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110 Cards in this Set
- Front
- Back
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what is a difficulty or delay in defecation present for 2 or more weeks without pathology?
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functional constipation
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What is sufficient to diagnose functional constipation in most cases?
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a thorough history and physical exam
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If celiac disease is suspected, what test should be done?
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IgA and IgG . check for vit A deficiency
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what are the pathological causes of constipation?
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-hirschprungs (agangiolonic megacolon)
-delayed meconium stool -hypothyroidism -imperforate anus -infant botulism |
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how does an infant usually get botulism?
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by being given honey in the first year of life
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how will a child with infant botulism present?
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hypotonic and constipated
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what is an external sign of hischprungs?
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skin wasting
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during a rectal exam, what will you feel with an anterior shelf?
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you will have to maneuver your finger to get up and in
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what is a web upon rectal exam?
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a second very tight ring that tneeds to be dilated. you must teach the mother to do it. Will break in 3-4 days
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ToF: early toilet training shows less constipation/
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false
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what is encoporesis?
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pain, bleeding and fecal soiling
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what is involved int he a constipation hx?
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-caregiver definition
-freq/consistency of stool -encoporesis? -abd pain -change in stool pattern over time -toilet training -wt loss, NVD -medications |
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what is a KUB of the abdomen?
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xray in the ED that looks for stool and normal gas pain
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during a PE for constipation, what neurologic checks should you do?
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have them do gower's sign to find it they have decreased LE tone
-check for dimpling/hair tuft at lower spine |
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if a pt has an anterior displaced anus, what else will they have and need?
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will have anterior shelf and will need surgical correction
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what are the PE findings that distinguish organic constipation from functional?
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-FTT
-abd distention -pilonidal dimpled with tuft of hair -sacral agenesis -flat buttocks -ant displaced anus -absent and decreased DTRs -paulous anus -tight, empty rectum -gush of liquid stool and air after rectal exam -absent anal wink -absent cremasteric reflex -decreased LE tone |
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what is a differential for delayed meconium?
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CF
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what is the dx method for hirschprungs?
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rectal biopsy
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what test should be done on all constipated infants?
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stool occult
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what is a good test to determine transit time?
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corn test
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what is a good technique to help families avoid functional constipation?
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have routines
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what are the nonorganic developmental differential diagnoses for constipation?
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-cognitive handicaps
-ADD -situational -coercive toilet training -toilet phobia -school bathroom avoidance -exessive parental interventions -sex abuse -other depression |
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what are the neuropathic conditions that are differentials for constipation?
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-spinal cord abnormalities
-spinal cord trauma -neurofibromatosis -static encephalopaty -tethered cord |
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what are the drug classes that can cause constipation?
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-opiates
-phenobarbital -sucralfate -antacids -anti-HTN - |
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what are the intestinal nerve or muscle disorders on the differential for constipation?
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-hirschprungs
-intestinal neuronal dysplasia -visceral myopathies -visceral neruopathies -abnormal abdominal musculature -prune belly -gastroschisis |
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what are the connective tissue disorders on the differential for constipation?
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-scleroderma
-systemic lupus erythematous -ehlers danslo |
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what are the metabolic and gastrointestinal differentials for constipation?
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hypothyroidism
hypercalcemia hypokalemia cystic fibrosis sacral teratoma diabetes mellitus multiple endocrine neoplasia type 2B gluten neuropathy |
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what are the constitutional differentials for constipation?
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-colonic inertia
-genetic predisposition -reduced stool volume and dryness -low fiber in the diet -dehydration -underfeeding or malnutrtion |
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how should infants be managed with constipation?
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-no enemas, use glycerin suppositories
-no mineral oil (aspiration) -sorbitol gummy bears -limit prune juice to 2 tbsp -small amounts of apple juice |
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can enemas be used on children for constipation?
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yes, but not infants
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what has been found to be useful in the long term treatment of constipation in the children?
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polyethylene glycol electrolyte solution
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How long can you watch a hydrocele before intervention is needed?
