Pediatric emergency medicine trisk 1533 1533
Bạn đang xem bản rút gọn của tài liệu. Xem và tải ngay bản đầy đủ của tài liệu tại đây (99.43 KB, 1 trang )
especially those who are uncircumcised, are nonspecific bacterial infections that
can present with frequency, dysuria, and purulent discharge. The term urethral
syndrome refers to an entity that can be seen in female adolescents, characterized
by acute onset of frequency and dysuria with “insignificant” bacterial counts (less
than 10,000 colony-forming units per mL). Pyuria is generally, but not absolutely,
present. Vaginitis is a common cause of the urethral syndrome. C. trachomatis
and N. gonorrhoeae are again common culprits.
Irritative vulvovaginitis (e.g., secondary to poor hygiene or bubble baths) is a
relatively common cause of frequency, usually associated with dysuria but not
with pyuria. Candidal vulvovaginitis presents with similar symptoms, but also
with white discharge, and is more common in adolescent females. Vaginal foreign
bodies in young children also can cause frequency in addition to vaginal
discharge. Frequency may be secondary to urethral trauma such as straddle
injuries, catheterization, masturbation, or sexual abuse. As an isolated symptom,
frequency would be an atypical presentation of pediatric sexual abuse. However,
urinary frequency may be seen in association with pertinent history or physical
findings (e.g., vulvovaginal infection or genital trauma), which would be
suggestive of sexual abuse. Pinworms (Enterobius vermicularis ) may
occasionally cause frequency in young females. Children with pinworm
infestation may or may not present with perineal itching. Pyuria and dysuria are
usually absent.
Extraurinary System
Neurologic
Central DI is a deficiency in the hypothalamic production of antidiuretic hormone
that leads to inability of the renal system to properly concentrate urine. Etiologies
such as septo-optic dysplasia and other developmental anomalies present in the
neonatal and infancy period. However, most causes of central DI are acquired
(e.g., head injury, brain tumors) and therefore can present at any age. DI is a lifethreatening cause of urinary frequency as lack of access to appropriate hydration
leads to hypernatremic dehydration.
A neurogenic bladder associated with a spinal cord lesion (e.g., tethered cord)
may present with urinary frequency, as the patient cannot empty the bladder fully.
Urine volumes are small but frequent. Physical examination may yield associated
abnormalities (hairy patches, cutaneous dimples or tracts, lipoma, or bony
irregularities), decreased anal tone, lower-extremity weakness, or reflex
abnormalities. Generally, postvoid residual urine volumes are increased.
