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Dysuria in Children

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661. Urinary Tract Stones

acidosis, hypercalciuria, hyperuricosuria. Deficiency of citrate in the urine. Cystinuria (an autosomal-recessive aminoaciduria). Drugs - eg, diuretics such as triamterene and calcium/vitamin D supplements. More common occurrence in hot climates. Increased risk of stones in higher socio-economic groups. Contamination - as demonstrated by a spate of melamine-contaminated infant milk formula. [ ] Presentation [ ] Many stones are asymptomatic and discovered during investigations for other conditions (...) a good correlation with the current site of the stone. Other symptoms which may be present include: Rigors and fever. Dysuria. Haematuria. Urinary retention. Nausea and vomiting. Examination The patient with colic of any sort writhes around in agony. This is in contrast to the patient with peritoneal irritation who lies still. The patient is apyrexial in uncomplicated renal colic (pyrexia suggests infection and the body temperature is usually very high with pyelonephritis). Examination of the abdomen

2008 Mentor

662. Herpes Simplex Genital

; OR Valaciclovir, 500 mg twice daily for five days. BASHH alternative regimens (also for five days) are: Aciclovir 200 mg five times daily; OR Famciclovir250 mg three times daily. Antiviral therapy reduces the severity and duration of episodes but does not alter the natural history of the disease Management in people with HIV This requires specialist advice. More detailed information is given in the BASHH guidelines. Management in children The presence of genital ulceration in a child may be alarming and has (...) a broad differential diagnosis as listed above. According to the National Institute for Health and Care Excellence (NICE) guidelines, the presence of such lesions in a child should prompt the clinician to . [ ] This consideration involves: Looking for other alerting features of abuse in the history and presentation. Discussing the case with a more experienced clinician and/or a designated professional for safeguarding children. Gathering collateral information from other health agencies

2008 Mentor

663. Gonorrhoea

of the efficacy of ocular prophylactic agents used for the prevention of gonococcal and chlamydial ophthalmia neonatorum. J Midwifery Womens Health. 2010 Jul55(4):319-27. ; Genital gonorrhoea in children: determining the source and mode of infection. Arch Dis Child. 2011 Mar96(3):247-51. Epub 2010 Jun 3. ; What is the evidence for non-sexual transmission of gonorrhoea in children after the neonatal period? A systematic review. J Forensic Leg Med. 2007 Nov14(8):489-502. Epub 2007 Jul 30. ; Previous history (...) %) and/or dysuria (>50%), asymptomatic (<10%). [ ] Rectal infection - usually asymptomatic; may cause anal discharge (12%) or perianal/anal pain, pruritus or bleeding (7%). Pharyngeal infection - usually asymptomatic (>90%). Women [ ] Endocervical infection - frequently asymptomatic (up to 50%); increased or altered vaginal discharge is the most common symptom (up to 50%), although lower abdominal pain may also be present (up to 25%); a rare cause of intermenstrual bleeding or menorrhagia. Urethral infection

2008 Mentor

664. Haematuria

haematuria: Symptomatic non-visible haematuria (s-NVH) - associated symptoms include voiding lower urinary tract symptoms (LUTS): hesitancy, frequency, urgency, dysuria. Asymptomatic non-visible haematuria (a-NVH) - incidental detection in the absence of LUTS or upper urinary tract symptoms. Significant haematuria is defined as: Any single episode of VH. Any single episode of s-NVH (in absence of urinary tract infection (UTI) or other transient causes). Persistent a-NVH (in absence of UTI or other (...) , Henoch-Schönlein purpura, IgA nephropathy, Goodpasture's syndrome, polyarteritis, post-irradiation. Structural: calculi (renal, bladder, ureteric), simple cysts, polycystic renal disease, congenital vascular anomalies. Haematological: sickle cell disease, coagulation disorders, anticoagulation therapy. Surgery: invasive procedures to the prostate or bladder. Toxins: sulfonamides, cyclophosphamide, non-steroidal anti-inflammatory drugs. Others: genital bleeding, including child abuse; menstruation

2008 Mentor

665. Gynaecology History and Examination

. Dyspareunia - superficial or deep. Urinary symptoms Leakage. Cloudiness. Haematuria. Hesitancy. Dysuria. Frequency. Strangury. Stress or urge incontinence. Obstetric history Number of children, details of pregnancy, labour and delivery, birth weights, complications. Miscarriages/terminations. Any postnatal problems - eg, depression. Conception difficulties/subfertility. Contraception Contraceptive history. Any recent unprotected intercourse. Reliability of method and user. Potential contra-indications

