...
Is there fever? A significant fever would suggest either pyelonephritis, particularly in females, or acute prostatitis in males.
Is the urine grossly bloody or ... DIAGNOSTIC WORKUP
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Is the bed-wetting frequent or only occasional? Frequent bed-wetting should signify pathology in the urogenital tract or endocrine system. If the bed-wetting ... DIAGNOSTIC WORKUP
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Is there daytime frequency of urination also? If there is daytime frequency, the differential diagnosis of polyuria should be considered.
Is there associated pain or difficulty ... DIAGNOSTIC WORKUP
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Is it transient? Migraine, asthma, and drugs such as diuretics may produce transient polyuria.
Is it massive? Massive polyuria is usually due to pituitary ... DIAGNOSTIC WORKUP
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Are there significant numbers of white blood cells (WBCs) in the urine? This would suggest a UTI. If there are white cell casts or clumps, the infection may be a pyelonephritis. A urine ... DIAGNOSTIC WORKUP
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Are there significant RBCs in the urine? If so, one should consider glomerulonephritis, collagen disease, tuberculosis, neoplasm, trauma, renal calculus, and ... DIAGNOSTIC WORKUP
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Is there pain on urination? The presence of pain on urination should suggest cystitis, urethritis, urethral caruncle, vesicular calculus, urethral stricture, and acute ... DIAGNOSTIC WORKUP
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Is the 24-hr urine volume increased? If the 24-hr urine volume is increased, then one has identified polyuria. The differential diagnosis of this ... DIAGNOSTIC WORKUP
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Is the volume of urine large or small? If the volume of urine released is small, stress incontinence and vesicovaginal fistula should be considered. If the amounts released are large, one should consider ... DIAGNOSTIC WORKUP
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... Red urine may be due to hematuria,
hemoglobinuria (hemolytic anemia), myoglobinuria (muscle trauma, myocardial infarction), and coproporphyria or uroporphyria (porphyria).
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Has the patient been on any drugs? Sulfonamides are notorious for causing renal failure, but one must also consider amphotericin B, gold compounds that might be administered in ... DIAGNOSTIC WORKUP
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Dysuria is a painful or burning sensation during or immediately after urination. This is a common symptom in primary care; nearly 20% of women aged 20–55 will have one episode of dysuria per year. Women have episodes of acute dysuria... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Polyuria is defined as urine output greater than 3 L per day. The output of a large volume of dilute urine leads to extracellular dehydration, which stimulates the thirst centers to influence the... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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A perceived or observed decrease in the strength or flow of one's urine stream is a common complaint. This is often of concern to the patient because of the concern about both a... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Dysuria is defined as pain with urination and is a very common complaint in female children. It is commonly due to either urinary tract infection or perineal irritation from a variety of causes.
... Workup and Diagnosis ... Treatment
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Enuresis is defined as urinary incontinence. The age of achieving daytime or night-time continence can vary considerably. Nocturnal enuresis (night-time bedwetting) can be normal in children up to age 8. Daytime... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Proteinuria in children is defined as a quantitative 24-hour urine collection with >4 mg/m2/hour (>100 mg/m2/day) of protein. Semiquantitative definitions include urine dipstick ≥1+ (30 mg/dL) for specific... Differential Diagnosis ... Workup and Diagnosis ... Treatment
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Pyuria is defined as the presence of white blood cells in the urine. This condition is commonly caused by urinary tract infection, asymptomatic bacteriuria, or vaginal contamination of the urine specimen.
... Workup and Diagnosis ... Treatment
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... Dysuria is difficult or painful micturition. One could cover most of the causes simply by considering the inflammatory lesions of the genitourinary tract in ascending order. Thus, there may be a urethritis or urethral
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... Incontinence may be due to loss of voluntary control of urination, in which case neurologic disorders are usually the cause, or it may result from overflow of a distended bladder (overflow
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... 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,
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... Polyuria is an absolute increase in the urine output in a 24-hour period. The average individual excretes 1,500 mL of urine a day. Many physiologic conditions increase the output of urine (stress, exercise,
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... There are many causes of proteinuria. The mnemonic VINDICATE is a helpful way of developing a list of possibilities.
