Flashcards in Wetting And Soiling Deck (27)
When is enuresis abnormal?
Beyond age 5
Boys or girls get more enuresis?
When do you start Rx for enuresis?
Usually around age 7
Subgroups of enuresis?
Mono symptomatic: No daytime, only nighttime
Never having been dry continuous for 6/12
What is secondary NE?
Relapsed after a period of at least 6 months of dryness
3 physiological of enuresis?
High nocturnal production
Small nocturnal capacity
Poor arousal from sleep?
Non-ADH causes of nocturnal polyuria?
Common: high nocturnal diet (western countries)
The interview of Nocturnal Enuresis
Reassurance that it's NOT their fault.
MAnagement of Nocturnal Enuresis?
How long to use bed alarm for?
Second line Rx of nocturnal enuresis?
Is reduced bladder capacity: Anticholinergics
Synthetic ADH - sublingual, one hour before bed.
Short-term stop gap
No drinking until following morning!
What doesn't really work for nocturnal enuresis?
Imipramine (only Rx resistant)
Waking/lifting the child
When is day wetting abnormal?
If after age 4
How to bring up day wetting?
May not volunteered
Investigations for wetting?
Renal bladder ultrasound
What is dysfunctional voiding? How to ask?
Incoordination between detrusor and sphincteric
Ask about FLOW of urine.
Rx for overactive bladder?
Side effects of anticholinergics
Blurred vision, bloody nose
What causes soiling?
Usu. constipation: inadequate evacuation
Rare causes of soiling
Constipation red flags?
Before 1 month
Delayed me odium
Abnormal Neuro LL
Abnormal anus, buttocks/sacrum
Def'n of fecal incontinence?
Repeated defecation into clothes in a child >4y
Examination and investigation?
PR not really
AXR not recommended
Treatments for constipation children?
Simultaneously: senna, bisacodyl
Stool softener: coloxel, paraffin
Osmotic laxatives: not really for maintenance, macrogol