2008 Mentor

666. Incest

in the 2009 Sexual Offences Act, and in Northern Ireland in the Sexual Offences Order 2008). The aim of this law was to protect children up to the age of 18 from any form of activity that a person would consider sexual or indecent. The offender may be an adult or another child. It recognises the modern family unit and it defines familial sexual abuse as being between a person and their parent (including adoptive or foster), grandparent, child, grandchild, sibling or half-sibling, uncle, aunt, nephew (...) and contemporaneous records. Remember other children in the household - are they at risk? All doctors have a duty to safeguard children and to ensure follow-on care for the child: The non-specialist's role is not to make a definite diagnosis of child abuse but to recognise the possibility and enlist appropriate help. The doctor concerned about a child must ensure follow-on care. Did you find this information useful? Thanks for your feedback! Why not subscribe to the newsletter? Email address * We'd love to send

2008 Mentor

667. Genitourinary History and Examination (Male)

not be indicative of urological abnormality but may have other causes such as frequency of micturition in anxiety or urinary symptoms caused by neurological disease. The following account will both list important items as an aide-mémoire and provide diagnostic tips and suggestions for history and examination. Paediatric genitourinary history and examination are referred to and important aspects particular to developing children are outlined. The separate partner article covers detail specific to female patients (...) of the history overlaps with that for adults but an understanding of normal growth and development, particularly of normal pubertal development, is essential in paediatric practice. Child abuse may present with genitourinary symptoms. When child abuse is suspected the correct procedures should be followed with referral for further assessment and examination. Examination Again this will be conducted with a good understanding of normal growth and pubertal development. Sensitive handling is essential

2008 Mentor

668. Obstetric Shock

as abnormal bleeding from the genital tract, from 24 hours after delivery until six weeks postpartum. Shah Jehan built the Taj Mahal in memory of his third wife, Mumtaz Mahal, who died giving birth to her fourteenth child, apparently of a PPH, in 1631. Primary postpartum haemorrhage Aetiology The causes of PPH have been described as the "four T's": T one: uterine atony, distended bladder. T rauma: lacerations of the uterus, cervix, or vagina. T issue: or clots. T hrombin: pre-existing or acquired (...) anaesthetic. Retained products of conception (RPOC). Assessment History Symptoms vary but may include: Fever. Abdominal pain. Offensive smelling lochia. Abnormal vaginal bleeding - postpartum haemorrhage. Abnormal vaginal discharge. Dyspareunia. Dysuria. General malaise. Look for history of extended labour, difficult third stage, ragged placenta, PPH. Examination There may be: Fever. Rigors. Tachycardia. Tenderness of the suprapubic area and adnexae. Elevated fundus which feels boggy in RPOC

2008 Mentor

669. Pelvic Abscesses

Crohn's disease, diabetes mellitus, immunodeficiency and pregnancy. In Crohn's disease, abscesses may occur either spontaneously or as a complication of surgery. [ ] Presentation Systemic features of toxicity: fever, malaise, anorexia, nausea, vomiting, pyrexia. Local effects: eg, pain, deep tenderness in one or both lower quadrants, diarrhoea, tenesmus, mucous discharge per rectum, urinary frequency, dysuria, vaginal bleeding or discharge. Rectal or vaginal examination: may reveal tenderness (...) (8):373-8. doi: 10.4253/wjge.v6.i8.373. ; Percutaneous imaging-guided abdominal and pelvic abscess drainage in children. Radiographics. 2004 May-Jun24(3):737-54. ; Complex abdominal and pelvic abscesses: efficacy of adjunctive tissue-type plasminogen activator for drainage. Radiology. 2008 May247(2):567-73. doi: 10.1148/radiol.2472070761. Epub 2008 Mar 27. Health Tools Feeling unwell? Assess your symptoms online with our free symptom checker. Article Information Last Reviewed 06 November 2014

2008 Mentor

670. HerpeVac Trial for Young Women

] Genital herpes disease was defined as signs (swelling, papules, vesicles, ulcers, crusts, fissures, erythema, or vaginal discharge) and/or symptoms (pain, burning, itching, tingling, dysuria) which developed on the skin or mucosa of the anogenital region and/or buttocks and laboratory confirmation of Herpes Simplex Virus (HSV)-1 or 2 infection (either concomitant positive HSV culture or HSV seroconversion within 6 months after onset of signs and/or symptoms). Seroconversion to HSV-1 and/or HSV-2 (...) , tingling, dysuria) which developed on the skin or mucosa of the anogenital region and/or buttocks and laboratory confirmation of Herpes Simplex Virus (HSV)-1 or 2 infection (either concomitant positive HSV culture or HSV seroconversion within 6 months after onset of signs and/or symptoms). Seroconversion to HSV-1 and/or HSV-2 was defined as a positive HSV-1 and/or HSV-2 Western blot in a subject with a previously negative Western blot result for the corresponding HSV type. Number of Subjects With Newly

