pediatric genitourinary disorders
TRANSCRIPT
-
8/2/2019 Pediatric Genitourinary Disorders
1/28
PEDIATRIC GENITOURINARY
DISORDERS
Galvan, Maricar
Hernandez,Harley
-
8/2/2019 Pediatric Genitourinary Disorders
2/28
-
8/2/2019 Pediatric Genitourinary Disorders
3/28
-
8/2/2019 Pediatric Genitourinary Disorders
4/28
Urinary Tract Infection
-bacterial(e.coli) of
kidney or bladder whichis usually common in
children and girls.
-
8/2/2019 Pediatric Genitourinary Disorders
5/28
Urinary Tract Infection
- Assessment:
1. low grade fever
2. abdominal pain3. enuresis, pain/ burning sensation, frequency,
hematuria
-
8/2/2019 Pediatric Genitourinary Disorders
6/28
Urinary Tract Infection
INTERVENTIONS
1. administer antibiotics
2. Provide warm baths.3. Force fluids
4. encourage acid ash diet.
5. encourage perineal hygeine.
-
8/2/2019 Pediatric Genitourinary Disorders
7/28
Vesicouriteral Reflux
-Regergitation of urine
from bladder to urethersdue to faulty valve
mechanism at thevesicouretheral junction.
-
8/2/2019 Pediatric Genitourinary Disorders
8/28
Vesicouriteral Reflux
-ASSESSMENT FINDINGS ARESIMILAR WITH
THAT OF UTI.
-
-
8/2/2019 Pediatric Genitourinary Disorders
9/28
Vesicouriteral Reflux
INTERVENTION:
surgical repair
-
8/2/2019 Pediatric Genitourinary Disorders
10/28
Extrophy of the Bladder
ASSESSMENT FINDINGS:
Prolapsed rectum
Inguinal hernia
Widely separated symphysis
Rotated Hips
Epispadias
Cleft scrotum or clittoris
Cryptorchidism
Chordee
-
8/2/2019 Pediatric Genitourinary Disorders
11/28
Extrophy of the Bladder
MANAGEMENT
Two stage recostructivesurgery with urinary
diversion delayed until3-6 mons.
-
8/2/2019 Pediatric Genitourinary Disorders
12/28
Cryptorchidism
-ASSESSMENT
-Unable to palpate testes in
scotal sac and be careful not to
ilicit cremasteric reflex.
-
8/2/2019 Pediatric Genitourinary Disorders
13/28
Cryptorchidism
MEDICAL MANAGEMENT
If not descended by 8 or 9, chronic
gonadotropin can be given.
Orchipexy, surgical procedure to retrieve and
secure testes placement between ages 1 to 3
years.
-
8/2/2019 Pediatric Genitourinary Disorders
14/28
Hypospadias
Opening loacted anywhere along ventral
surface of penis.
Chordee is often associated, causing
constriction.
In extreme cases, child sex may be uncertain.
-
8/2/2019 Pediatric Genitourinary Disorders
15/28
Hypospadias
MANAGEMENT:
Minimal defects need no intervention.
Neonatal circumcision delayed, tissue may beneeded for corrective repair.
Surgery at 3-9 months, for complex repairs,
may be delayed until 2 years.
-
8/2/2019 Pediatric Genitourinary Disorders
16/28
Enuresis
Involuntary passage of
urine after the age ofcontrol is expected,
usually 4 years.
-
8/2/2019 Pediatric Genitourinary Disorders
17/28
Enuresis
TYPES:
1. Primary- children who have never achievedcontrol
2. secondary- those who developed control and
then lose it
-
8/2/2019 Pediatric Genitourinary Disorders
18/28
Enuresis
- MANAGEMENT:
1. Bladder retention exercises.
2. behavior modificatio such as bed alarmdevices.
3. drug theraphy:
a. tricyclic antidepressants: imipraminehydrochloride (tofranil)
b. anticholinergics
-
8/2/2019 Pediatric Genitourinary Disorders
19/28
Nephrotic Syndrome
Nephronic syndrome is a nonspecific autoimmunedisorder in which the kidneys are damaged, there isstructural alteration in the glomerular membrane,causing tem to leak large amounts of protein (
proteinuria at least 3.5 grams per day per 1.73 m2
bodysurface area) from the blood into the urine.
