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Dysuria in Children

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501. Toxicity, Seafood (Follow-up)

, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center Disclosure: Received salary from Merck for employment. Chief Editor Timothy E Corden, MD Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin Timothy E Corden, MD is a member of the following medical societies (...) resolve within 24 hours, although a late-presenting and extended course is not uncommon. GI symptoms generally consist of diaphoresis, abdominal cramps, nausea, vomiting, profuse watery diarrhea, and dysuria. GI symptoms are usually reported to occur prior to neurological symptoms. Interesting, however, is that the predominance of GI or neurologic symptoms seems to vary according to regions, with GI-predominant illness seen in the Caribbean, while neurologic symptoms predominate in the Indo-Pacific

2014 eMedicine Pediatrics

502. Toxicity, Marine - Ciguatera (Follow-up)

Painful paresthesias of the extremities Paradoxical temperature reversal (eg, cold objects feel hot and hot objects feel cold; classic symptom) Dental pain (teeth feel loose) Pruritus Arthralgias Myalgias Weakness Ataxia, vertigo Respiratory paralysis Coma In children, irritability may be the only presenting neurologic symptom. Cardiovascular findings may reflect the following: Bradycardia Hypotension Pulmonary edema Other general symptoms include the following: Dysuria Chills Sweating Painful (...) , Harvard Medical School Dana A Stearns, MD is a member of the following medical societies: Disclosure: Nothing to disclose. Jeffrey R Tucker, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center Disclosure: Merck Salary Employment John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals John T VanDeVoort, PharmD is a member of the following medical

2014 eMedicine Pediatrics

503. Arthritis, Conjunctivitis, Urethritis Syndrome (Follow-up)

). Rheumatol Int . 2009 Jul. 29(9):1097-9. . Rueda JC, Crepy MF, Mantilla RD. Clinical features of Poncet's disease. From the description of 198 cases found in the literature. Clin Rheumatol . 2013 Jul. 32(7):929-35. . Prati C, Bertolini E, Toussirot E, Wendling D. Reactive arthritis due to Clostridium difficile. Joint Bone Spine . 2010 Mar. 77(2):190-2. . Durand CL, Miller PF. Severe Clostridium difficile colitis and reactive arthritis in a ten-year-old child. Pediatr Infect Dis J . 2009 Aug. 28(8):750-1 (...) findings of enthesitis in reactive arthritis. Clin Nucl Med . 2011 Feb. 36(2):121-3. . Simonini G, Taddio A, Cimaz R. No evidence yet to change American Heart Association recommendations for poststreptococcal reactive arthritis: comment on the article by van Bemmel et al. Arthritis Rheum . 2009 Nov. 60(11):3516-8; author reply 3518-9. . Moorthy LN, Gaur S, Peterson MG, Landa YF, Tandon M, Lehman TJ. Poststreptococcal reactive arthritis in children: a retrospective study. Clin Pediatr (Phila) . 2009 Mar

2014 eMedicine Pediatrics

504. Somatoform Disorder: Somatization (Overview)

medical outpatient visits. [ ] Physical symptoms or painful complaints of unknown etiology are fairly common in pediatric populations. [ ] Many healthy young children express emotional distress in terms of physical pain, such as stomachaches or headaches, but these complaints are usually transient and do not effect the child's overall functioning. The somatoform disorders represent the severe end of a continuum of somatic symptoms. Somatization in children consists of the persistent experience (...) is the major factor in the pain symptom. [ ] Recurrent abdominal pain (RAP) is the most common recurrent pain complaint of childhood. RAP has been defined by intermittent pain with full recovery between episodes lasting more than 3 months. [ ] Epidemiological studies suggest that RAP effects 8-25% of school-age children aged 9-12 years, is more prevalent among girls, and accounts for 2-4% of pediatric office visits. [ ] An estimated 10% of these patients have documented physical illness, with one third

