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516501
Enuresis
Description
Paediatrics (kidneys ) Mind Map on Enuresis, created by v.djabatey on 01/30/2014.
No tags specified
kidneys
paediatrics
paediatrics
kidneys
Mind Map by
v.djabatey
, updated more than 1 year ago
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Created by
v.djabatey
almost 11 years ago
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Resource summary
Enuresis
primary nocturnal enuresis
daytime enuresis
=lack of bladder control during day in a child old enough to be continent (3-5 years)
nocturnal enuresis also present
causes
lack of attention to bladder sensation
manifestation of psychogenic or developmental prob
may be in normal kids too busy to respond to sensation of full bladder
detrusor instability
=sudden urgent urge to void induced by sudden bladder contractions
neuropathic bladder
bladder enlarged & fails to empty properly, irreg thick wall
assoc w/ spina bifida
UTI
rarely in absence of other sx
constipation
ectopic ureter
causes constant dribbling, child always damp
girls dry @ night but wet on getting up
ectopic ureter opening into vagina
O/E
neuropathic bladder
distended bladder
abnormal perineal sensation
abnormal anal tone
abnormal leg reflexes
abnormal gait
sensory loss in S2, S3 &S4 dermatomes
spinal lesion
Ix
urine sample
microscopy
culture
sensitivity
if indicated
ultrasound
bladder pathology
w/ incomplete bladder emptying
w/ thickening of bladder wall
urodynamic studies
X ray of spine
vertebral anomaly
MRI
confirm or exclude non-spinal bony defect
e.g. tethering of cord
Mx
if neuro cause excluded
star charts
bladder training
pelvic floor exercises
treat constipation
portable alarm w/ pad in pants
for lack of attention to bladder sensation
anticholinergics
to damp bladder contractions
e.g. oxybutynin
if other measures fail
secondary (onset) enuresis
loss of previously achieved urinary continence
causes
emotional upset
commonest cause
UTI
polyuria
from osmotic diuresis in diabetes mellitus
from renal concentrating disorder e.g. sickle cell disease or chronic renal failure
Ix
urine sample: look for
infection
glycosuria
proteinuria
assessment of renal concentrating ability
measure osmolality of early morning urine sample
formal water deprivation test
to exclude urinary concentrating defect
rarely needed
ultrasound of renal tract
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