PROTEINURIA
V
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... Pyuria is included here although it is not a symptom or a definitive finding on physical examination. Examination of the urine, however, is so frequently a part of every physical examination that the causes of pyuria should be available for
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... Frequency of urination may be due to polyuria (increased output of urine), obstruction to the output of urine (requiring frequent voiding to get the urine out) because the net capacity of the bladder is reduced, or
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... Apart from hematuria, red urine may signify hemoglobinuria or myoglobinuria, suggesting the various hemolytic anemias, the march hemoglobinuria, paroxysmal “cold” hemoglobinuria and
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ANURIA AND OLIGURIA
ANURIA AND OLIGURIA
Diminished output of
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... By following the innervation of the bladder from its termination to the spinal cord, brain, and “supratentorium,” one can develop an extensive list of possibilities for this mischievous condition. Thus, anatomy is the
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... Bladder distention — abnormal enlargement of the bladder — results from an inability to excrete urine, which results in its accumulation. Distention can be caused by a mechanical or anatomic obstruction,... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pictures
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... Enuresis usually refers to nighttime urinary incontinence in girls age 5 and older and boys age 6 and older. This sign rarely continues into adulthood, but may occur in some... History and physical examination ... Medical causes ... Special considerations
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... Nocturia — excessive urination at night — may result from disruption of the normal diurnal pattern of urine concentration or from overstimulation of the nerves and muscles that control urination. Normally,... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers
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... A cardinal sign of renal and urinary tract disorders, oliguria is clinically defined as urine output of less than 400 ml/24 hours. Typically, this sign occurs abruptly and may herald serious — possibly life... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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... A relatively common sign, polyuria is the daily production and excretion of more than 3 L of urine. It’s usually reported by the patient as increased urination, especially when it occurs at night... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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... Urinary frequency refers to increased incidence of the urge to void without an increase in the total volume of urine produced. Usually resulting from decreased bladder capacity, frequency is a cardinal... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers
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... Hesitancy — difficulty starting a urine stream generally followed by a decrease in the force of the stream — can result from a urinary tract infection, a partial... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers
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... Incontinence, the uncontrollable passage of urine, can result from a bladder abnormality, a neurologic disorder, or an alteration in pelvic muscle strength. A common urologic sign,... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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... A sudden compelling urge to urinate, accompanied by bladder pain, is a classic symptom of urinary tract infection (UTI). As inflammation decreases bladder capacity, discomfort results from the accumulation of even small amounts... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers
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... Cloudy, murky, or turbid urine reflects the presence of bacteria, mucus, leukocytes or erythrocytes, epithelial cells, fat, or phosphates (in alkaline urine). It’s... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers
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... Central diabetes insipidus
Renal disease
Nephrogenic diabetes insipidus, congenital
Chronic renal
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... Benign/Physiologic
Fever
Exercise
Orthostatic
Contrast dye
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... Urethral
Congenital urethral stenosis, web, atresia
Posterior urethral valves
Inflammation or stricture
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... Cystitis and urethritis, the two forms of lower urinary tract infection (UTI), are nearly 10 times more common in females than in males and affect approximately 10% to 20% of all females at least once. Lower UTI is also a prevalent... Causes and incidence ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations
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... Bladder distention—abnormal enlargement of the bladder—results from an inability to excrete urine, which then accumulates in the bladder. Distention can be caused by a mechanical or anatomic obstruction... Emergency interventions ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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Dysuria
(Professional Guide to Signs & Symptoms (Fifth Edition))
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... Dysuria—painful or difficult urination—is commonly accompanied by urinary frequency, urgency, or hesitancy. This symptom usually reflects lower urinary tract infection (UTI)—a common disorder, especially in women. ... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Geriatric pointers ... Pictures
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Enuresis
(Professional Guide to Signs & Symptoms (Fifth Edition))
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... Enuresis usually refers to nighttime urinary incontinence in girls age 5 and older and boys age 6 and older. This sign rarely continues into adulthood but may occur in some adults with sleep apnea.... History and physical examination ... Medical causes ... Special considerations ... Pictures
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Nocturia
(Professional Guide to Signs & Symptoms (Fifth Edition))
