Urology & Gynaecology Flashcards by Amy Spicer

What is enuresis?

Inappropriate voiding of urine after an age when bladder control should be achieved
Night time control harder
Need conscious awareness of fullness & suppress urge to void

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At what age are children usually toilet trained?

Day dry at 3years
Night dry at 4 years
Slightly older in boys

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What are the causes of primary & secondary bed wetting?

Primary: Polyuria, sleep arousal difficulties, delayed maturation of control mechanisms, bladder dysfunction, neuro disorder
Secondary (enuresis after a period of control): UTI, constipation, DM, abuse

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How is enuresis investigated?

Urinalysis & culture

USS of renal tract

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How is enuresis managed?

Avoid caffeine
Restrict drinks 1hr before bed
Drinking/voiding chart
Remove nappies/pull ups
Star chart
Bladder training
Enuresis alarm
Enuresis: Desmopressin (give at bedtime, reduced fluid intake)
Bladder stabilising/OAB: Oxybutinin

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What are the causes of a UTI in children?

90% E.Coli
Proteus: Boys- can cause renal stones 
Pseudomonas
Klebsiella
Staph Saprophyticus

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What are the signs & symptoms of a UTI in a child?

Infant: Fever, irritable, poor feeding, failure to thrive, vomiting, febrile convulsions, prolonged jaundice, offensive urine, haematuria
Child: Dysuria, frequency, fever, loin pain, lethargy, enuresis, haematuria, dysfunctional voiding, offensive/cloudy urine

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How is a UTI investigated?

Urinalysis
Cultures
Abdo exam
Recurrent/atypical (>2 episodes): USS
Recurrent/<3yo: DMSA

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How are UTIs prevented in children?

Inc fluid intake
Encourage micturition
Constipation managed
Hygiene
Avoid Nylon underwear &amp; bubble bath
Trimethoprim prophylaxis

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How is a UTI treated?

Fluids
Don't advise ibuprofen as reduces glomerular filtration rate
Abx: <3m= IV Ceftriaxone
Cystitis: Trimethoprim
Pyelo: Co-Amox 7-10days
Acute illness: IV Cefuroxime

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What are the 2 forms of HUS?

Atypical/Sporadic: Familial, not diarrhoea associated

Epidemic: Diarrhoea, E.Coli 0157 associated

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What are the causes of HUS?

E.COLI

Epidemic also: Shigella, Strep Pneumoniae

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What are the RFs for getting HUS?

6m-5yrs old
ImmunoC
Farm animal contact
Summer
Consuming undercooked beef
Genetics
Tumours

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How can E.Coli leading to HUS be contracted?

Consuming undercooked beef (mince)
Drinking unpasteurised milk
Close contact w/person with bacteria in faeces
Drinking/swimming/playing in contaminated water
Contact w/farm animals

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What is the pathophysiology of HUS?

Circulating shiga toxins bind to endothelial receptors in renal/GI/CNS tracts
Causes platelet activation & aggregation
Thrombus deposited in microvasculature
Erythrocytes damaged passing through occluded small vessels- haemolysis

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What are the signs & symptoms of HUS?

Acute renal failure
Profuse diarrhoea (bloody after 3d)
Irritability
Endocrine: Jaundice, DM
Fever
Vomiting
Abdo pain
Haemorrhagic colitis
Myocarditis (rare)

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What is the classic triad seen in HUS?

Acute renal failure
Thrombocytopenia
Microangiopathic haemolytic anaemia

How is HUS investigated?

Blood film
Blood cultures
Bloods: FBC, U&amp;E, LFTs, Clotting
E.Coli PCR
Stool: Microscopy &amp; culture
Urinalysis: Haematuria, proteinuria

How is HUS treated?

Paediatric nephrology unit
Supportive
Fluids
?Dialysis
Nutrition
Blood transfusion
Tx HTN

What are the causes of haematuria?

Infection: Bacterial, viral (Adenovirus), TB, Schistosomiasis
Glomerular: IgA nephropathy, SLE, Henoch, post-infectious glomerulonephritis, hereditary
Trauma
Stones
Tumours
Polycystic kidneys
Sickle cell anaemia
Bleeding disorders

How can you tell where about the pathology is in haematuria?

Red urine: Lower urinary tract, beginning/end of urinary stream, no proteinuria
Brown urine: Glomerular, deformed RBCs & casts pass through basement membrane, also proteinuria

How is haematuria investigated?