2014 eMedicine Pediatrics

505. Toxicity, Marine - Ciguatera (Overview)

Painful paresthesias of the extremities Paradoxical temperature reversal (eg, cold objects feel hot and hot objects feel cold; classic symptom) Dental pain (teeth feel loose) Pruritus Arthralgias Myalgias Weakness Ataxia, vertigo Respiratory paralysis Coma In children, irritability may be the only presenting neurologic symptom. Cardiovascular findings may reflect the following: Bradycardia Hypotension Pulmonary edema Other general symptoms include the following: Dysuria Chills Sweating Painful (...) , Harvard Medical School Dana A Stearns, MD is a member of the following medical societies: Disclosure: Nothing to disclose. Jeffrey R Tucker, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center Disclosure: Merck Salary Employment John T VanDeVoort, PharmD Regional Director of Pharmacy, Sacred Heart and St Joseph's Hospitals John T VanDeVoort, PharmD is a member of the following medical

2014 eMedicine Pediatrics

506. Toxicity, Seafood (Overview)

, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, University of Connecticut School of Medicine, Connecticut Children's Medical Center Disclosure: Received salary from Merck for employment. Chief Editor Timothy E Corden, MD Associate Professor of Pediatrics, Co-Director, Policy Core, Injury Research Center, Medical College of Wisconsin; Associate Director, PICU, Children's Hospital of Wisconsin Timothy E Corden, MD is a member of the following medical societies (...) resolve within 24 hours, although a late-presenting and extended course is not uncommon. GI symptoms generally consist of diaphoresis, abdominal cramps, nausea, vomiting, profuse watery diarrhea, and dysuria. GI symptoms are usually reported to occur prior to neurological symptoms. Interesting, however, is that the predominance of GI or neurologic symptoms seems to vary according to regions, with GI-predominant illness seen in the Caribbean, while neurologic symptoms predominate in the Indo-Pacific

2014 eMedicine Pediatrics

507. Somatoform Disorder: Somatization (Diagnosis)

medical outpatient visits. [ ] Physical symptoms or painful complaints of unknown etiology are fairly common in pediatric populations. [ ] Many healthy young children express emotional distress in terms of physical pain, such as stomachaches or headaches, but these complaints are usually transient and do not effect the child's overall functioning. The somatoform disorders represent the severe end of a continuum of somatic symptoms. Somatization in children consists of the persistent experience (...) is the major factor in the pain symptom. [ ] Recurrent abdominal pain (RAP) is the most common recurrent pain complaint of childhood. RAP has been defined by intermittent pain with full recovery between episodes lasting more than 3 months. [ ] Epidemiological studies suggest that RAP effects 8-25% of school-age children aged 9-12 years, is more prevalent among girls, and accounts for 2-4% of pediatric office visits. [ ] An estimated 10% of these patients have documented physical illness, with one third

2014 eMedicine Pediatrics

508. Urinary Tract Obstruction (Diagnosis)

obstruction is usually indolent and may be asymptomatic. When infection is present, the patient may experience fever, chills, and dysuria. Hematuria may also be present. When bilateral obstruction or unilateral obstruction in a solitary kidney is severe and renal failure has occurred, uremia can be present. Uremia symptoms include weakness, peripheral edema, mental status changes, and pallor. If hydronephrosis is severe, the kidney may be palpable on physical examination, especially in children. In cases (...) malignancies. In men, hydronephrosis is most likely after age 60 years secondary to prostatic obstruction. Hydronephrosis is found in 2-2.5% of children. Previous Next: Etiology Obstruction of urinary flow can occur anywhere from the kidneys to the urethral meatus. Dividing the urinary tract into the upper urinary tract, defined as the kidney and ureter to the hiatus with the bladder, and the lower urinary tract, defined as the bladder and urethra to the urethral meatus, allows for further delineation

