Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Final Notes > Paeds: UTI > Flashcards

Paeds: UTI Flashcards

1
Q

Symptoms and Signs

A

Fever
Vomiting
Lethargy
Irritability

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Symptoms and Signs

A
  • Poor feeding

Failure to thrive

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Symptoms and Signs

A

Abdominal pain
Jaundice
Haematuria
Offensive urine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Infants and children >3 months (preverbal)

Most common

A

Fever

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Infants and children >3 months (preverbal) Less common

A
  • Abdominal pain
  • Loin tenderness
  • Vomiting
    Poor feeding
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Infants and children >3 months (preverbal) Least common

A
  • Lethargy
  • Irritability
  • Haematuria
  • Offensive urine
    Failure to thrive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Infant and children >3 months verbal;

Most common

A

Fever

Dysuria

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Infant and children >3 months verbal;

Less common

A
  • Dysfunctional voiding
  • Changes in continence
  • Abdominal pain
    Loin tenderness
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Infant and children >3 months verbal; Least common

A
  • Fever
  • Malaise
  • Vomiting
  • Haematuria
  • Offensive urine
    Cloudy urine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Infants symptoms of UTI

A
  • Fever
  • Vomiting
  • Lethargy or irritability
  • Poor feeding/failure to thrive
  • Jaundice
  • Septicaemia
  • Offensive urine
    Febrile convulsion (>6 months)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Children

symptoms of UTI

A
  • Dysuria and frequency
  • Abdominal pain or loin tenderness
  • Fever with or without rigors (exaggerated shivering)
  • Lethargy and anorexia
  • Vomiting, diarrhoea
  • Haematuria
  • Offensive/cloudy urine
  • Febrile convulsion
    Recurrence of enuresis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Collection of samples:

Child in nappies:

A
  1. Clean catch (recommended method)
  2. An adhesive plastic bag applied to the perineum after careful washing – may be contamination from the skin
  3. A urethral catheter (urgency in obtaining sample)
  4. Suprapubic aspiration – in severely ill infants requiring urgent diagnosis and treatment
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Older children:

collection of samples

A

Mid stream urine may be possible

Note: Cleaning of area needed as contamination high in boys due to foreskin and reflux into the vagina.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Leucocyte esterase and nitrite positive

A

Regard as UTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Leucocyte esterase negative and nitrite positive

A

Start antibiotic treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Leucocyte esterase positive and nitrite negative

A

Only start antibiotic treatment if clinical evidence of UTI

Diagnosis depends on urine culture

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Leucocyte esterase and nitrite negative

A

UTI unlikely. Repeat or send urine for culture if clinical hx suggests
UTI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Blood, protein and glucose present on stick testing

A

Useful in any unwell child to identify other diseases e.g. nephritis, DM but will not discriminate between children with and without UTIs

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Bacterial and host factors that predispose to infection:

Causative organism:

A
  • E.coli
  • Klebsiella
  • Proteus
  • Pseudomonas
  • Strep. faecalis
  • Newborn: likely to be haematogenous
20
Q

Proteus organism more common in

A

(more common in boys – potentially due to presence under prepuce)

21
Q

Pseudomonas may indicate

A

may indicate the presence of some structural abnormality in the urinary tract affecting drainage.

22
Q

Predisposing Factors:

A
  1. Infecting organism
  2. Antenatally diagnosed renal or urinary tract abnormality
  3. Incomplete bladder emptying
  4. Vesicoureteric reflex
23
Q

Incomplete bladder emptying

A
  • Infrequent voiding, resulting in bladder enlargement
  • Vulvitis
  • Incomplete micturition with residual post-micturition bladder volumes
  • Obstruction by a loaded rectum from constipation
  • Neuropathic bladder
    Vesicoureteric reflux
24
Q

Vesicoureteric reflux: Definition

A

A developmental anomaly of the vesicoureteric junctions

Displaced laterally and enter directly into the bladder

25
Q

Vesicoureteric reflux:

Cause

A

Familial with a 30-50% chance of occurring in first-degree relative.
May also occur with bladder pathology e.g. neuropathic bladder or urethral obstruction or temporarily after a UTI

