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Pathophysiology Cellular As perfusion to the tissues is reduced, cells are deprived of oxygen and must switch from aerobic to anaerobic metabolism. The product of anaerobic respiration is not carbon dioxide but lactic acid. When enough tissue is underperfused...

Recognition and diagnosis of shock Shock may be profound and easily recognised or it may be - subtle and only diagnosed with directed clinical examination and cardiovascular and metabolic monitoring. Compensated shock As shock progresses, the body’s cardiovasc...

SHOCK RESUSCITATION Immediate resuscitation manoeuvres for patients presenting in - shock are to ensure a patent airway and adequate oxygenation and ventilation. Once ‘airway’ and ‘breathing’ are assessed and - controlled, attention is directed to cardiovasc...

SHOCK Shock is a systemic state of low tissue perfusion that is inade quate for normal cellular respiration. With insu ffi cient delivery of oxygen and glucose, cells switch from aerobic to anaerobic metabolism. If perfusion is not restored in a timely fashio...

TRANSFUSION The transfusion of blood and blood products has become commonplace since the first successful transfusion in 1818. Although the incidence of severe transfusion reactions and infections is now very low , in recent years it has become - apparent tha...

Transfusion reactions If antibodies present in the recipient’s serum are incompatible with the donor’s cells, a transfusion reaction will result. This usually takes the form of an acute haemolytic reaction. Severe immune-related transfusion reactions due to ...

Vasopressor and inotropic support Vasopressor or inotropic therapy is not indicated as first-line therapy in hypovolaemia. Administration of these agents in the absence of adequate preload rapidly leads to decreased coro nary perfusion and depletion of myocar...

Antenatal fetal hydronephrosis Hydronephrosis /uni00A0 – /uni00A0 a dilated renal pelvis /uni00A0 – /uni00A0 is found in 1% of - antenatal scans and most commonly it resolves, especially if the dilatation is mild to moderate. Severe dilatation is asso - ciated...

DISORDERS OR DIFFERENCES IN SEX DIFFERENTIATION Some, but not all, children with abnormalities of their sex chromosomes, gonads or reproductive anatomy are consid ered to have a disorder or di ff erence in sex di ff erentiation (DSD). Isolated undescended teste...

EMBRYOLOGY Four areas of developmental biology are relevant: (i) the two stages of testicular descent; (ii) the Weigert–Meyer rule a duplex system the ectopic upper pole ureter has an orifice lying inferomedial to the lower pole ureter; (iii) the role of the ...

Epispadias/bladder exstrophy Epispadias is a rare dorsal penile defect with an opening whose upper limit lies anywhere from the penopubic junction to the glans ( Figure 20.3 ). Epispadias may be part of the bladder exstrophy–epispadias complex in which the bl...

Hypospadias The genital tubercle becomes a penis under the influence of androgens with a tubular urethra arising from the urethral plate. The urethral plate develops a diamond-shaped groove whose edges fold over and fuse in the midline, forming a tube. In gi...

INTRODUCTION Paediatric urologists are paediatric surgeons who subspecialise in the conditions outlined in this chapter; they also manage the acute and elective inguinoscrotal pathology described in Chapter 17 . Surgeons in many specialities are consulted abou...

Learning objectives At the end of this chapter, you will be able to: Explain the indications for circumcision in childhood and of stone management • list the complications Describe three levels of urinary tract obstruction and • outline their management Descri...

NEUROPATHIC BLADDER A myelomeningocele, lipomyelomeningocele, fatty filum or an occult tethered cord can cause a neuropathic bladder that may need lifelong care to protect the kidneys from high urinary pressures and reflux, and support continence and independenc...

Posterior urethral valves PUVs are membranous folds that obstruct the lumen of the posterior urethra, a ff ecting about 1 in 4000 live-born boys. Girls are not a ff ected. About one-third are identified antenatally with bilateral hydronephrosis, a dilated bladder...

Radioisotope renal imaging 99m The metastable radioisotope Tc emits gamma rays during 99 an isomeric transition to Tc. It has a 6-hour emission half-life and a 1-day biological half-life, so imaging with low exposure is 99m possible. For static imaging, Tc is ...

THE PENIS Foreskin disorders and circumcision Surgical referrals for foreskin problems are common in early childhood, and reassurance is often all that is needed after taking a careful history and examination. The foreskin, or prepuce, is a highly innervated, ...