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Paediatrics > UTI > Flashcards

UTI Flashcards

1
Q

Risk Factors for UTI

A

Female - Shorter urethra, wipe back to front

Constipation in sigmoid or rectum

Poor urine flow or dysfunctional voiding. (not going when they need to go)

Previous UTI

Fam hx of Vescioureteric reflux or renal disease

Neurogenic bladder: spina bifida or spinal lesions (cause stasis of urine)

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2
Q

Tx for UTI

A

Any child with pyleonephritis, start IV abx immediately. Co-amoxiclav + gentamicin.

If < 3 months add, cefatoxime

Give for 7-10 days

Always rescan the kidney after 4-6months to check for dilation or abnormalities.

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3
Q

When should you switch from IV to PO abx

A
  1. IV for at least 48 hours
  2. Child hasn’t had temperature for 24 hours
  3. Blood cultures are negative
  4. No renal abnormality
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4
Q

What is recurrent UTI

A 
2 pyelonephritis (or)
1 pyelonephritis + 1 cystitis

Over 6 months
(or)
3 cystitis over 1 year.

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5
Q

Atypical UTI features

A
  1. Seriously ill, septicemia
  2. poor urine flow
  3. Abdo or bladder masses
  4. Failure to respond to abx w/in 48 hours - do US for abscess
  5. Infection with non-E Coli organisms (Proteus, Klebsiella, pseudomonas)
  6. Raised Creatinine
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6
Q

What is the gold standard for diagnosing vesicoureteric reflux? What added measures must be taken or explained to the patient?

A

MCUG - micturating cystourethrography

There is radiation exposure & requires prophylatic antibotics.

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7
Q

When are urine cultures sent?

A
  1. Any child < 3 months with fever
  2. +ve dipstick
  3. Recurrent UTI (can you recall the definition of recurrent UTI?)
  4. Not responding to treatment
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8
Q

Whats the most common organism causing UTI

A

E Coli

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9
Q

Which organism is more common in boys than girls? And what does it predispose them to?

A

Proteus. predisposes to renal phosphate stones

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10
Q

Which bacteria is more common in neonates

A

Grp B

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11
Q

If ptx has poor urinary flow, what organism is more likely to be present?

A

Pseudomonas

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12
Q

What imaging will you do for < 6mo old that is responding well to Tx?

A

Just a USS 6 weeks after infection to check for scarring

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13
Q

What imaging will you do for < 6mo old that has atypical UTI? (what constitutes as an atypical UTI?)

A

Acute USS during infection
DMSA 4-6 months after
MCUG - 6 months after infection

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14
Q

What is DMSA gold standard for?

A

Detecting Renal scarring

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15
Q

What imaging will you do for < 6mo old that has recurrent UTI?

A

Acute USS during infection
DMSA - 4-6 months after
MCUG - 6 months after infection

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16
Q

For children 6mo to 3 years, when do you not require imaging?

A

When they respond well to tx

17
Q

For children 6mo to 3 years wth atypical UTI, what imaging do you want?

A

Acute renal USS during the infection

DMSA after 4 months for scarring

18
Q

For children 6mo to 3 years wth recurrent UTI, what imaging do you want?

A

US 6 weeks after infection

DMSA after 4 months for scarring

19
Q

For children > 3 years, when do you reqiure imaging? Which would you want?

A

If they aren’t responding to treatment or atypical UTI or recurrent UTI.

For atypical: need an acute renal USS. Thats it.

For recurrent UTI:

  • US after 6 weeks post infection
  • DMSA 4 months after for scarring
20
Q

What is the incidence of VUR if there is a fam hx in a 1st degree relative?

A

30-50%

21
Q

With growth, reflux resolves in what % of patients?

A

10%

22
Q

What are the associated urinary tract abnormalities?

A

Posterior urethral valves

Bladder exstrophy (skin over bladder didn;t close, exposed to outside environment)

Ureterocoele (congenital, ureters balloon into bladder)

Ureter duplication

23
Q

Describe the grades of VUR (just the 1st 4 grades). There is a 5th one

A

grade 1: reflux into upper part of ureter. no dilation

grade 2: reflux into ureter + collecting systems. No dilation

grade 3: Grade 2 + mild dilation. And mild blunting of calyces.

Grade 4: Grossing dilates the ureter & collecting system. More obvious blunting of calcyes

24
Q

Describe 5th grade of VUR

A

Grade 5: Massive reflux, gross dilation. ALL calcyes are blunted. Loss of papillary impression. +/- intrarenal reflux

Significant ureteral dilation & torsion

25
Q

When is the highest recurrence for UTI

A

in the 1st year. 50% recur in 1st year

26
Q

How is UTI diagnosed?

A

Clinically + presence of bacteria in > 10^5 cfu/ml

27
Q

Even if dipstick says urine -ve for nitrites, it can still be UTI? T or F?

A

true, nitrates need 1 hour in the bladder to be convered to nitrates.

28
Q

What conditions to rule out

A

Constipation
Phimosis in boys
Labia adhesions in girls

Paediatrics (9 decks)

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