Ebook Jones’ clinical paediatric surgery: Part 2

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Ebook Jones’ clinical paediatric surgery: Part 2

PART VUrinary TractCHAPTER 31Urinary Tract InfectionCASE 1:Stacey is a 5-ye

Ebook Jones’ clinical paediatric surgery: Part 2levant past history.Q 1.1 What investtgabons should be done?Q 1.2 What IS the likelihood 0. an underlying ur^ary tract anomaly?Q 1.3 tí there is no ur

inary tract anomaly, why has the mfecton occurred?CASE 2:Thomas »5 6 months old and presents with fever, lethargy and smelly, turtood urine He ts not Ebook Jones’ clinical paediatric surgery: Part 2

gaining weightQ 2.1 How would a unnary tract infection (ƯTII be confirmed’0 2.2 What tests are reeded to document a possib'e urinary tract anomaly?A U

Ebook Jones’ clinical paediatric surgery: Part 2

TI is best defined as the symptomatic occurrence of pathcrgenic microorganisms, usually bacteria, in the urinary tract. It is a common cause of illnes

PART VUrinary TractCHAPTER 31Urinary Tract InfectionCASE 1:Stacey is a 5-ye

Ebook Jones’ clinical paediatric surgery: Part 2the development of hypertension. UTls arc commonly misdiagnosed in children. Dysuria and the passage of cloudy urine are common symptoms In children w

ith a febrile illness and do not necessarily reflect UTI. On the other hand, many children with a ƯTI have non-specific symptoms or have unexplained f Ebook Jones’ clinical paediatric surgery: Part 2

ever, vomiting or even failure to thrive: in these patients, the diagnosis may 1>C overlooked.The diagnosis of UTI is based on the presence of a singl

Ebook Jones’ clinical paediatric surgery: Part 2

e species of bacteria growing in large numbers in an appropriately collected specimen of urine. The standard required for a significant culture Is gre

PART VUrinary TractCHAPTER 31Urinary Tract InfectionCASE 1:Stacey is a 5-ye

Ebook Jones’ clinical paediatric surgery: Part 2icant in specimens obtained in a more sterile manner, for example, IO'cfu/mL for specimens obtained by urethral catheterisation and KFcfu/mL for speci

mens obtained by suprapubic aspiration. Asymptomatic bacteriuria has been reported in the urine of 8% of infants and 6.6% of children.The diagnosis of Ebook Jones’ clinical paediatric surgery: Part 2

a UTI is further supported by the detection of white blood cells (WBCs) in the urine (>5x 10'7 L In boys and >40X 10*/L In girls). But this Is not a

Ebook Jones’ clinical paediatric surgery: Part 2

prerequisite for the diagnosis. Children on Immunosuppressant therapy may not be able to produce an immune response, and some infants with overwhelmin

PART VUrinary TractCHAPTER 31Urinary Tract InfectionCASE 1:Stacey is a 5-ye

Ebook Jones’ clinical paediatric surgery: Part 2(e.g. append!-dtis) and other pyrexia! Illnesses; however, there will not be a significant bacterlurla.Incidence/prevalenceThere Is considerable varia

tion In the reported incidence of UTI. By the age of 7 years, approximately 8% of girls and 3% of boys will have been treated for a UTI. ƯTI is more c Ebook Jones’ clinical paediatric surgery: Part 2

ommon in neonates and decreases steadily after the first month of life. A large Swedish populationbased study of infants under the age of 2 years repo

Ebook Jones’ clinical paediatric surgery: Part 2

rted an incidence of UTI in 2.2% of boys and 2.1% of girls. After this age, UTI becomes more common in girls such that by the age of 16 years, 3.6% of

PART VUrinary TractCHAPTER 31Urinary Tract InfectionCASE 1:Stacey is a 5-ye

Ebook Jones’ clinical paediatric surgery: Part 2rien, Spencer w. Beasley. Warwick J. Teague and Sebastian K. King.Ữ 2015 John Wiley b Sons. Ltd. Published 2015 by John Wiley b Sons. Ltd.191192 Part

V: Urinary TractUTls arc responsible for 1-5% OÍ febrile illnesses in children under 2 years of age. A UT1 is more common in children with higher temp Ebook Jones’ clinical paediatric surgery: Part 2

eratures, with ƯTI as the cause of pyrexia greater than 38° in 9% infants less than 2 months old. It was diagnosed In 7% of infants with a maximum tem

Ebook Jones’ clinical paediatric surgery: Part 2

perature of less than 39° and in 16% of those whose temperature was 39° or higher.Clinical presentationThe symptoms and signs of UTI vary in children

PART VUrinary TractCHAPTER 31Urinary Tract InfectionCASE 1:Stacey is a 5-ye

Ebook Jones’ clinical paediatric surgery: Part 2ndary enuresis and suprapubic pain, or upper ƯTI) and pyelonephritis (such as fever, vomiting, malaise and loin pain). All children with unexplained p

yrexia should have a ƯTI excluded.HistoryA detailed history Is important and should include antenatal and perinatal history, fluid intake and voiding Ebook Jones’ clinical paediatric surgery: Part 2

patterns as well as bowel habits. A history of previous UT1 or any previous episodes of unexplained fever is important. Bed-wetting or voiding disorde

Ebook Jones’ clinical paediatric surgery: Part 2

rs do not necessarily indicate a urinary tract abnormality, except in a child who has been previously continent, although bladder instability may ofte

PART VUrinary TractCHAPTER 31Urinary Tract InfectionCASE 1:Stacey is a 5-ye

Ebook Jones’ clinical paediatric surgery: Part 2c insertion of a ureter. The family history Is pertinent, as veslcoureteric reflux (VUR) and duplex kidneys are known to be common among siblings.Tabl

e 31.1 Presentation of urinary tract infectionInfants Older childrenpyuria of unknown originAbdcm. ^al pa nSepticaemiaDysunaUstlessness and lethargyPy Ebook Jones’ clinical paediatric surgery: Part 2

rexiaHaematuriaHaematunaVomitingPyelonephritisFailure to thrrreDysfunctional voidingPersistent neonatal jaundice

PART VUrinary TractCHAPTER 31Urinary Tract InfectionCASE 1:Stacey is a 5-ye