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up to 1 year
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how do you assess a hydrocele?
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transillumination
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what should you ensure is not present when there is a hydrocele?
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a hernia inside the hydrocele
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what does a hernia feel like to the touch>?
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squishy and air filled
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describe the assessment findings of a hernia?
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hx: "lump" with straining, crying
-subsides at rest -PE: palpate testes first -extend arms over head, crying, visible -reduce it -have the child jump up and down and then cough |
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what are the assessment findings for a hydrocele?
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-bulging scrotum
-testes not palpable -soft, non-tender -non-reducible -transilluminate |
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what are the differential diagnoses for hernia/hydrocele?
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-undescended/retractile testicle
-varicocele -epididymitis -tumor, soft tissue swelling - |
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what are the characteristics of an inguinal hernia?
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-patent process vaginalis (inguinal ring)
-bowel slips thru ring -lump in groin area or scrotal sac -incarcerated bowel -hydrocele (maybe) |
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if a female presents with an umiblical hernia, what should be a differential?
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xxy or kleinfelters
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what is it called when the hernia is felt sliding back and forth?
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silk glove
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ToF: umbilical hernias often get incarcerated
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false
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how should a PCP go about a pt with an inguinal hernia?
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always refer to surgery
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when is a hernia a surgical emergency?
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when it is not reducible
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what are the characteristic of a hydrocele?
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-patent process vaginalis
-inguinal canal open -intra-abdominal fluid leaks into scrotum -can be accompanied by hernia |
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what is the management of hydrocele?
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-spontaneous resolution by age 1
-surgical repaire if not sponatenous |
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what is hematuria?
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-the presence of 5 or more RBCs per high power (40) field in three consecutive fresh, centrifuged specimens obtains over the span of several weeks.
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ToF; most cases of hematuria are pathologic?
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false
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what type of "issue" is hematuria?
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a medical, not urologic
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what is orthostatic proteinuria? what can also occur with it?
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first urine in the morning while standing can have protein in it. as well as RBCs
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should a UA be one for a patient with FTT?
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yes
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when does most hematuria begin and why?
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at age 4-5yo in boys because of masterbation
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What are the hallmarks of glomerular bleeding?
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discolored urine, RBC casts, and distored RBC morphology
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what is an evaluation of the RBC morphology good in determining in terms of hematuria?
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if the bleeding is glomerular or extraglomerular sources
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what do red cell casts in urine usually indicate?
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renal disease
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what group often have gross hematuria?
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males with chlamydia
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what are the types of hematuria?
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-gross
-symptomatic microscopic -hematuria -asymptomatic microscopic hematuria with proteinuria -isolated asymptomatic microscopic hematuria |
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what are the family hx/possible diagnoses associated with hematuria?
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-benign family hematuria, thin basement membrane disease
-hearing loss or prominent history of renal failure in males/ Alport syndrome -cystic kidney disease -nail/patellar agnormalities/ nail patella syndrome -sickle cell disease or trait |
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in assessing for symptomatic mciroscopic hematuria, the most important finding is..?
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the protein-to-creatinine ratio checked on the first urine of the morning (>0.2 is pathologic)
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what are the signs of systemic lupus that occur with hematuria?
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malar rash, arthritis, pericardial rub edema, and HTN
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what are the signs that the urinary tract might be involved in hematuria?
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fever, flank pain, nausea and vomiting
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what are the signs of crystalluria or UTI with hematuria?
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dysuria, frequency, urgency and incontinence
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ToF: high calcium levels can cause hematuria?
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true
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ToF: hemturia and proteinuria together are not pathologic
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false: very worrisome
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what should be done when hematuria and proteinuria occur?
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serial urinalysis
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___ is frequently associated with asymptomatic hematuria
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hypercalciuria
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what are patients with AH at risk for?
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symptomatic urolithiasis
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ToF: AH has been found associated with renal disease
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false; very rare
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what is another name for benign familia hematuria?
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asthin basement membrane disorder
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what occurs in asthin basement membrane disorder?
