peds exam 2 GU/endo
the more concentrated the urine the ________ the specific gravity
High level of ADH
Low levels of ADH
do peds have bigger or smaller kidneys?
do peds have a longer or shorter urethra?
when is bladder control usually achieved?
normal urine outputs
- Infants & toddlers:
- Preschool & school age =
- Adolescents =
- Infants & toddlers: 1-3 ml/kg/hr
- Preschool & school age = 1-2 ml/kg/hr
- Adolescents = 0.5-1 ml/kg/hr
minimum urine outputs
- Under 1 year at least =
- 1 year up to 30 kg =
- 30kg & more at least =
- Under 1 year at least = 2 ml/kg/hr
- 1 year up to 30 kg = 1 ml/kg/hr
- 30kg & more at least = 30 ml/hr or 0.5 ml/kg/hr
exposed or open dorsal urethra
urethra just off the tip of the glans
when is corrective surgery for hypospadias/epispadias?
is a patient circumcised or uncircumcised prior to corrective surgery of hypospadias/epispadias?
how long is a urethral stent/catheter placed to maintain patency after correction surgery of hypospadias/epispadias?
when can a patient have a bath after corrective surgery for hypospadias/epispadias?
after 3 days (if not stent)
medication for postop hypospadias/epispadias corrective surgery
abx, oxybutynin, pain medication
medication that controls bladder spasms
how often is oxybutynin given?
q 8 hours
Involuntary voiding by a child old enough that bladder control is expected
involuntary urination at night (sleeping hours)
diagnosis for nocturnal/enuresis
- Must be twice a week for at least 3 months
- Must be at least 5 years old
- Rule out organic causes: structural defects, UTI, Endocrine: diabetes & pituitary, sickle cell, neurological
meds for nocturnal enuresis
desmopressin (DDAVP), tofranil (imipramine), ditropan (oxybutynin)
med that reduces urine volume at night
side effects of tofranil
arrythmias, drowsiness, N/V, tachycardia
presence of bacteria in the urine (can be symptomatic or asymptomatic
inflammation of the bladder
Inflammation of upper urinary tract and kidneys
bacterial illness; urinary pathogens in blood
most common cause of UTI (organism)
single most contributing factor to UTI
diagnostic tests for UTI
- Ultrasound (bladder after voiding or anatomical structures)
- Voiding Cystourethrography (VCUG)
- Urine culture and sensitivity (cath or clean catch)
- Urinalysis (nitrites, WBC, RBC, bacteria)
contrast medium injected into bladder through urethral catheter until the bladder is full
s/sx of UTI in infants
jaundice, foul smelling urine, fever, poor feeding, vomiting, irritability, dehydration, screaming with urination, seizures, resp distress
s/sx of UTI in preschool
incontinence/enuresis, fatigue, abd/suprapubic/flank pain, pain with urination, fever, poor appetite, vomiting, diarrhea, blood in urine, edema, seizures, hypertension
Abnormal retrograde flow of bladder urine into ureters acting as a reservoir for bacteria
vesicoureteral reflux (VUR)
diagnostic for VUR
primary cause of VUR
congenital abnormality in ureters
secondary cause of VUR
tx for VUR
abx, UA q few months, annual evaluation, surgical intervention
bulking agent, dextranomer-hyaluronic acid polymer (Deflux) injected into mucous membrane of ureter
what causes HUS (hemolytc-uremic syndrome)?
e coli (main cause), contaminated food/food borne, swimming pools/lakes
other organisms that can cause HUS?
- Streptococcus Pneumoniae infection (5-15%)
- Children under 5 years of age
- People over 75
meds for HUS
quinine sulfate, chemotherapy, immunosuppressants, antiplatelet medications
patho of HUS
The toxin causes-
- destruction of the glomerular arterioles
- activates platelets
- destruction of RBC (hemolytic)
= Acute Renal Failure
Triad of HUS
anemia, renal failure, thrombocytopenia
the tiny filter units in the kidneys known as glomeruli become clogged with platelets and damaged red blood cells
s/sx of HUS
bloody stools, oliguria, petechiae, jaundice, diarrhea, abdominal tenderness, pale and lethargic, proteinuria, hematuria, BUN and creat elevated, seizure, HTN
tx for HUS
BMP/CBC/DIC, PICC, TPN, NG feeds, dialysis, plasmapheresis, fresh frozen plasma, blood transfusion, stop antibiotics
manifestions of nephrotic syndrome
- Massive urinary protein loss
s/sx of nephrotic syndrome minimal change
occurs over weeks, weight gain, edema, ascites, frothy urine, anorexia, pallor/fatigue
diagnostic for nephortic syndrome minimal change
labs (low alobumin, low protein, high lipids), UA +2 protein, biopsy
why is nephrotic syndrome at increased risk for infection?
low on protein, losing immunoglobulin, giving steroids
meds for nephrotic syndrome
diet for nephrotic syndrome
restrict sodium, possible fluid restriction, good nutrition
causes of acute post-strep glomerulonephritis (PSGN)
s/sx of glomerulonephritis
abrupt onset, hematuria, proteinuria, oliguria/dysuria, HTN, edema, flank pain/abd pain, anorexia, malaise/lethargy, altered immunity
Increased amount of protein reflects __________
increased severity of renal disease
diagnostic for acute glomerulonephritis
progression of edema, decrease urine output, tea color urine, UA (hematuria, proteinuria, WBCs), labs (elevated BUN/creat, elevated ESR, positive ASO titer, low H&H)
the most common of several antibodies that are produced by the body's immune system in response to a strep infection
ASO and anti-DNase B
meds for acute glomerulonephritis
diet for acute glomerulonephritis
limit sodium, fluid restrict, protein NOT restricted, possible K+ restrict
Most common malignant renal and intra-abdominal tumor of childhood
AKA wilms tumor
nephoblastoma is three times more common in ______ children
peak age for wilms tumor dx
clincal manifestations for wilms tumor (nephroblastoma)
abd swelling/mass, HTN, difficulty breathing, hematuria
dx for nephroblastoma
ultrasound, CT/MRI, CBC/BUN/creat
tx for nephroblastoma
chemotherapy, surgery (within 24-48 hr discovery), nephrectomy
Is epispadias on top or below shaft of penis?
Is hypospadias on top or below shaft of penis?
Is E. coli positive or negative gram stain bacteria?
What do positive nitrites indicate?
Presence of E Coli
What do you do first for HUS?
a condition that affects the blood and blood vessels. It results in the destruction of blood platelets (cells involved in clotting), a low red blood cell count (anemia) and kidney failure due to damage to the very small blood vessels of the kidneys
Normally impermeable to large proteins becomes permeable to proteins, especially albumin
albumin lost in urine
albuminuria or proteinuria
serum albumin decreased
Urine cloudy, smoky brown, resembles tea or cola
what has edema with glomerulonephritis?
periorbital, hands, feet/ankles