Urine: P:C<20, Ca:C<0.7
MCS: 10+ RBCs
PCR urine
Bloods: FBC, U&amp;E, Clotting, Creatinine, albumin, ANA, complement
USS renal tract
Cystoscopy

What are the other causes of ‘red’ urine?

Haemoglobinuria/ myoglobinuria
Foods: Beetroot
Drugs: Rifampicin
Urate crystals
External source: Menstrual bleeding
Ficticious

What are casts suggestive of?

Nephritis

What is nephrotic syndrome defined as?

Heavy proteinuria: Urine P:C >200 Hypoalbuminaemia: Albumin <25 Oedema Hyperlipidaemia

What are the 2 types of nephrotic syndrome?

Primary: Congenital, infantile Secondary: Minimal change disease, Focal segment glomerulosclerosis, membranous glomerulonephritis, membranoproliferative glomerulonephritis

What is the treatment for nephrotic syndrome based on?

Whether the type of nephrotic syndrome is steroid sensitive or resistant

What are the causes of nephrotic syndrome?

``` Inc capillary membrane permeability & protein leak into urine Hypoalbuminaemia: Oedema develop Henoch Scholein Purpura SLE Malaria & Schistosomiasis Leukaemia & lymphoma Sickle Cell DM Syphilis, Hep B & C Beestings Toxoplasmosis ```

What are the signs & symptoms of nephrotic syndrome?

``` Insidious onset of oedema: Initially periorbital (noticeable am) Becomes generalised pitting oedema Ascites Weight gain Pleural effusion Rx infections Lethargy & fatigue Weakness Abdo pain Thrombosis Hypothyroid ```

What is the pathophysiology of nephrotic syndrome?

Normal: Glomerulus filters out Na & water into nephron -urine Nephrotic syndrome: Glomerulus damage & more permeable Allow plasma proteins (albumin & lipids) to enter the urine Less protein in the blood lowers oncotic & osmotic pressures so water leaks out of vessels into tissues- oedema

What is the pathophysiology of minimal change disease?

Cytotoxic damage of foot processes of podocytes Podocytes are -vely charged Effacement means less charge barrier so albumin able to get into urine Larger proteins still unable to pass through- selectively permeable membrane

How is nephrotic syndrome investigated?

Urine: Microscopy (haematuria, casts), culture, early morning P:C ratio Urinalysis- protein +++, Bloods: Serum albumin (<25), U&E, Creatinine, C3/C4, Lipid profile, Hb Varicella Zoster immunity

How is nephrotic syndrome managed?

Admit Daily weights Fluid restriction 800-1L/24hr & prevent hypoV Diuretic: Furosemide Steroid: Oral Prednisolone 60mg/m2/day 4weeks Diet: No added salt Proph Abx: Oral Penicillin V until oedema free

What are the complications of nephrotic syndrome?

Hypovolaemia: Oliguria & low BP Infection: Due to dec IgG & immunoS by steroids (bacterial peritonitis) Thrombosis: Hypercoagulable state Acute renal failure: Pre-renal

What is focal segmental glomerulosclerosis?

Aka FSGS Sclerosis occurs at part of a glomerulus and only in a select few glomeruli Allowing proteins to leak into the urine

Who is affected by FSGS & membranous glomerulonephritis?

FSGS: AFRICAN/HISPANIC ADULTS &KIDS | Membranous Glomerulonephritis: Caucasian adults

What components are seen in glomerulonephritis?

``` Haematuria Oliguria Oedema Hypertension Proteinuria ```

What are the causes of glomerulonephritis?

``` 1-2w post sore throat/URTI Strep Staph Aureus Mycoplasma Pneumonia Salmonella Herpes EBC CMV Varicella Candida Malaria Toxoplasmosis Schistosomiasis ```

How is glomerulonephritis investigated?

``` Urinalysis Microscopy Throat swabs & culture Bloods: FBC, U&E, Complements (C3,C4) Renal USS CXR ```

How is glomerulonephritis treated?

``` 95% complete recovery Admit Fluids Beta blocker & CCB Abx: Penicillin 10d ```

How is renal colic diagnosed?

``` Rule of 3s: Baby who cries for... >3hours in any 3 days of 3 consecutive weeks ```