Paeds funny tummies Flashcards
What are some predisposing factors for a UTI in paediatrics?
Infecting organism
Congenital abnormalities of the KUB
Dehydration
Incomplete bladder emptying -> constipation, infrequent voiding and bladder enlargement, neuropathic bladder
Vesicoureteric reflux
What are some potential congenital abnormalities of the urinary tract?
Kidney - hypoplasia, dysplaisa, agenesis, multicystic dypaslia
Uretra - vesicoureteral reflux, duplex collecting system, uteropelvic junction obstruction
Posterior urethral valves
Primary megaureter
What are the features of posterior urethral valves?
Congenital abnormality of the lower urinary tract
ONly occurs in boys
Variable severity
Results in bladder outflow obstruction and backflow of urine into the bladder, ureters and renal pelvis.
What are the different grades of vesicoureteric reflux?
Grade 1 - into nondilated ureter
Grade 2 - into nondilated ureter, pelvis and calcyes
Grade 3 - mild to mod dilation of urter, pelvis, calyces and minimal blunting of fornices
Grade 4 - torturous ureters, dilate of pelvis and clalyx
Grade 5 - gross dilation and turosity, loss of papillary impressions
What signs and symptoms increase the likelihood of a UTI in children?
Dysuria
Polyuria - new bedwetting
Malodorous urine
Darker, cloudy urine
Frank haematuria
Reduced fluid intake
Fever
Shivering
Abdo pain
Loin or suprapubic tenderness
CRT >3seconds
History of UTI
What signs and symptoms make a UTI less likely in a child?
Absence of dysuria
Nappy rash
Breathing difficulties
Abnormal chest sounds
Abnormal ear examination
Fever with known alternative cause.
What is meant by an atypical UTI in children?
Seriously ill
Poor urine flow
Abdominal or bladder mass
Raised creatinine
Septicaemia
Failure to respond to suitable antibiotics in 48hrs
Non E.coli organisms
What is meant by a recurrent UTI in children?
Two or more acute upper UTI
One acute upper UTI and lower UTI
Three or more lower UTI
What are the potential investigations that may be needed for a child with a UTI?
Ultrasound during acute infection
Ultrasound within 6 weeks
Dimercaptosuccininc acid scintigraphy scan 4/6 months after
Micrurating cystourethrogram
What further investigations are needed for children older than 6 months with a UIT that respnds to treatment within 48hrs?
No further testing
What further testing is needed for children over 6 months old with recurrent UTI?
Ultrasound within 6 weeks
Dimercaptosuccininc acid scintigraphy scan 4 to 6 months after infection
What investigations are needed for children over 6 months with atypical UTI?
If older than 3yrs - ultrasound during acute infection only
If between 6m and 3yrs also needs a DMSA renal scintigraphy scan 4 to 6 months after infection
What investigations are needed for children under 6 months with a typical UTI that responds to antibiotics in 48hrs?
Ultrasound at 6 weeks
What investigations are needed for children less than 6m with an atypical UTI or a recurrent UTI?
Ultrasound during acute infection
DMSA scinitgraphy 4 to 6 months
Micturating cystourethrogram
What is the use of an ultrasound in assessing UTI in children?
Static anatomical assessment
Urinary stones, dilation, nephrocalcinosis
Non invasive, mobile, operator dependent
What is the use of s DMSA scan for UTI in children?
Detects function defects - scars or non-functioning tissue
Very sensitive needs to be two months after to avoid false scars
What is the use of an MCUG micturating cystourethrogram in UTI investigation in children?
Urethral catheter inserted
Contrast introduced into the bladder
Visualises bladder and urethral anatomy
Detects VUR and urethral obstruction
Unpleasant, high radiation, can introduce infection
What are some red flags in paediatric constipation?
Failure to pass meconium within 24hrs -> CF
Faltering growth -> Coeliac
Gross abdominal distention
Abnormal lower limb neurology or
Sacral dimple -> spina bifida
Abnormal position/appearance of anus -> spinal or neuro pathology
Perianal bruising/fissure - SA
Perianal fistulae -> Crohn’s
What investigations are done for paediatric constipation?
Consider coeliac or hypothyroidism
Overflow soiling and faecal mass may indicate impaction
What is the treatment for mild constipation in children?
Optimise fluid intake and toileting behaviour
Macrogol ow dose +/- stimulant
Continue for 6 months min for regular soft stool atleast 1 per day.
What is the treatment for faecal impaction in children?
Optimise fluid intake and toileting behaviour
Escalating disimpaction regimen - macrogol increases dosing until decompaction complete
Add stimulant is response inadequate
Then treat as mild constipation
