categorised?

A

Macroscopic

Microscopic - asymptomatic/symptomatic

53
Q

What examination would you do if a child has haematuria?

A

Abdominal exam - palpate for masses

54
Q

What investigations would you request for haematuria?

A 
Urine dip
BP
FBC - clotting, eGFR, PCR
Cytology - examine urine
Renal tract USS
Cystoscopy
55
Q

What do the letters stand for in the VITAMIN O model for differential diagnoses?

A 
Vascular
Infection
Trauma
Autoimmune
Metabolic
Inherited
Neoplastic
Other
56
Q

Using the VITAMIN O model, list some causes for haematuria

A 
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
Q

If a child has haematuria, what must be done?

A

Refer to specialist!

Child Health (30 decks)

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