2014 eMedicine.com

509. Urinary Tract Infections in Pregnancy (Diagnosis)

mucosal vaccine for urinary tract infections. J Urol . 2003 Sep. 170(3):867-9. . Mann JR, McDermott S. Are Maternal Genitourinary Infection and Pre-Eclampsia Associated With ADHD in School Aged Children?. J Atten Disord . 2010 Sep 13. . Sun Y, Vestergaard M, Christensen J, Nahmias AJ, Olsen J. Prenatal exposure to maternal infections and epilepsy in childhood: a population-based cohort study. Pediatrics . 2008 May. 121(5):e1100-7. . Kazemier BM, Koningstein FN, Schneeberger C, Ott A, Bossuyt PM, de (...) and childhood neurologic consequences. For patient education information, see the and , as well as , , , and . Definitions of key terms Urinary tract infection UTI is defined as the presence of at least 100,000 organisms per milliliter of urine in an asymptomatic patient, or as more than 100 organisms/mL of urine with accompanying pyuria (> 7 white blood cells [WBCs]/mL) in a symptomatic patient. A diagnosis of UTI should be supported by a positive culture for a uropathogen, particularly in patients

2014 eMedicine.com

510. Urinary Tract Infection, Females (Diagnosis)

of estrogen with attendant changes in vaginal flora (notably, loss of lactobacilli), which allows periurethral colonization with gram-negative aerobes, such as E coli; and higher likelihood of concomitant medical illness, such as diabetes. Of neonates, boys are slightly more likely than girls to present with UTI as part of a gram-negative sepsis syndrome. The incidence in preschool-aged children is approximately 2% and is 10 times more common in girls. UTI occurs in 5% of school-aged girls, but it is rare (...) infection) represents the majority of these infections (see the image below). Related terms include pyelonephritis, which refers to upper urinary tract infection; bacteriuria, which describes bacteria in the urine; and candiduria, which describes yeast in the urine. Plain radiograph in a 63-year-old patient with poorly controlled type 2 diabetes mellitus shows emphysematous cystitis. Signs and symptoms Symptoms and signs of UTI in the adult are as follows: Dysuria Urinary urgency and frequency

2014 eMedicine.com

511. Urinary Tract Infection, Males (Diagnosis)

to the normal male urinary tract’s many natural defenses to infection, many experts consider UTIs in males, by definition, to be complicated (ie, more likely to be associated with anatomic abnormalities, requiring surgical intervention to prevent sequelae). Signs and symptoms Dysuria is the most frequent chief complaint in men with UTI. The combination of dysuria, urinary frequency, and urinary urgency is about 75% predictive for UTI, whereas the acute onset of hesitancy, urinary dribbling, and slow stream (...) organisms can retard ureteral peristalsis. E coli is responsible for approximately 25% of cases in males, with and causing many remaining infections; , Pseudomonas , , and are less frequent. Bacterial cystitis Bacterial cystitis without concomitant infection in other portions of the genitourinary tract is believed to be a rare event in males. The abrupt onset of irritative voiding symptoms (eg, frequency, urgency, nocturia, dysuria) and suprapubic pain are clinically diagnostic. Most cases of bacterial

2014 eMedicine.com

512. Uric Acid Nephropathy (Diagnosis)

practice, the prognosis for persons with acute renal failure from acute urate nephropathy is excellent. The morbidity of uric acid nephrolithiasis arises from the manifestations of stones, obstruction, and crystalluria and is often accompanied by dysuria and hematuria. [ ] Secondary bacteriuria and pyelonephritis also can occur. However, life-threatening complications are rare. Race See the list below: A number of different malignancies cause a predisposition to acute uric acid nephropathy, making (...) demographics for this entity difficult to characterize. Sex See the list below: Uric acid nephrolithiasis occurs most frequently in those with underlying hyperuricemia or gout, which occurs in men more frequently than women by a male-to-female ratio of 4:1. In the United States, the prevalence rate is 4-9% in men and 1.7-4.1% in women. Age See the list below: Uric acid nephropathy has been well documented in the pediatric and adult populations. It may occur more often in pediatric patients because

