NOCTURIA
The differential diagnosis of nocturia is similar to that of polyuria. A pathophysiologic analysis of the symptom 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 kidney 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.
NOCTURIA
Approach to the Diagnosis
The workup of nocturia is essentially the same as the workup of polyuria and urinary frequency (see page 429). Obviously, the search for obstruction and infection are most important. A venous pressure and circulation time and pulmonary function studies to rule out congestive heart failure should be done if the urinary tract is clean.
Book Source Details
- Book Title: Differential Diagnosis in Primary Care
- Author(s): R. Douglas Collins
- 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)
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- ENURESIS
- "Algorithmic Diagnosis of Symptoms and Signs" (2003)
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- Enuresis
- "In A Page: Pediatric Signs and Symptoms" (2007)
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- NOCTURIA
- "Differential Diagnosis in Primary Care" (2007)
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- Nocturia
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
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- Enuresis
- "Handbook of Signs & Symptoms (Third Edition)" (2006)
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- Nocturia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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- Enuresis
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
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- Nocturia
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
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- 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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