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multiple family membranes have hx of hematuria but are free of the long term complications of progressive renal insufficiency, hearing or occular abnormalities seen.
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what is involved in the first stage of evaluation for hematuria?
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-BP
-urine dipstick -urine microscopy -crystalluria -hypercalciuria -urine culture |
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what 2 organ diseases manifest the same?
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liver and kidney
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Why is a second stage of evaluation usually done with hematuria?
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the presence of edema, HTN, alterations in urine output and systemic symptoms are present
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what should be done if there is a suspicion of PIAGN?
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order an ASO, DINASE and a Ce
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how will the C3 value come out in renal disease?
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low
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how do you diagnose vasculitis?
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ANCA
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What values are low in lupus?
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C3, C4 and C50
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what are the secondary causes of renal disease?
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systemic lupus, small vessel vasculitis, hep B, hep C, HIV,
evaluate for sickle cell |
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a patient with CRD with have __ anemia
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normocytic
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what is Dr. John's saying through the GU lecture?
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THink URINE
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what bacteria is often associated with alkaline urine?
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E. coli
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what should be considered if urine culture comes back with klebsiella or proteus?
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anatomical problem
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ToF: a VCUG is the first line for renal exams?
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false! renal ultrasound
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UTIs are cause of ___ in children
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SBI (serious bacterial infections)
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ToF: constipation coexists with UTIs?
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true
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what does vesicoureteral reflux predispose a child to?
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UTIs and renal scarring
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what is the def of bacteriuria?
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bacteria in urine without other sympotoms; may indicate underlying anatomic abnormality
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what is cystitis?
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infection of the blaedder
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what is pyelonephritis?
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most sever type of UTI involving the renal parenchyma
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ToF: it is common for boys to get UTIs?
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false: if they do they probably have reflux
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The incidence of UTI recurrence is ___ % in children who had their first in infancy?
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75%
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what are the SxS of UTI in infants?
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-fever
-malaise -irritability -poor weight gain -NVD -malodor -dribbling -abd pain -difficulty healing |
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what are the SxS of UTI in children?
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-voiding dysfunction
-malodor -enuresis -VorD -malaise -fever and chills -abd pain |
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nitrates are produced after urine has been in bladder for __ hours or longer
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4
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ToF: false negatives of UTI are common in infancy
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true
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what are the new UTI guidelines?
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-if clinician decidse a febrile infant needs treatment since child is ill or another pressing reason, abx should be started after urine specimen is obtained for culture
-the specimen needs to be obtain through catheterization -bag specimens are not reliable |
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ToF: the sensitivity and specificity of urinalysis is poor in many cases
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true
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what are the female risk factors for UTI?
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-white
-age < 12 months -term > or = 39 degress or 102.2 -fever > 2 days -absence of another source of infection |
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what are the male risk factors for UTI?
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-nonblack race
-temp > 102.2 -fever > 24 hours -absence of another source of infection |
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what is the new number of pyuria and colony count for diagnostic criteria of UTI?
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> 50,000
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What organisms if found in 2-4 month olds are not clinically relevant for UTIs?
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lactobacillus spp. coagulase neg staph or cornyebacterium
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how many days of abx therapy are needed for UTI?
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7-14
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what are the meds used for UTI?
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-amox
-augmentum -bactrim (not in G6PD) -cephalosporins (keflex covers e. coli) |
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under the new guidelines for UTI, febrile infants should undergo ___
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renal and blaadder US, (RBUS)
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ToF: VCUG are performed after first UTI
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false
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when is a VCUG indicated for first UTI?
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when RBUS shows hydronephrosis, scarring or obstructive uropathy
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what grade of reflex reaches the top of the ureter closes to the kidney
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grade 2
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when reflux causes dilation of the ureter with minimal dilatation of the ureter, what is the grade?
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3
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what is grad 4 reflux
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marked dilatation of the ureter and calyces
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what at grade 5 reflux
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urine all the way up with marked torutuosity and dilatation of the ureter and calyces.
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