Urology & Gynaecology Flashcards
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
At what age are children usually toilet trained?
Day dry at 3years
Night dry at 4 years
Slightly older in boys
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
How is enuresis investigated?
Urinalysis & culture
USS of renal tract
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
What are the causes of a UTI in children?
90% E.Coli Proteus: Boys- can cause renal stones Pseudomonas Klebsiella Staph Saprophyticus
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
How is a UTI investigated?
Urinalysis Cultures Abdo exam Recurrent/atypical (>2 episodes): USS Recurrent/<3yo: DMSA
How are UTIs prevented in children?
Inc fluid intake Encourage micturition Constipation managed Hygiene Avoid Nylon underwear & bubble bath Trimethoprim prophylaxis
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
What are the 2 forms of HUS?
Atypical/Sporadic: Familial, not diarrhoea associated
Epidemic: Diarrhoea, E.Coli 0157 associated
What are the causes of HUS?
E.COLI
Epidemic also: Shigella, Strep Pneumoniae
What are the RFs for getting HUS?
6m-5yrs old ImmunoC Farm animal contact Summer Consuming undercooked beef Genetics Tumours
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
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
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)
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&E, LFTs, Clotting E.Coli PCR Stool: Microscopy & 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&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
