Wetting And Soiling Flashcards Preview

Jason's MD3 Paeds > Wetting And Soiling > Flashcards

Flashcards in Wetting And Soiling Deck (27):
1

When is enuresis abnormal?

Beyond age 5

2

Boys or girls get more enuresis?

Boys

3

When do you start Rx for enuresis?

Usually around age 7

4

Subgroups of enuresis?

Mono symptomatic: No daytime, only nighttime

5

Primary NE?

Never having been dry continuous for 6/12

6

What is secondary NE?

Relapsed after a period of at least 6 months of dryness

7

3 physiological of enuresis?

High nocturnal production
Small nocturnal capacity
Poor arousal from sleep?

8

Non-ADH causes of nocturnal polyuria?

Common: high nocturnal diet (western countries)

9

The interview of Nocturnal Enuresis

Reassurance that it's NOT their fault.
Inherited
Discuss prevalence

10

MAnagement of Nocturnal Enuresis?

Bed alarms

11

How long to use bed alarm for?

8-12 weeks

12

Second line Rx of nocturnal enuresis?

Polyuria: desmopressin
Is reduced bladder capacity: Anticholinergics

13

Desmopressin is?

Synthetic ADH - sublingual, one hour before bed.
Short-term stop gap
No drinking until following morning!

14

What doesn't really work for nocturnal enuresis?

Imipramine (only Rx resistant)
Waking/lifting the child
Fluid restriction

15

When is day wetting abnormal?

If after age 4

16

How to bring up day wetting?

May not volunteered
Voiding diary

17

Investigations for wetting?

Urinanalysis
Renal bladder ultrasound
Imaging/testing

18

What is dysfunctional voiding? How to ask?

Incoordination between detrusor and sphincteric

Ask about FLOW of urine.

19

Rx for overactive bladder?

Anticholinergic
Oxybutynin

20

Side effects of anticholinergics

Dry mouth
Rash
Constipation
Mood changes
Blurred vision, bloody nose

21

What causes soiling?

Usu. constipation: inadequate evacuation

22

Rare causes of soiling

Neurological
Congenital
Inflam
Psychogenic

23

Constipation red flags?

Before 1 month
Delayed me odium
Ribbon stools
Abdo distension/vomiting
Decrease growth
Protective concerns
Abnormal Neuro LL
Abnormal anus, buttocks/sacrum

24

Def'n of fecal incontinence?

Repeated defecation into clothes in a child >4y
Boys>girls

25

Examination and investigation?

Motor/sensory exam
Abdo exam
PR not really
AXR not recommended

26

Treatments for constipation children?

Lubricants
Simultaneously: senna, bisacodyl
Stool softener: coloxel, paraffin
Osmotic laxatives: not really for maintenance, macrogol

27

How long does treatment last?

Around 6 months