urinary problems in pediatrics Flashcards

1
Q

day time urinary continence by age…

A

4

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2
Q

daytime and night time continence by age…

A

5

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3
Q

an infant voids approx ___ times per day

A

20 (small voided volumes and incomplete bladder emptying)

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4
Q

increased daytime frequency = voiding ___ or more times during waking hours

A

8

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5
Q

decreased daytime frequency= voiding ___ or less

A

3

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6
Q

abnormal frequent small voids in a previously toilet-trained kid (with NO evidence of polyuria or uti)

A

pollakiuria

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7
Q

T/F intermittent stream is normal physiologic pattern in kids <3y.o

A

TRUE

  • voiding stream of urine that occurs in several discrete bursts rather than the normal continuous stream
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8
Q

polyuria= urine output exceeding __L/m2

A

2 L/m^2 in kids and 3L in adults

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9
Q

primary enuresis

A

80% of cases

involuntary urination in kids who has never established continence for more than 6 months

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10
Q

secondary enuresis

A

20% of cases

resumption fo enuresis after at least 6 mo of continence

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11
Q

monosymptomatic enuresis

A

aka uncomplicated enuresis

enuresis without lower urinary tract symptoms other than nocturia

no hx of bladder dysfunction

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12
Q

nonmonosymptomatic enuresis

A

enuresis with lower urinary tract symptoms:

  • incr/decr voiding frequency
  • daytime wetting, urgency, hesitancy
  • straining, weak, intermittent stream
  • posturination dribbling, holding maneuvers
  • sensation of incomplete emptying
    lower abd or genital discomfort
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13
Q

nocturnal enuresis= discrete episodes of urinary incontinence during sleep in kids > ___ yo

A

5

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14
Q

causes of monosymptomatic nocturnal enuresis

A
  1. detrusor over-activity
  2. disturbed sleep
  3. psychologic (bx)
  4. neuropsych (intellectual disability, low self-esteem, adhd)
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15
Q

when would you get a renal US and VCUG (voiding cystourethrogram)

A
  • kids with significant daytime complaints
  • uti that hasnt been evaluated
  • signs of structural urologic abnormalities
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16
Q

US helpful to determine

A

post-void residual volume

bladder wall thickness

17
Q

abd xray for…

A

to determine presence and extent of stool retention

18
Q

MRI for…

A

kids with lower lumbosacral spine abnormality

abnormal neuro exam of the perineum and lower extremities

19
Q

kids who have BOTH bladder and bowel symptoms are described as ___

A

bowel and bladder dysfunction

complex/ complicated enuresis

20
Q

overactive bladder

A

abnormal bladder contraction during the filling phase
[
2nd MC bladder dysfunction (nocturnal enuresis is #1)

main symtom= URGENCY

21
Q

girl with h/o never gaining urinary control prob has ___

A

ectopic ureter

anatomic cause of dysfunctional voiding

duplex collecting system

22
Q

t/f boys with ectopic ureter is always proximal to the external urethral sphincter

A

TRUE

this is why males w ectopic ureter dont present with incontinence

23
Q

posterior urethral valves (PUV)

A

obstructing membranous folds within the lumen of the posterior urethra

obstructs bladder outlet

results from disruptions in male embryologic urethral development

MC cause of chronic renal dz d/t urinary tract obstruction

24
Q

how are PUVs diagnosed?

A

prenatal US

as kids: UTI
- presumptive diagnosis w VCUG, confirmation by cystoscopy

25
PUV can lead to ___-
vesicoureteral reflux
26
vesicoureteral reflux
voiding against closed sphincter increases bladder pressure
27
what does a urinalysis measure?
leaukocyte esterase (from neutrophils) nitrites (gram-neg bacteria) both can be detected by color change on dipstick test
28
what test is used to definitively diagnose UTI?
urine culture
29
what is the test of choice to establish vesicoureteral reflux
VCUG - voiding cystourethrogram/ renal scintigraphy involved catheterization to fill the bladder with a radioopaque or radioactive liquid and recoridng images during voiding