Kidneys affected by the nephrotic syndrome havesmall pores in the podocytes, large enough to permitproteinuria ( and subsequently hypoalbumenemia,
because some of the protein albumin has gone fromthe blood to the urine) but not large enough to allowcell pass through ( hence no hematuria).
-
8/2/2019 Pediatric Genitourinary Disorders
20/28
Nephrotic Syndrome
Characterized by:
Proteinuria (less than 3.5g/day)
Hypoalbuminemia Hyperlipidemia
Generalized edema
-
8/2/2019 Pediatric Genitourinary Disorders
21/28
Nephrotic Syndrome
Management
Monitor urine output.
Fluid restriction to 1 L.
Diuretics (IV furosemide).
Treat hyperlipidemiato prevent further aterolosclerosis.
Albumin infusions are generally not used because their effects last onlytransiently. Prophylactic anticoagulation may be appropriate to somecircumstances.
Immunosuppression for the glumerulonephritides ( corticosteroids,cyclosporin)
Standard reime for the firstepisode id prednisolone, frequent relapses
treated by cyclophosphamide. Achieve better blood glucose level control if the patient is diabetic.
Blood pressure control. ACE Inhibitors rea the drug of choice. Independentof their blood pressure lowering effect , they have been shown todecrease protein loss.
-
8/2/2019 Pediatric Genitourinary Disorders
22/28
Nephrotic Syndrome
Dietary Recommendations
1. Reduce sodium intake to 1000 to 2000 mg daily. Foods high in sodium includesalt used in cooking and at the table seasoning blends( garlic salt, adobo, seasonsalt) canned soups, canned vegetable containing salt, luncheon meats includingturkey, ham bologna and salami, prepared foods , fast food, soy sauce, ketchup,and salad dressing. On food labels, compare milligrams of sodium to calories perserving . sodium should be less than or equal to calories per serving.
2. Eat moderate amount of high protein animal food: 3 to 5 oz per meal (preferablylean cuts of meat, fish, and poultry)
3. Avoid saturated fats such as butter, cheese, fried foods, fatty cuts of red meat,egg yolks and poultry skin. Increase unsaturated fat intake, including olive oil,canola oil, peanut butter, avocadoes, fish and nuts. Eat low fat desserts.
4. Increase intake of fruits and vegetables. No potassium or phosphorus restriction
necessary.5. Monitor fluid intake, which includes all fluids and foods that are liquid at room
temperature. Fluid management in nephrotic syndrome is tenuous, especiallyduring an acute flare.
-
8/2/2019 Pediatric Genitourinary Disorders
23/28
Acute Glumerulonephritis
A self-limiting immunecomplex disease resulting
from an antigen-antibodyreaction secondary to a beta-
hemolytic streptococcalinfection.
-
8/2/2019 Pediatric Genitourinary Disorders
24/28
Acute Glumerulonephritis
Interventions
1. Administer drugs
a) Antibiotics
b) Antihypertensives
c) Digitalis
2. Fluid restriction of with urinal insufficiency
3. Peritoneal dialysis if severe renal orcardiopulmonary problems develop.
-
8/2/2019 Pediatric Genitourinary Disorders
25/28
Hydronephrosis
Collection of urine in renal
pelvis due to obstruction to
outflow common at
uretheral and pelvicjunction
-
8/2/2019 Pediatric Genitourinary Disorders
26/28
Hydronephrosis
Obstruction causes of the ffg:1. Increase intrarenal pressure
2. Decrease circulation3. Atrophy of the kidney
-
8/2/2019 Pediatric Genitourinary Disorders
27/28
Hydronephrosis
ASSESSMENT findings
1. Repeated UTI
2. Failure to thrive3. Abdominal pain, fever
4. Fluctuating mass in region of kidney
-
8/2/2019 Pediatric Genitourinary Disorders
28/28
Hydronephrosis
MANAGEMENT
Surgery to correct or remove obstruction.