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... Nocturia—excessive urination at night—may result from disruption of the normal diurnal pattern of urine concentration or from overstimulation of the nerves and muscles... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling
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Oliguria
(Professional Guide to Signs & Symptoms (Fifth Edition))
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... A cardinal sign of renal and urinary tract disorders, oliguria is clinically defined as urine output of less than 400 ml/24 hours. Typically, this sign occurs abruptly and may herald serious&mdash... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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Polyuria
(Professional Guide to Signs & Symptoms (Fifth Edition))
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... A relatively common sign, polyuria is the daily production and excretion of more than 3 L of urine. It’s usually reported by the patient as increased urination, especially when it occurs... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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... Urinary frequency refers to an increased urge to void without an increase in the total volume of urine produced. Usually resulting from decreased bladder capacity, urinary frequency is a... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling
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... Urinary hesitancy—difficulty starting a urine stream generally followed by a decrease in the force of the stream—can result from a urinary tract infection (UTI), a partial lower urinary tract obstruction... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers
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... Incontinence, the uncontrollable passage of urine, can result from a bladder abnormality, a neurologic disorder, or an alteration in pelvic muscle strength. A common urologic sign, incontinence may be transient or permanent and may... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Pictures
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... A sudden compelling urge to urinate accompanied by bladder pain is a classic symptom of urinary tract infection (UTI). As inflammation decreases bladder capacity, discomfort results from the... History and physical examination ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling
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... Cloudy, murky, or turbid urine reflects the presence of bacteria, mucus, leukocytes or erythrocytes, epithelial cells, fat, or phosphates (in alkaline urine). It’s... History and physical examination ... Medical causes ... Special considerations ... Pediatric pointers
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Dysuria
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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... David M. Quillen
Approach Dysuria is defined as “painful urination.” Acute dysuria is a frequent problem seen in ambulatory practices, accounting for more than three million office visits a year.... History ... Physical examination ... Testing ... Diagnostic assessment
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Nocturia
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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... Anna M. Wright and Vincent H. Ober
Approach Nocturia, defined as awakening from sleep to urinate, is a frequent symptom in patients of all ages and it is... History ... Physical examination ... Testing ... Diagnostic assessment
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Proteinuria
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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... Irene M. Hamrick
The prevalence of proteinuria in the general population is 3%, and 5% in healthy adolescents (1). Heavy and persistent proteinuria is associated with the development of end-stage
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Urinary Incontinence
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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... Richard Rathe
Urinary incontinence (UI) in adults is one of the most prevalent and underdiagnosed afflictions in the United States (>25 million effected individuals, >50% of nursing home residents).... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment ... Pictures
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Oliguria and Anuria
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
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... Marcia W. Funderburk
Oliguria and anuria are important clinical signs that should be recognized quickly so that the cause can be identified and treatment... Approach ... History ... Physical examination ... Testing ... Diagnostic assessment
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... Differential Overview
❑ Lower urinary tract infection
❑ Acute pyelonephritis
❑... Diagnostic Approach ... Clinical Findings ... Pictures
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... Differential Overview
❑ Urinary tract infection
❑ Diabetes mellitus
❑ Diuretic therapy
❑... Diagnostic Approach ... Clinical Findings
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... Differential Overview
❑ Diabetes
❑ Drugs/toxins
❑ Acute tubular necrosis ... Diagnostic Approach ... Clinical Findings
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... Differential Overview
❑ Cystitis
❑ Benign prostatic hypertrophy
❑ Pelvic floor relaxation
❑ Drugs ... Diagnostic Approach ... Clinical Findings
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... Differential Overview
❑ Acute tubular necrosis
❑ Prerenal azotemia
❑ Tubular toxins ... Diagnostic Approach ... Clinical Findings
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... Cystitis and urethritis, the two forms of lower urinary tract infection (UTI), are nearly 10 times more common in women than in men and affect approximately 10% to 20% of all women at least once. Lower UTI is also a... Causes ... Signs and symptoms ... Diagnosis ... Treatment ... Special considerations ... Pictures
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Bladder distention
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)
