BIOLOGY 2F03 Lecture Notes - Lecture 5: Low Sodium Diet, Urinary Tract Infection, Vulvitis
19 May 2018
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Intussusception
• Invagination of proximal bowel into distal
• Commonest cause of intestinal obstruction in infants, usually 2 months to 2 yrs.
• Presentation:
o Acute, severe colicky pain and pallor
o Sausage shaped mass in abdomen
o Passage of red currant jelly stools
o Abdo distension and shock
• X-ray shows distended small bowel + absent gas in distal colon and rectum
• Rx: fluid resus and air enema. Surgical reduction if this fails.
GENITOURINARY SYSTEM
Nephrotic suyndrome (nephrosis)
• ++proteinuria → albumin + oedema + hypoproteinaemia + hypercholestrolaemia
• Sx:
o Anorexia,
o GI disturb,
o Infections,
o Irritability
o Oedema (periorbital, genital),
o Ascites,
o Oliguria,
o Breathlessness
• Ix: urine (frothy, +++albumin and casts, Na , blood (albumin, urea and creatinine normal). Renal
biopsy in older kids.
• Rx:
o Low sodium diet limits oedema
o Consider furosamide IV + spironolactone PO
o Prednisolone (course of 3-7/12)
• Complications:
o Hypovolaemia
o Thrombosis
o Infection
o Hypercholesterolemia
Urinary tract infection
• Presentation:
o Newborn Sx non-specific and may develop rapidly into septicaemia.
o Toddlers: present as gastro-enteritis, FTT, colic, PUO
o Older child: dysuria without fever due to vulvitis in girls and balanitis in boys
• Collection of sample:
o clean catch in to sterile pot
o Adhesive bag applied to perineum, after careful washing
o Suprapubic aspiration (SPA) in severely ill child
• Diagnosis: culture
• Causes:
o Infecting organism: E. Coli, Proteus, Pseudomonas
o Incomplete bladder opening: infrequent voiding therefore large bladder, vulvitis, hurried
micturition, obstruction from loaded rectum, neuropathic bladder.
o Vesicoureteric reflux: developmental anomaly of vesicoureteric junctions therefore urine goes
bladder→ureters.
• Management:
o Oral AB (co-amoxiclav) or IV AB (cefotaxime or ampicillin
o Preventative: avoid constipation, oral fluids, encourage full voiding
Glomerulonephritis
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Document Summary
Nephrotic suyndrome (nephrosis: ++proteinuria albumin + oedema + hypoproteinaemia + hypercholestrolaemia, sx, anorexia, gi disturb, Irritability: oedema (periorbital, genital), ascites, oliguria, breathlessness, ix: urine (frothy, +++albumin and casts, na , blood ( albumin, urea and creatinine normal). Renal biopsy in older kids: rx, low sodium diet limits oedema, consider furosamide iv + spironolactone po, prednisolone (course of 3-7/12, complications, hypovolaemia, thrombosis. Glomerulonephritis: haematuria + oliguria (+/- ht + ureamia) produced by immune mechanism in kidney, peak age 7yrs, causes: Strep sore throat or skin infection: hsp, toxins (heavy metals, berger(cid:859)s disease, malignancies. Infection (viruses, sbe, syphilis: presentation, haematuria, oliguria, renal vein thrombosis, bp, periorbital oedema, fever, gi dist, loin pain. Ix: msu: rbcs, wbcs, red cell casts, bloods: urea, esr, acidosis, c3 titre. Rx: restrict protein in oliguric phase, penicillin iv and then po for strep infection, renal us, renal bx, monitor bp, treat severe ht. Wil(cid:373)"s (cid:374)euroblasto(cid:373)a: malignant tumour composed of embryonic nerve cells, originates from embryonic renal tissue.
