Dr. Mersch received his Bachelor of Arts degree from the University of California, San Diego, and prior to entering the University Of Southern California School Of Medicine, was a graduate student (attaining PhD candidate status) in Experimental Pathology at USC. He attended internship and residency at Children's Hospital Los Angeles.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Urinary tract infections are a fairly common problem in
childhood and may have either a benign course responding to simple antibiotic
therapy or be associated with significant disruption in either the anatomy or
function of a child's urinary system. This article will focus on UTIs affecting
children, with an emphasis on those less than 2 years of age. Because of their
more unique and complicated nature, neonatal (less than 28 days of age) UTIs
will not be addressed as a specific issue. The principles discussed below,
however, are applicable to that age group.
The urinary tract is commonly divided into two areas. The upper urinary tract
consists of the kidneys and the delicate tubular structure (ureter) that runs
from the kidney to the bladder. The lower tract includes the bladder and the
urethra (the tube from the bladder to the outside of the body).
Bacteria cause the large majority of urinary tract infections in children.
Viral infection of the bladder is less common, while fungal infections of the
urinary tract are rare and occur most commonly in immunocompromised individuals
(for example, those with HIV/AIDS, chemotherapy recipients).
What are symptoms and signs of urinary tract infections (UTIs) in children?
Characteristic symptoms of a urinary tract infection include pain with
urination (dysuria), urinary frequency (needing to urinate frequently) and
urgency (feeling a compelling urge to urinate) and loss of previously
established urinary control (for example, bedwetting). Nonspecific but common symptoms
include fever (especially >102.2 F or 39 C) and abdominal pain.
For some children less than 2 years of age, these more subtle problems may be
the only indicator of a UTI. Associated symptoms of concern include flank pain,
fever, and vomiting. Obvious blood in the urine (gross hematuria) as well as a
positive family history for childhood urinary tract
infections (especially in siblings) are also red flags and should raise the level of concern.
Interestingly, the odor and color (with the exception of obvious blood) of the
urine are not predictors of a UTI.
Urinary tract infection (UTI) is an infection of the kidney, ureter, bladder, and/or urethra. Not
everyone with a UTI has symptoms. Common symptoms include a frequent urge to
urinate and a painful, burning when urinating.
Abdominal pain is pain in the belly and can be acute or chronic. Causes include inflammation, distention of an organ, and loss of the blood supply to an organ. Abdominal pain can reflect a major problem with one of the organs in the abdomen such as the appendix, gallbladder, large and small intestine, pancreas, liver, colon, duodenum, and spleen.
Kidney infection (pyelonephritis) usually is caused from bacteria that have spread from the bladder from a UTI (urinary tract infection), poor hygiene, sexual intercourse, pregnancy, catheter, cystoscope exam, surgery, kidney stones, or prostate enlargement. Symptoms of kidney infection include: back pain, frequent urination, pain during urination, fever, and or pus or blood in the urine. Kidney infection is usually treated with antibiotics.
Although a fever technically is any body temperature above the normal of 98.6 degrees F. (37 degrees C.), in practice a person is usually not considered to have a significant fever until the temperature is above 100.4 degrees F (38 degrees C.). Fever is part of the body's own disease-fighting arsenal: rising body temperatures apparently are capable of killing off many disease- producing organisms.
Interstitial cystitis (IC) is an inflammatory disease of the bladder that can cause ulceration and bleeding of the bladder's lining and can lead to scarring and stiffening of the bladder. Symptoms of interstitial cystitis may vary among individuals and may even vary with time in the same individual.
E. coli is the most common cause of bladder infections. Bladder infection symptoms and signs include frequent urination, burning urination, and foul smelling urine. Mild bladder infections may go away by increasing one's intake of fluid. More severe infections may be treated with a few days of antibiotics.
Vaginal dryness and vaginal atrophy occurs in women during perimenopause, menopause, and postmenopause. With vaginal atrophy, the lining of the vaginal wall becomes thinner, drier, less elastic, and light pink to bluish in color. Symptoms of vaginal atrophy include vaginal dryness, itching, irritation, and/or pain during intercourse. Treatment options for vaginal dryness and vaginal atrophy include hormone treatment and over-the-counter vaginal lubricating and moisturizing products.
A urethral stricture, or narrowing of the urethra, may cause decreased urine output. Symptoms include painful urination, urinary retention, and pelvic pain. Surgery is the only treatment for people with uncontrolled symptoms of urethral narrowing.
People who have bladder spasms, the sensation occurs suddenly and often severely. A spasm itself is the sudden, involuntary squeezing of a muscle. A bladder spasm, or "detrusor contraction," occurs when the bladder muscle squeezes suddenly without warning, causing an urgent need to release urine. The spasm can force urine from the bladder, causing leakage. When this happens, the condition is called urge incontinence or overactive bladder.
Children's health is focused on the well-being of children from conception through adolescence. There are many aspects of children's health, including growth and development, illnesses, injuries, behavior, mental illness, family health and community health.
A nerve problem might affect your bladder control if the nerves that are supposed to carry messages between the brain and the bladder do not work properly. Such problems include urine retention, poor control of sphincter muscles, and overactive bladder. Treatment depends upon the cause of the nerve damage and resulting type of bladder control problem.
There are many syndromes and defects that may cause urine blockage in newborns. Defects in the urinary tract that may cause urine blockage include vesicoureteral reflux, ureteropelvic junction obstruction, bladder outlet obstruction, posterior urethral valves, nerve disease, and ureterocele. Syndromes that may cause urinary blockage include congenital heart defects, esophageal atresia, and prune belly syndrome. Treatment for urine blockage in newborns depends on the cause of the blockage.
While the patient's history and physical examination are the building blocks
of making a medical diagnosis, the ability to peer inside the body can be a
powerful tool. Ultrasound is an imaging technique that provides that
ability to medical practitioners.
What is an ultrasound?
Ultrasound produces sound waves that are beamed into the body causing return
echoes that are recorded to "visualize" structures beneath the skin. The ability
to measure different echoes reflected from a variety of tissues allows a shadow
picture to be constructed. The technology is especially accurate at seeing the
interface between solid and fluid filled spaces. These are actually the same
principles that allow SONAR on boats to see the bottom of the ocean.
What is ultrasonography?
Ultrasonography is body imaging using ultrasound in medical diagnosis. A
skilled ultrasound technician is able to...