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Paeds > Urology > Flashcards

Urology Flashcards

1
Q

What are some symptoms of UTI in infants?

A 
Fever
Vomiting
Lethargy/irritability
Poor feeding/faltering growth
Jaundice
Offensive-smelling urine
Febrile seizure
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2
Q

What are some symptoms of UTI in children?

A 
Dysuria, Frequency and Urgency
Abdo pain/loin tenderness
Fever +/- Rigors
Lethargy and Anorexia
Vomiting and Diarrhoea
Haematuria
Offensive-smelling urine
Febrile seizure
Bed wetting
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3
Q

How can a clean catch urine sample be obtained from infants?

A

Sample pot
In-and-out Catheter
Bag on Perineum once perineum has been cleaned

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4
Q

When must a urine sample from children be cultured?

A

Immediately or refridgerate to prevent contamination

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5
Q

Why are children pre-disposed to develop UTIs?

A

Bowel flora can easily enter the urethra

They may have incomplete bladder emptying

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6
Q

What are some of the common causative organisms of UTIs in children?

A

E. Coli
Pseudomonas
Strep. Faecalis

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7
Q

Which factors in children may lead to incomplete bladder emptying?

A 
Infrequent voiding
Vulvitis
Incomplete micturition with residual volumes
Obstruction from a loaded rectum
Neuropathic bladder
Vesicoureteric Reflux
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8
Q

What is Vesicoureteric Reflux?

A

Ureters are displaced laterally, meaning they enter the bladder directly. This can give severe reflux leading to renal pelvis dilatation and intra-renal reflux

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9
Q

What is the risk with prolonged Vesicoureteric reflux?

A

Can lead to intra-renal scarring giving CKD and HTN

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10
Q

At what age should all UTIs in children be investigated?

A

<6m of age

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11
Q

Which features of a UTI in children >6m suggest an atypical cause that warrants investigation?

A 
Seriously ill
Poor urine flow
Abdominal/bladder mass
Raised serum creatinine
Failure to respond to suitable antibiotics within 48h
Infection with atypical organism
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12
Q

What is some general advice parents can be given to reduce the risk of their child developing a UTI?

A 
Stay hydrated
Use potty more often - time sessions
Empty the bladder completely - encourage double voiding
Proper wiping - front to back
Avoid constipation
Avoid tight-fitting underwear
No bubble baths
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13
Q

How should a confirmed UTI be managed in a child <3m?

A

Admit for Parental Abx, Microscopy and culture

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14
Q

How should a confirmed Upper UTI/Pyelonephritis be managed in a child >3m?

A

Cefalexin

Co-Amoxiclav

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15
Q

How should a Lower UTI be managed in a child >3m?

A

Trimethoprim

Nitrofurantoin

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16
Q

When do children commonly present with Nephrotic syndrome?

A

2-5y

17
Q

What three features are usually found in Nephrotic Syndrome?

A

Hypoalbuminaemia
Proteinuria
Oedema

18
Q

What are some causes of Nephrotic Syndrome in children?

A 
Minimal Change Disease - Most common cause in children
Focal Segmental Glomerulosclerosis
HSP
Diabetes
Infection
19
Q

How should Nephrotic Syndrome be managed?

A

High Dose Steroids - Prednisolone
Low salt diet
Diuretics for oedema
Albumin infusions if severe hypoalbuminaemia

20
Q

What are some potential complications of Nephrotic Syndrome in children?

A

Hypovolaemia
Thrombosis
Infection
Acute/Chronic renal failure

21
Q

What is Nocturnal Enuresis?

A

Bed wetting at night

22
Q

What are some causes of Primary Nocturnal Enuresis in children?

A 
Variation on normal development
Overactive bladder
Excess fluid intake prior to bedtime
Failure to wake due to deep sleep
Psychological distress
23
Q

What is Primary Nocturnal Enuresis?

A

Child has never been dry at night

24
Q

How can Primary Nocturnal Enuresis be managed?

A 
Reassurance that it will resolve without treatment
Reduce fluid intake in the evenings
Pass urine before bed
Avoid blame or shame, no punishment
Treat any underlying cause
Enuresis alarms
Pharmacological treatment
25
Q

What is Secondary Nocturnal Enuresis?

A

Child begins wetting the bed when they have been previously dry for at least 6m

26
Q

What are some potential causes of Secondary Nocturnal Enuresis?

A 
UTI
Constipation
T1DM
New psychosocial problems
Maltreatment
27
Q

How should secondary nocturnal enuresis be managed?

A

Treat the underlying cause

28
Q

What is an Enuresis Alarm?

A

A device that makes a noise at the first sign of bed wetting, waking the child and stopping them from urinating

29
Q

Which medication can be used to reduce nocturnal enuresis?

A

Desmopressin - ADH analogue reducing volumes of urine

30
Q

Which medication can be used to treat nocturnal enuresis due to an overactive bladder?

A

Oxybutinin - Anticholinergic that reduces contractility of the bladder

31
Q

What is a Wilms tumour?

A

A specific tumour of the kidney found in children, usually under 5y

32
Q

What are some symptoms a Wilms’ tumour may present with?

A 
Abdominal pain
Haematuria
Lethargy
Fever
Hypertension
Weight loss
Parents notice the mass in the abdomen
33
Q

How is a Wilms’ tumour diagnosed?

A

USS of the Abdo
CT/MRI
Biopsy of the tumour

34
Q

How is a confirmed Wilms’ tumour managed?

A

Surgical excision of the tumour along with the affected kidney - Nephrectomy

35
Q

What is a Posterior Urethral valve?

A

Tissue at the proximal end of the urethra causes obstruction of urine output. Occurs in newborn boys

36
Q

How can a Posterior Urethral valve present?

A 
Difficulty Urinating
Weak urinary stream
Chronic urinary retention
Palpable bladder
Recurrent UTIs
Impaired kidney function
37
Q

What are the possible consequences of a Posterior

Urethral Valve in utero?

A

Bilateral Hydronephrosis
Oligohydramnios
Pulmonary Hypoplasia

38
Q

Which investigations are appropriate for a suspected Posterior Urethral valve?

A

Abdominal USS - Enlarged bladder and bilateral hydronephrosis
MCUG - Shows location of tissue and extent of reflux
Cystoscopy - Can be curative too

39
Q

How is a confirmed Posterior Urethral valve managed?

A

Ablation via cystoscopy

Paeds (11 decks)

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