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Flashcards in GU Deck (14)
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1

When is enuresis not normal?

when child is older than 7 yrs, and they have been dry for 6 months


2

Management of Enuresis?

Enuresis- Management
• Urinalysis-if abnormal --> renal ultrasound, vesicoureterogram
• Family counseling- do not punish child, but child should take some responsibility - remove sheets, etc.
• Conditioning therapies - alarm triggered when child wets the bed
Meds: DDAVP

3

UTI suspected?

children <2 hospitalized
- UA: (suggestive)
leukocyte esterase, nitrates, blood
Urine culture is mandatory for diagnosis:
clean catch (older girls/ circumcised males)
positive = 50,000 - 100,000 CFU/mL
straight cath
positive = >10,000

4

When do you do further studies for a UTI and what are they?

children 2 - 24 month first febrile
• Any child with complicating factors: GU defects, neurogenic bladder dysfunction, family hx, HTN
• Boys of any age
• Febrile infants
• Recurrent UTIs any age

Renal and bladder ultrasonography (RBUS)
&
if abnormal, odd bacteria + high fever, growth or HTN, >2 febrile UTI
>>>>> voiding cystourethrogram (VCUG) is the test of choice to establish the presence and degree of VUR.

5

Management of vesicoureteral reflux?

grade I - II = no prophylactic abx unless non-verbal or BBD
> grade III = abx prophylaxis (bactrim) Trimethoprim/sulfamethoxazole { > 2 mo only}

6

pharm therapy for UTI

10 to 14 days
Increasing rates of resistance to Bactrim
• Cephalosporins --> Second & third generations cephalosporins more effective (e.g., cefixime)
• Fluorquinolones (e.g.,Cipro) are effective against E.
o coli but should not be used as first line treatment in younger children (AAP) because safety in children is still under study
o Ciprofloxacin may cause joint damage in children.
• Aminoglycosides also a good first line treatment for UTI (e.g., gentamycin, amikacin)

7

Cryptorchidism

(Undescended Testicle)
• Need to differentiate from retractile testis
• May descend spontaneously in first 3 months of life, particularly in premature infant
• Refer to pediatric urology for repair, if not descended by 1 year
• Long-term monitoring for cancer (40x more)

8

Hypospadias

urethral opening on ventral side of penis
• Postpone circumcision until surgical repair
• Management: referral to pediatric urology for surgical repair between 6-12 months
- mild cases are cosmetic

9

Hydrocele

When to refer?

• Fluid trapped in scrotum when processus vaginalis does not close or closes late (painless scrotal swelling)
• Most resolve spontaneously during the first year of life
•Treatment: first year = supportive
• Referral when
• – Persists after 12 months of life
• – Bowel present in scrotum; ie does not transilluminate (inguinal hernia)
– increases in size,
– causes PAIN

10

when can you fully retract foreskin?

10 yrs

11

unilateral acute painful swelling of scrotum, no urinary symptoms, no systemic symptoms. occurring in 10 - 20 yr males

what is it? test you could do?

Testicular Torsion - twisting and strangulation of the spermatic cord (EMERGENCY - surgical intervention in 6 - 12 hours to save)

Prehn's sign - lifting the testis does not relive pain
(prehn +)
absent cremasteric reflex

12

Acute Glomerulonephritis

• Result of an immune process that injures the glomeruli of the kidney
• Most often develops 8-14 days after a strep infection
S&S– hematuria, proteinuria, tea colored urine, lethargy, abdominal pain, headache, vomiting, azotemia, hypertension
• Edema (peripheral) – peri- orbital edema is where you first see it, HTN, gross hematuria, oliguria --> hospitalization

DX: • Urinalysis- Hematuria, high specific gravity >1.020 and low PH (acidic)
o +Leukocytes, +protein
Blood: BUN and creatinine may be increased
o ASO (antistreptolysin O) titer may be increased- increased when exposed to strep within the last 6 weeks
throat cultures

13

Azotemia

– Azotemia is a medical condition characterized by abnormal levels of nitrogen-containing compounds, such as urea, creatinine, various body waste compounds, and other nitrogen-rich compounds in the blood

14

Acute Glomerulonephritis treatment?

• Bedrest during acute phase --> Not necessary if BP and UOP is normal
• BP should be taken at home (if not possible child should be seen in the office)
• May require antihypertensives- without treatment --> seizures
• Daily weight at home
• Water restriction not necessary unless UOP is significantly decreased- may need to restrict water in relation to urinary output

Treatment-AGN
Diuretics may be useful (Lasix) to decrease fluid overload and edema
Nutrition-regular diet unless BP is elevated- may require low sodium diet
Antibiotics-may be necessary if it is determined that strep infection is present
• Prognosis-98% fully recover; a few patients may develop chronic renal failure