PAEDS - renal/urinary, neuro, psych, endocrine/reproductive Flashcards
what is testicular torsion?
a twisted spermatic cord, ischaemia of testes
when are the two peaks of incidence of testicular torsion?
neonatal and puberty
presentation of testicular torsion (4)
- SUDDEN ONSET SEVERE PAIN (unilateral)
- vomiting/nausea
- tender testicle
- abdominal pain
what are LATE signs of testicular torsion?
redness and swelling
investigations for testicular torsion
clinical - only reliably diagnosed with surgical exploration
what is the window of time for surgically treating testicular torsion?
6 hours
key differential for testicular torsion and how it presents differently
- torsion of appendix testes (called the hydatid of morgagni)
- this is a remnant of the Mullarian duct
- mimics testicular torsion but pain not as severe/acute, prepuburtal, looks like “blue dot”
what constitutes an atypical UTI in children? (5)
- septicaemia
- non e.coli organism
- poor urine flow
- not responding to tx in 48h
- abdominal/bladder mass
what is the most common bacterial cause of UTIs in children? what are two other possible causes and which is more common in boys?
E.COLI
others - proteus mirabilis (boys) and staph saprophyticus
what is a big risk factor for paediatric UTIs? give 3 examples
structural abnormalities e.g.
- horseshoe kidney
- duplex kidney (two ureters from one kidney)
- vesicoureteric reflux (VUR)
UTI signs/symptoms in infants <3m
common
- fever
- vomiting
- lethargy
- irritability
- poor feeding
- failure to thrive
less common
- abdo pain
- jaundice
- haematuria
- offensive urine
signs and symptoms of UTIs in children/infants >3m
- fever
- frequency/dysuria
- dysfunctional voiding/changes to continence
- abdominal pain
- loin tenderness
- less common = malaise, vomiting, haematuria, offensive/cloudy urine
signs of acute pyelonephritis in children (2)
- fever >38 degrees
- loin pain/tenderness
what may be the ONLY sign of a UTI in children?
FEVER
investigating UTIs in children - what are some urine sampling techniques? what is gold std?
- cotton wool in nappy
- bag urine
- clean catch (midstream)
- gold std = in/out catheter or suprapubic aspirate
what tests are done on a child’s urine sample when investigating a UTI?
- urine dipstick
- MSU for culture and sensitivity testing
what indicates a UTI on a urine dipstick?
high nitrites
high leukocyte esterase
what are the 3 indications for ultrasound scanning when investigating a paediatric UTI?
- all children <6 months
- children with recurrent UTIs
- children with atypical UTIs (e.g. not treating w abx)
what imaging techniques can be used when investigating paeds UTIs? (3)
- ultrasound
- micturating cystourethrogram (MSUG)
- DMSA scan
when are IV vs oral abx indicated in the tx of children with UTIs?
IV if <3 months
oral if >3m (if otherwise well)
UTI management in:
a) <3m old
b) >3m old with upper UTI
c) >3m old with lower UTI
a) immediate referral to paediatrician
b) consider admission to hospital, if not oral abx e.g. cephalosporin/co-amoxiclav for 7-10 days
c) oral abx for 3 days
oral abx options for children with a lower UTI
- trimethoprim (usually)
- nitrofurantoin
- cephalosporin
- amoxicillin
3 indications for follow-up clinics following a UTI in children
- all children <3m
- children of any age who were systemically unwell
- children with recurrent UTIs
long-term complications of UTIs in children
- kidney scarring
- HTN
- CKD