26
Q

Vesicoureteric reflux:

Presentation

A

Mild (reflux into ureter only) to Severe (Gross dilatation o ureter, renal pelvis and calyces)

27
Q

Vesicoureteric reflux:

Severe reflux leads to

A

Predisposes to intrarenal reflux and renal scarring with UTI via
Backflow of urine from the renal pelvis into the papillary collecting ducts; intrarenal reflux

28
Q

Vesicoureteric reflux:

Reflux with associated ureteric dilatation is important, as:

A
  • Urine returning to the bladder from the ureters after voiding results in incomplete bladder emptying, which encourages infection
  • The kidneys may become infected (pyelonephritis), particularily if there is intrarenal reflux
    Bladder voiding pressure is transmitted to the renal papillae; this may contribute to renal damage if voiding pressure are high
29
Q

Vesicoureteric reflux:

Consequence

A

Chronic renal failure due to scarring leading to hypertension in childhood or early adult life (10%)

30
Q

Vesicoureteric reflux:

Outcome

A

Mild – resolves spontaneously

31
Q

Investigation:

NICE recommendation

A

NICE don’t recommend an ultrasound for first UTI if there was response to antibiotic treatment within 48h, unless

32
Q

Paediatrician protocol

A
  1. First proven urinary tract infection
  2. Antibiotic therapy + ultrasound of kidneys and urinary tract
    Ultrasound
33
Q

After ultrasound in

A

MCUG and DMSA

34
Q

After ultrasound in >1 year and

A

DMSA

35
Q

Atypical UTI symtpoms

A
  • Seriously ill or septicaemia
  • Poor urine flow
  • Abdominal or bladder mass
  • Raise creatinine
  • Failure to respond to suitable antibiotics within 48h
  • Infection with non-E.coli organism
36
Q

Ultrasound with reveal:

A
  • Serious structural abnormalities and urinary obstruction

- Renal defects (but poor at identifying renal scars).

37
Q

MSUG: for

A

micturating cystorethrogram – useful for reflux but INVASIVE

38
Q

DMSA scan

A

radionuclidescan – for scarring

39
Q

Plain abdo X-ray:

A

if haematuria look for stones

40
Q

Management All infants

A
  • Referral to hospital

IV antibiotics e.g. cefotaxime until temp reduced

41
Q

Management Infants >3 months and children with acute pyelonephritis/upper urinary tract infection (bacteruria and fever > 38oC) or bacteruria and loin pain/tenderness even if fever is

A
  • Oral antibiotics with low resistance patterns (e.g. co-amoxiclav for 7-10 days) or
    IV antibiotics cefotaxime 2-4 days followed by oral antibiotics for 7-10 days total
42
Q

Management Children with cystitis/lower UTI infection (dysuria but no systemic symptoms or signs)

A

Oral antibiotics for 3 days

43
Q

Medical measures for the prevention of UTI:

A

Ensure washout of organisms that ascend into the bladder from the perineum, and to reduce the presence ofaggressive organisms in the stool, perineum and under the foreskin.

44
Q

Prevention and advice for parents

A
  • High fluid intake to produce a high urine output
  • Regular voiding
  • Ensuring complete bladder emptying by encouraging the child to try a second time to empty his bladder after a minute or two, commonly know as double micturition, this empties any urine residue or refluxed urine returing to the bladder
  • Prevention or treatment of constipation
  • Good perineal hygiene
  • Lactobacillus acidophilus, a probiotic to encourage colonization of the gut by this organism that might potentially cause invasive disease
    Antibiotic prophylaxis:
45
Q

Antibiotics prophylaxis

A
  • often used in the under 2 with a congenital abnormality: trimethoprim (2mg/kg at night), but nitrofurantoin or cephalexin may be given
46
Q

Follow-up

A
  • Urine culture in nonspecific illness
  • Low-dose prophylaxis can be used
  • Circumcision considered
  • Anti-reflux surgery with evidence of progression
  • Blood pressure checked if renal disease present
  • Regular assessment of renal growth and function if bilateral defects present

Final Notes (196 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions