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Jason's MD3 Paeds > Wetting And Soiling > Flashcards

Wetting And Soiling Flashcards

1
Q

When is enuresis abnormal?

A

Beyond age 5

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2
Q

Boys or girls get more enuresis?

A

Boys

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3
Q

When do you start Rx for enuresis?

A

Usually around age 7

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4
Q

Subgroups of enuresis?

A

Mono symptomatic: No daytime, only nighttime

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5
Q

Primary NE?

A

Never having been dry continuous for 6/12

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6
Q

What is secondary NE?

A

Relapsed after a period of at least 6 months of dryness

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7
Q

3 physiological of enuresis?

A

High nocturnal production
Small nocturnal capacity
Poor arousal from sleep?

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8
Q

Non-ADH causes of nocturnal polyuria?

A

Common: high nocturnal diet (western countries)

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9
Q

The interview of Nocturnal Enuresis

A

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

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10
Q

MAnagement of Nocturnal Enuresis?

A

Bed alarms

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11
Q

How long to use bed alarm for?

A

8-12 weeks

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12
Q

Second line Rx of nocturnal enuresis?

A

Polyuria: desmopressin

Is reduced bladder capacity: Anticholinergics

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13
Q

Desmopressin is?

A

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

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14
Q

What doesn’t really work for nocturnal enuresis?

A

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

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15
Q

When is day wetting abnormal?

A

If after age 4

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16
Q

How to bring up day wetting?

A

May not volunteered

Voiding diary

17
Q

Investigations for wetting?

A

Urinanalysis
Renal bladder ultrasound
Imaging/testing

18
Q

What is dysfunctional voiding? How to ask?

A

Incoordination between detrusor and sphincteric

Ask about FLOW of urine.

19
Q

Rx for overactive bladder?

A

Anticholinergic

Oxybutynin

20
Q

Side effects of anticholinergics

A 
Dry mouth
Rash
Constipation
Mood changes
Blurred vision, bloody nose
21
Q

What causes soiling?

A

Usu. constipation: inadequate evacuation

22
Q

Rare causes of soiling

A

Neurological
Congenital
Inflam
Psychogenic

23
Q

Constipation red flags?

A 
Before 1 month
Delayed me odium
Ribbon stools
Abdo distension/vomiting
Decrease growth
Protective concerns
Abnormal Neuro LL
Abnormal anus, buttocks/sacrum
24
Q

Def’n of fecal incontinence?

A

Repeated defecation into clothes in a child >4y

Boys>girls

25
Q

Examination and investigation?

A

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

26
Q

Treatments for constipation children?

A

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

27
Q

How long does treatment last?

A

Around 6 months

Jason's MD3 Paeds (28 decks)

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