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Paediatrics > Urology & Gynaecology > Flashcards

Urology & Gynaecology Flashcards

1
Q

What is enuresis?

A

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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2
Q

At what age are children usually toilet trained?

A

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

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3
Q

What are the causes of primary & secondary bed wetting?

A

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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4
Q

How is enuresis investigated?

A

Urinalysis & culture

USS of renal tract

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5
Q

How is enuresis managed?

A 
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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6
Q

What are the causes of a UTI in children?

A 
90% E.Coli
Proteus: Boys- can cause renal stones 
Pseudomonas
Klebsiella
Staph Saprophyticus
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7
Q

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

A

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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8
Q

How is a UTI investigated?

A 
Urinalysis
Cultures
Abdo exam
Recurrent/atypical (>2 episodes): USS
Recurrent/<3yo: DMSA
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9
Q

How are UTIs prevented in children?

A 
Inc fluid intake
Encourage micturition
Constipation managed
Hygiene
Avoid Nylon underwear &amp; bubble bath
Trimethoprim prophylaxis
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10
Q

How is a UTI treated?

A 
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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11
Q

What are the 2 forms of HUS?

A

Atypical/Sporadic: Familial, not diarrhoea associated

Epidemic: Diarrhoea, E.Coli 0157 associated

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12
Q

What are the causes of HUS?

A

E.COLI

Epidemic also: Shigella, Strep Pneumoniae

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13
Q

What are the RFs for getting HUS?

A 
6m-5yrs old
ImmunoC
Farm animal contact
Summer
Consuming undercooked beef
Genetics
Tumours
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14
Q

How can E.Coli leading to HUS be contracted?

A

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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15
Q

What is the pathophysiology of HUS?

A

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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16
Q

What are the signs & symptoms of HUS?

A 
Acute renal failure
Profuse diarrhoea (bloody after 3d)
Irritability
Endocrine: Jaundice, DM
Fever
Vomiting
Abdo pain
Haemorrhagic colitis
Myocarditis (rare)
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17
Q

What is the classic triad seen in HUS?

A

Acute renal failure
Thrombocytopenia
Microangiopathic haemolytic anaemia

18
Q

How is HUS investigated?

A 
Blood film
Blood cultures
Bloods: FBC, U&amp;E, LFTs, Clotting
E.Coli PCR
Stool: Microscopy &amp; culture
Urinalysis: Haematuria, proteinuria
19
Q

How is HUS treated?

A 
Paediatric nephrology unit
Supportive
Fluids
?Dialysis
Nutrition
Blood transfusion
Tx HTN
20
Q

What are the causes of haematuria?

A 
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
21
Q

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

A

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

22
Q

How is haematuria investigated?

A 
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
23
Q

What are the other causes of ‘red’ urine?

A 
Haemoglobinuria/ myoglobinuria
Foods: Beetroot
Drugs: Rifampicin
Urate crystals
External source: Menstrual bleeding
Ficticious
24
Q

What are casts suggestive of?

A

Nephritis

25
Q

What is nephrotic syndrome defined as?

A

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

26
Q

What are the 2 types of nephrotic syndrome?

A

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

27
Q

What is the treatment for nephrotic syndrome based on?

A

Whether the type of nephrotic syndrome is steroid sensitive or resistant

28
Q

What are the causes of nephrotic syndrome?

A 
Inc capillary membrane permeability &amp; protein leak into urine
Hypoalbuminaemia: Oedema develop
Henoch Scholein Purpura
SLE
Malaria &amp; Schistosomiasis
Leukaemia &amp; lymphoma
Sickle Cell
DM
Syphilis, Hep B &amp; C
Beestings
Toxoplasmosis
29
Q

What are the signs & symptoms of nephrotic syndrome?

A 
Insidious onset of oedema: Initially periorbital (noticeable am)
Becomes generalised pitting oedema
Ascites
Weight gain
Pleural effusion
Rx infections
Lethargy &amp; fatigue
Weakness
Abdo pain
Thrombosis
Hypothyroid
30
Q

What is the pathophysiology of nephrotic syndrome?

A

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

31
Q

What is the pathophysiology of minimal change disease?

A

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

32
Q

How is nephrotic syndrome investigated?

A

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

33
Q

How is nephrotic syndrome managed?

A

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

34
Q

What are the complications of nephrotic syndrome?

A

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

35
Q

What is focal segmental glomerulosclerosis?

A

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

36
Q

Who is affected by FSGS & membranous glomerulonephritis?

A

FSGS: AFRICAN/HISPANIC ADULTS &KIDS

Membranous Glomerulonephritis: Caucasian adults

37
Q

What components are seen in glomerulonephritis?

A 
Haematuria
Oliguria
Oedema
Hypertension
Proteinuria
38
Q

What are the causes of glomerulonephritis?

A 
1-2w post sore throat/URTI
Strep
Staph Aureus
Mycoplasma Pneumonia
Salmonella
Herpes
EBC
CMV
Varicella
Candida
Malaria
Toxoplasmosis
Schistosomiasis
39
Q

How is glomerulonephritis investigated?

A 
Urinalysis
Microscopy
Throat swabs &amp; culture
Bloods: FBC, U&amp;E, Complements (C3,C4)
Renal USS
CXR
40
Q

How is glomerulonephritis treated?

A 
95% complete recovery
Admit
Fluids
Beta blocker &amp; CCB
Abx: Penicillin 10d
41
Q

How is renal colic diagnosed?

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

Paediatrics (26 decks)

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