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