2003 Clinical Trials

671. Urinary schistosomiasis: a report of four cases and a review. Full Text available with Trip Pro

enuresis was the presenting symptom in the index case; this patient also had hematuria and dysuria. Nocturia occurred in a second child, and the other two children were asymptomatic. All four were cured by a single dose of praziquantel, a new schistosomicide. The life cycle of the causative organism, the clinical manifestations of schistosomiasis, the host response and treatment with praziquantel are reviewed. (...) Urinary schistosomiasis: a report of four cases and a review. Urinary schistosomiasis is a common cause of hematuria in tropical regions, where it most often affects teenage boys. Children presenting with hematuria in the developed world are usually considered to have bacterial cystitis or a structural lesion and are investigated and treated accordingly. The authors report on a family recently returned to Canada from Nigeria in which all four children had urinary schistosomiasis. Nocturnal

1984 Canadian Medical Association Journal

672. Cowper's syringocele: an analysis of 15 consecutive cases. Full Text available with Trip Pro

Cowper's syringocele: an analysis of 15 consecutive cases. Cystic dilatation of Cowper's gland ducts (Cowper's syringocele) is uncommon in children and is frequently asymptomatic, but it may cause urinary infection, haematuria, dysuria, and obstructive voiding symptoms. Fifteen consecutive children with syringocele aged 15 days to 15 years old are reported here. Only four patients with obstructive syringocele were successfully treated surgically; all the others were successfully treated

1996 Archives of Disease in Childhood

673. Gastrocystoplasty: long-term followup. (Abstract)

Gastrocystoplasty: long-term followup. The use of stomach has become controversial in pediatric lower urinary tract reconstruction. Recent series have reported a high incidence of hematuria-dysuria syndrome and metabolic abnormalities, which has prompted a significant decrease in its use at our institution during the last 5 years.We retrospectively reviewed the medical records of children who underwent urinary reconstruction with gastrocystoplasty. Patients were excluded from consideration (...) . Two patients had severe hematuria while anuric from renal failure which was managed conservatively with bladder cycling and H2 blockers. Symptoms resolved completely after renal transplantation in both cases. Febrile urinary tract infection occurred in 20% of cases and asymptomatic bacteriuria was present in 36%.The use of stomach segments in pediatric urinary reconstruction can be beneficial in patients with chronic renal insufficiency, metabolic acidosis or short gut syndrome. Despite negative

2003 Journal of Urology

674. The effect of endoscopic injections of dextranomer based implants on continence and bladder capacity: a prospective study of 31 patients. (Abstract)

The effect of endoscopic injections of dextranomer based implants on continence and bladder capacity: a prospective study of 31 patients. A prospective study was conducted to assess the efficacy of dextranomer based implants as a new bulking agent for endoscopic treatment of pediatric structural incontinence.A total of 33 children and adolescents 5 to 18 years old with severe incontinence due to sphincteric incompetence (exstrophy-epispadias in 13, neuropathic bladder in 16, bilateral ectopic (...) period 2 patients had temporary dysuria and 10 had a nonfebrile urinary tract infection. At 1 month 24 of the 33 patients (73%) were dry or improved. Two patients were subsequently excluded from study for noncompliance with followup. At 6 months 17 of 31 patients (55%), at 1 year 13 of 28 (46%), at 2 years 10 of 23 (43%) and at 3 years 10 of 20 (50%) were dry or improved. Similar success occurred in cases of neuropathic bladder (57%) and exstrophy-epispadias complex (46%). Success rate of re-treated

2002 Journal of Urology

675. Does this child have a urinary tract infection? Full Text available with Trip Pro

into the relationship between race and UTI. Bibliographic details Shaikh N, Morone N E, Lopez J, Chianese J, Sangvai S, D'Amico F, Hoberman A, Wald E R. Does this child have a urinary tract infection? JAMA 2007; 298(24): 2895-2904 PubMedID DOI Original Paper URL Indexing Status Subject indexing assigned by NLM MeSH Adolescent; Algorithms; Child; Child, Preschool; Diagnosis, Differential; Female; Fever; Humans; Infant; Male; Urinalysis; Urinary Tract Infections /diagnosis /epidemiology AccessionNumber 12008008008 (...) Does this child have a urinary tract infection? Does this child have a urinary tract infection? Does this child have a urinary tract infection? Shaikh N, Morone N E, Lopez J, Chianese J, Sangvai S, D'Amico F, Hoberman A, Wald E R CRD summary This review assessed the diagnostic accuracy of signs and symptoms for urinary tract infection (UTI) in children. The authors concluded that individual signs and symptoms are useful but insufficient to diagnose UTI, whereas combinations can be used

