NOCTURIA
The differential diagnosis of nocturia is similar to that of polyuria.
A pathophysiologic analysis of the symptoms would indicate that the patient
is producing excessive urine at night, there is an obstruction to the output
of urine so that the bladder cannot be emptied fully on one voiding, or
there is an irritative focus in the urinary tract stimulating the patient to
urinate more frequently.
-
Excessive urine production at night. This category includes all
the causes of polyuria: diabetes insipidus, diabetes mellitus,
hyperthyroidism, diuretic drugs, nephrogenic diabetes insipidus, and chronic
nephritis. In addition, the one condition that produces excessive urine
output almost exclusively at night—congestive heart failure—must be
considered. In heart failure, edema accumulates in the extremities during
the day while the patient is in the upright position and is returned to the
circulation and poured out through the kidneys at night while the patient is
in the recumbent position.
- Obstructive uropathy. Bladder neck obstruction by a calculus,
enlarged or inflamed prostate, median bar hypertrophy, or urethral stricture
is a condition to consider here. Neurogenic bladder from poliomyelitis,
multiple sclerosis, and other spinal cord diseases must also be considered.
- Irritative focus in the urinary tract. Nocturia may result from
inflammation of the bladder, prostate, urethra, and kidney on this basis.
Occasionally a bladder tumor or prostate carcinoma may be the irritative
focus. Inflammation of the vagina, fallopian tubes, and rectum are also
occasionally responsible.
Approach to the Diagnosis
The workup of nocturia is essentially the same as the workup of
polyuria and urinary frequency . Obviously, the search for obstruction and infection are most
important. Venous pressure, circulation time, and pulmonary function studies to rule out congestive heart failure
should be done if the urinary tract is clean.
Pictures
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins MD, FACP
- Year of Publication: 2007
- Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2007 Lippincott Williams & Wilkins.
Other Book Chapters Related to Enuresis
Read excerpts from these other book chapters related to Enuresis:
Medical Books Excerpts
- NOCTURIA
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- ENURESIS
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
- [ read ]
- Enuresis
- "In A Page: Pediatric Signs and Symptoms" (2007)
- [ read ]
- NOCTURIA
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
- Nocturia
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Enuresis
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
- [ read ]
- Nocturia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Enuresis
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Nocturia
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Nocturia
- "Signs & Symptoms: A 2-in-1 Reference for Nurses" (2007)
- [ read ]
- Nocturia
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
- Enuresis
- "Nursing: Interpreting Signs and Symptoms" (2007)
- [ read ]
- NOCTURIA
- "Differential Diagnosis in Primary Care" (2007)
- [ read ]
Copyright Details: Differential Diagnosis in Primary Care, Copyright © 2008 Williams & Wilkins.
More About Causes of Enuresis
» Next page: ENURESIS (BEDWETTING) (Differential Diagnosis in Primary Care)
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