2014 eMedicine.com

513. Urethritis (Diagnosis)

with urethritis, including approximately 25% of those with NGU, are asymptomatic and present to a clinician following partner screening. [ ] Up to 75% of women with Chlamydia trachomatis infection are asymptomatic. Signs and symptoms in patients with urethritis may include the following: Urethral discharge: May be yellow, green, brown, or tinged with blood; production unrelated to sexual activity Dysuria (in men): Usually localized to the meatus or distal penis, worst during the first morning void, and made (...) is highest in the summer months. International Worldwide, approximately 62 million new cases of gonococcal urethritis and 89 million new cases of NGU are reported each year. Previous Next: Mortality/Morbidity Approximately 10%-40% of women with urethritis eventually develop (PID), which may subsequently cause and ectopic pregnancy secondary to postinflammatory scar formation in the fallopian tubes. PID can occur even in women with asymptomatic infections. Children born to mothers with Chlamydia infection

2014 eMedicine.com

514. Urethral Syndrome (Diagnosis)

Updated: Jun 23, 2017 Author: Martha K Terris, MD, FACS; Chief Editor: Edward David Kim, MD, FACS Share Email Print Feedback Close Sections Sections Urethral Syndrome Overview Practice Essentials Urethral syndrome is characterized by urinary frequency, dysuria, and suprapubic discomfort without any objective finding of urological abnormalities. It is also characterized by sterile urine culture results and urinary frequency that is typically worse during the day than during the night. The dysuria (...) syndrome is to relieve the discomfort and urinary frequency. This often involves a trial-and-error approach that uses behavioral, dietary, and medical therapy. See and . Next: Background Urethral syndrome was originally described as urinary frequency and dysuria without demonstrable infection. As a diagnosis, urethral syndrome (also known as frequency-dysuria syndrome) is controversial, and the term (coined by Powell and Powell in 1949) may be outdated, partially because of the lack of consensus

2014 eMedicine.com

515. Urethral Prolapse (Diagnosis)

is predominantly asymptomatic. Often, urethral prolapse is an incidental finding during routine examination. The most common presentation is vaginal bleeding associated with a periurethral mass. [ ] Symptomatic children present with bloody spotting on their underwear or diapers. is uncommon. Until urethral prolapse is definitively diagnosed, the presence of blood in the genital area should raise suspicion of and warrant ruling out this possibility. Voiding disturbances are typically rare in the pediatric (...) population, but when they are present, patients may report dysuria, urinary frequency, or introital pain. Again, hematuria is uncommon. Children may report genital pain if the prolapsed mucosa becomes very large or if thrombosis and necrosis have developed. Furthermore, although reportedly a nonobstructive lesion, acute urinary retention secondary to urethral prolapse has been reported. [ ] In contrast, patients with postmenopausal urethral prolapse are often symptomatic. Vaginal bleeding associated

2014 eMedicine.com

516. Nonneoplastic Epithelial Disorders of the Vulva (Diagnosis)

, diaphragms Fixed drug eruption A fixed drug eruption is a cell-mediated allergic drug reaction typically recurring in the same site upon reexposure. Common causative agents include oral drugs such as nonsteroidal anti-inflammatory agents, acetaminophen, sulfonamides, tetracycline, and barbiturates. Fluconazole as a possible causative agent has also been recently reported. [ ] Atopic dermatitis Atopic dermatitis usually occurs in patients with a personal or family history of asthma, hay fever, childhood (...) of 180 kd now thought to be collagen XVII), located in the basement membrane of the skin. [ ] Mucosal lesions of the vulva occur less frequently and are less severe than other blistering disorders. [ ] A juvenile localized subtype of immunoglobulin G (IgG)–mediated bullous pemphigoid occurring in children in the first year of life and characterized by a self-limited nonscarring bullous pemphigoid–like process involving only the vulva has been described. [ ] Cicatricial pemphigoid Cicatricial

