PEDIATRICS
COMPLICATIONS
■ Bowel perforation
■ Peritonitis
GENITOURINARYWilm’s Tumor
The most common renal tumor in children, with a peak incidence at 3–4
years of age (98% occur before age seven). It may be congenital or acquired.
SYMPTOMS/EXAM
■ Abdominal mass, with or without abdominal pain
■ Hematuria (25%)
■ Hypertension (25%)
■ Congenital Wilm’s tumor is associated with Aniridia, GU anomalies, and
mental Retardation (WAGR syndrome).
DIAGNOSIS
■ CT abdomen and chest
TREATMENT
■ Surgical excision
■ Adjuvant chemotherapy, sometimes with addition of radiation
COMPLICATIONS
■ Metastatic spread of tumor
■ Recurrent disease after treatment
Urinary Tract Infection
The term UTI includes lower tract infections of the urethra and bladder
(urethritis or cystitis), and upper tract infections of the kidney (pyelonephritis).
Most UTIs are due to ascending infection of enteric bacteria, although occa-
sionally a child with bacteremia may directly seed the kidney, resulting in
pyelonephritis. Infants are most likely to become infected by group B strepto-
coccus. UTIs in all other pediatric age groups are most commonly caused by
E. coli. The overall incidence of UTIs before puberty is 3% of girls, and 1%
of boys. There is a higher incidence of UTI in Caucasians, infants, and
uncircumcised males.
SYMPTOMS/EXAM
■ Depends upon the age of the child and severity of infection
■ Among infants, the presentation may be subtle, with poor feeding, dehy-
dration, and increased crying. Fever may be present, particularly in infants
with pyelonephritis.
■ In older children:
■ Dysuria and frequency, fever and flank pain if development of
pyelonephritis