2007 DARE.

676. Childhood Urinary Tract Infection (UTI)

and the infant or child is at high risk of serious illness. Carefully assess the degree of toxicity, dehydration and ability to maintain oral fluid intake. Encourage fluids, avoid or correct constipation and encourage full voiding. Pharmacological Consider referral to secondary care for children aged 3 months and older with acute pyelonephritis or upper UTI but, if appropriate, treat with 7-10 days of oral antibiotics. If the child is unable to tolerate oral antibiotics, start treatment with intravenous (IV (...) ; Diagnosis and management of urinary tract infection in children: summary of NICE guidance. BMJ. 2007 Aug 25335(7616):395-7. ; NICE Quality Standard, July 2013 ; British Infection Association and Health Protection Agency ; Interventions for covert bacteriuria in children. Cochrane Database Syst Rev. 2012 Feb 152:CD006943. doi: 10.1002/14651858.CD006943.pub2. ; Urinary tract infections in children: a review. Minerva Pediatr. 2012 Apr64(2):145-57. ; NICE on childhood UTI: Nasty processes produce nasty

2008 Mentor

677. Childhood Gastro-oesophageal Reflux Disease

and adolescents: when and how to treat. Paediatr Drugs. 2012 Apr 114(2):79-89. doi: 10.2165/11594360-000000000-00000. ;341:c4420. doi: 10.1136/bmj.c4420. ; Management of cow's milk protein allergy in infants and young children: an expert panel perspective. J Paediatr Child Health. 2009 Sep45(9):481-6. Epub 2009 Aug 21. Hi. About 1 1/2 years ago I had very similar symptoms. pain when I swallowed on the left side which involved the ear too. I could drink and Icy type treat drink and it would feel better. My GP (...) , continuous, thickened enteral tube feeding. Complications Possible complications of GOR in infants, children and young people include: [ ] Reflux oesophagitis. Recurrent aspiration pneumonia. Frequent otitis media (for example, more than three episodes in six months). Dental erosion in a child or young person with a neurodisability, particularly cerebral palsy. Prognosis Most cases are benign with 55% resolved by 10 months and the vast majority resolved by 18 months. Not all infants require medications

2008 Mentor

678. Child Abuse - Recognition

in children aged <2 years, a skeletal survey or radionuclide bone scan is indicated. This may also be needed in some older children. Brain imaging: This is needed if head injury is suspected clinically. Also, infants aged <1 year with any physical abuse injuries should have neuro-imaging for possible non-accidental brain injury. A child with abusive injuries and any signs or symptoms of brain injury should have neuro-imaging performed. Retinal examination: If there is head injury, also arrange a retinal (...) Child Abuse - Recognition What is Child Abuse? How to deal with different types of abuse | Patient TOPICS Try our Symptom Checker TREATMENT RESOURCES Try our Symptom Checker PROFESSIONAL Upgrade to Patient Pro / / Search Safeguarding Children - How to Recognise Abuse or a Child at Risk Authored by , Reviewed by | Last edited 19 Nov 2015 | Certified by This article is for Medical Professionals Professional Reference articles are designed for health professionals to use. They are written by UK

2008 Mentor

679. Ill and Feverish Child

. : consider in any child <3 months with fever. In children older than 3 months, consider if there is associated vomiting, poor feeding, lethargy, irritability, abdominal pain or tenderness, urinary frequency or dysuria or offensive urine or haematuria. and : consider if there is limb or joint swelling or non-use or non-weight-bearing of an extremity. : consider this if there is fever that has lasted >5 days, plus four of the following: Bilateral conjunctival injection. Change in mucous membranes (...) a specific diagnosis has not been made, should either be referred to urgent paediatric care or the carers of the child should be given a 'safety net', either detailing exactly when to seek further help (ie specific warning symptoms or signs) or arranging a further follow-up assessment. Children with only green features can be managed at home with advice for parents and carers, including advice on when to seek further help. Oral antibiotics should not be prescribed if there is no identifiable source

2008 Mentor

680. A randomized trial to assess childhood circumcision with the Plastibell device compared to a conventional dissection technique. (Abstract)

A randomized trial to assess childhood circumcision with the Plastibell device compared to a conventional dissection technique. A randomized trial of routine circumcision in children using the Plastibell device is described and compared to a dissection suturing technique. One hundred children were studied with a mean age of 4.7 years. The device was applicable to all boys up to the age of 8, and a few older. General discomfort was carefully assessed and slightly less common after plastibell (...) circumcision, but dysuria more so. No serious complication was encountered with either method; infection was slightly more common after the conventional procedure. Cosmetic results were similar for both methods. It is concluded that the Plastibell device is a satisfactory method for circumcising children of this age.

1981 British Journal of Surgery Controlled trial quality: uncertain

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