renal/urinary system Flashcards
(48 cards)
what is enuresis
it is bedwetting when older than 5 yrs old
what are the different types of enuresis
primary enuresis without day time symptoms
primary enuresis with day time symptoms
Secondary enuresis
aetiology of enuresis
inability to arouse + capacity of bladder vs nocturnal urine production
what is the aetiological theory behind enuresis
it is when there is insufficient ADH production at night and so polyuria during the night and the inability of the child to wake up during the night to wee
what is the normal cut off for enuresis
up to 5 yrs old
what is primary enuresis
it is when the child involuntary urinate during the night older the age of 5 and have never achieved continence before
what is secondary enuresis
it is when the child involuntary urinate during the night older the age of 5 and have achieved continence before for > 6 months
what is the general underlying believe of primary enuresis
it is when there is a possible developmental delay in the child but will resovle in time
what is the general underlying believe of secondary enuresis
it is regarded as regression of development and will always require investigation
what can aggravate enuresis
constipation
what is the absolute cut up point of normal enuresis according to NICE
10 yrs old
how common is enuresis in 5 yrs old
8-20%
how common is enuresis in 10 yrs old
1.5 - 10%
how common is enuresis in adult
0.5-2%
RF for enuresis
constipation poor bedtime hygiene caffeine stress daytime incontinence FH sleep apnoea or obstructive sleeping - DM obese children
underlying neuro conditions - spinal bifida or cerebral palsy
underlying developmental conditions
assessment of enuresis
determine which type of enuresis it is
look at enuresis diary
associated symptoms
questions to ask in primary enuresis
FH of bedwetting
male?
daytime LUTS - frequency, urgency, incontinence, poor stream even when straining, pain on urination
if it only occurs in partiuclar situations? eg avoiding toilet in school
lifetime stress - bullying. family bereavement
questions to ask in secondary enuresis
medical conditions
physical health
social problems - eg bullying
environmental - school
examination findings of enuresis
abdo distension - bladder full
palpable feal mass - incontinence
other masses
neuro - leg reflexes
spina bifida occulta - midline lipoma, hairy patch or spinal deformity, legs for neuro signs (neurogenic bladder)
Ix for enuresis
urinalysis not recommended unless recent onst or daytime symptoms
urine MC+S - look for any signs of UTI
renal tract USS - to see pre- and post-micturition residual volume
management of primary enuresis
with/without daytime symptoms
- intervention not usually advised until age 7 - connection of the brain is still developing
- avoid caffeine drink before bed, restricted fluid intake before bed
- good bedtime hygiene
- star chart - do not offer star for not wetting bed because children can not control it
- enuresis alarm
- desmopressin for short term purpose - sleepover
- oxybutynin
when will you refer an enuresis case
severe daytime symptoms - because potential developmental delay
secondary enuresis
suspected neuro probs
what is the management of secondary enuresis
exclude UTI, constipation, emotional/stress related
refer to specialist
definition of UTI
presence of symptoms - dysuria, frequency and loin pain
+
detection of a significant culture of organisms
(any detected in suprapubic aspirate or > 10(5) organism in MSU, clean catch urine or bag urine