2014 eMedicine.com

517. Normal and Abnormal Puerperium (Diagnosis)

), the American College of Obstetricians and Gynecologists (ACOG), and the United States Preventive Services Task Force recommend exclusive breastfeeding for the first six months of life. In 1991 The World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) launched a global program called The Baby-Friendly Hospital Initiation (BFHI) that aims to increase the numbers of infants who are exclusively breastfed worldwide. The BFHI program developed “Ten Steps to Successful Breastfeeding (...) by the ovaries is highly variable and is greatly influenced by breastfeeding the infant. The woman who breastfeeds her infant has a longer period of amenorrhea and anovulation than the mother who chooses to use formula. The mother who does not breastfeed may ovulate as early as 27 days after delivery. Most women have a menstrual period by 12 weeks; the mean time to first menses is 7-9 weeks. In the breastfeeding woman, the resumption of menses is highly variable and depends on a number of factors, including

2014 eMedicine.com

518. Nephrolithiasis: Acute Renal Colic (Diagnosis)

in people aged 35-45 years, but the disease can affect anyone at any age. Patients in whom multiple recurrent stones form usually develop their first stones while in their second or third decade of life. An initial stone attack after age 50 years is relatively uncommon. Nephrolithiasis in children has historically been rare, with approximately 5-10 children aged 10 months to 16 years being seen annually for the condition at a typical US pediatric referral center. Over the last 25 years, however (...) . Pyonephrosis: diagnosis and treatment. Br J Urol . 1992 Oct. 70(4):360-3. . Jeffrey RB, Laing FC, Wing VW, Hoddick W. Sensitivity of sonography in pyonephrosis: a reevaluation. AJR Am J Roentgenol . 1985 Jan. 144(1):71-3. . Schneider K, Helmig FJ, Eife R, Belohradsky BH, Kohn MM, Devens K, et al. Pyonephrosis in childhood--is ultrasound sufficient for diagnosis?. Pediatr Radiol . 1989. 19(5):302-7. . Fultz PJ, Hampton WR, Totterman SM. Computed tomography of pyonephrosis. Abdom Imaging . 1993. 18(1):82-7

2014 eMedicine.com

519. Nephrolithiasis (Diagnosis)

at any age. Patients in whom multiple recurrent stones form usually develop their first stones while in their second or third decade of life. An initial stone attack after age 50 years is relatively uncommon. Nephrolithiasis in children has historically been rare, with approximately 5-10 children aged 10 months to 16 years being seen annually for the condition at a typical US pediatric referral center. Over the last 25 years, however, the incidence of nephrolithiasis in children has increased (...) , Laing FC, Wing VW, Hoddick W. Sensitivity of sonography in pyonephrosis: a reevaluation. AJR Am J Roentgenol . 1985 Jan. 144(1):71-3. . Schneider K, Helmig FJ, Eife R, Belohradsky BH, Kohn MM, Devens K, et al. Pyonephrosis in childhood--is ultrasound sufficient for diagnosis?. Pediatr Radiol . 1989. 19(5):302-7. . Fultz PJ, Hampton WR, Totterman SM. Computed tomography of pyonephrosis. Abdom Imaging . 1993. 18(1):82-7. . Wu TT, Lee YH, Tzeng WS, Chen WC, Yu CC, Huang JK. The role of C-reactive

2014 eMedicine.com

520. Schistosomiasis (Treatment)

endemic areas are rising. In the complete absence of routine presymptomatic screening of these groups in developed countries, it is increasingly likely that patients with acute or chronic schistosomiasis will present to emergency departments (EDs) with a variety of complaints in nonendemic areas. [ , ] Pediatric and adolescent patients who have traveled or lived in endemic areas are at the highest risk for exposure to schistosomes and are at risk for serious long-term complications. These patients (...) . [ ] Acutely, patients with schistosomiasis may present with the following: Pruritic rash due to cercarial penetration into the skin Nonspecific symptoms such as fever, myalgias, and malaise Right upper quadrant abdominal pain Diarrhea Dysuria or hematuria Important laboratory findings include (1) eosinophilia and (2) hematuria and proteinuria, which is associated with urinary schistosomiasis. Manifestations of chronic schistosomiasis can also months or years after acute infection. Symptoms are nonspecific

2014 eMedicine Emergency Medicine

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