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... Bladder distention is an abnormal enlargement of the bladder due to the accumulation of urine arising from an inability to excrete urine. Distention can be caused by a mechanical... Assessment ... History ... Physical examination ... Pediatric pointers ... Geriatric pointers ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Bladder distention — abnormal enlargement of the bladder — results from an inability to excrete urine, which results in its accumulation. Distention can be caused by a mechanical or anatomic obstruction,... Emergency Actions ... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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Dysuria
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
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... Dysuria (painful or difficult urination) is commonly accompanied by urinary frequency, urgency, or hesitancy. This symptom usually reflects lower urinary tract infection (UTI) —... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Geriatric pointers ... Patient counseling ... Pictures
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... Nocturia — excessive urination at night — may result from disruption of the normal diurnal pattern of urine concentration or from overstimulation of the nerves and muscles that... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... A cardinal sign of renal and urinary tract disorders, oliguria is clinically defined as urine output of less than 400 ml/24 hours. Typically, this sign occurs abruptly and may herald serious — possibly life... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... A relatively common sign, polyuria is the daily production and excretion of more than 3 L of urine. It’s usually reported by the patient as increased urination, especially when it occurs at night. Polyuria is aggravated by... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Urinary frequency refers to increased incidence of the urge to void without an increase in the total volume of urine produced. Usually resulting from decreased bladder capacity, urinary frequency is a cardinal sign of urinary tract... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... Urinary hesitancy — difficulty starting a urine stream generally followed by a decrease in the force of the stream — can result from a urinary tract infection (UTI), a... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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... Incontinence, the uncontrollable passage of urine, can result from a bladder abnormality, a neurologic disorder, or an alteration in pelvic muscle strength. A common urologic sign, incontinence may be transient or permanent and... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Geriatric pointers ... Patient counseling ... Pictures
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... A sudden compelling urge to urinate, accompanied by bladder pain, is a classic symptom of urinary tract infection (UTI). As inflammation decreases bladder capacity, discomfort results from the accumulation... History ... Physical assessment ... Medical causes ... Other causes ... Special considerations ... Pediatric pointers ... Patient counseling ... Pictures
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Dysuria
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
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...Dysuria (pain on urination) is usually producedby inflammation of urethra or bladder or both. Principal Causes of Dysuria Urinarytract infection Urethritis Cystitis ... Clinical Features and Diagnosis ... Diagnostic Approach ... Table 15.1. Criteria for Diagnosis of Urinary Tract Infections ... References
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Proteinuria
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
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... Proteinuriais a common finding in childhood and adolescence. Usual pathogenesis involves increasein permeability of glomerular basement membrane. Less common isdecreased absorption or increased... Principal Causes of Proteinuria ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... Urinaryincontinence or enuresis refers to the involuntary passage of urine. Most children have achieved urine continenceduring the day by 4 yrs of age, and during the night by 6 yrs ofage. ... Principal Causes of Urinary Incontinence ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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...Polyuria (excessive urine volume) is usuallyassociated with polydipsia (excessive thirst). Principal Causes of Polyuria and Polydipsia Diabetesmellitus Diabetes insipidus Antidiuretichormone ... Clinical Features and Diagnosis ... Diagnostic Approach ... References
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... Bladder distention—abnormal enlargement of the bladder—results from an inability to excrete urine, which results in its accumulation. Distention can be caused by a mechanical or... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
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... Dysuria—painful or difficult urination—is commonly accompanied by urinary frequency, urgency, or hesitancy. This symptom usually reflects lower urinary tract infection (UTI)—a common disorder, especially in women. ... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
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... Enuresis usually refers to nighttime urinary incontinence in girls age 5 and older and boys age 6 and older. This sign rarely continues into adulthood, but may occur in some adults with sleep apnea. It's... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching
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... Nocturia—excessive urination at night—may result from disruption of the normal diurnal pattern of urine concentration or from overstimulation of the nerves and muscles that... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
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... A cardinal sign of renal and urinary tract disorders, oliguria is clinically defined as urine output of less than 400 ml/24 hours. Typically, this sign occurs abruptly and may herald serious—possibly life... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... A relatively common sign, polyuria is the daily production and excretion of more than 3 L of urine. It's usually reported by the patient as increased urination, especially when it occurs at night. Polyuria is aggravated by overhydration,... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
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... Urinary frequency refers to increased incidence of the urge to void without an increase in the total volume of urine produced. Usually resulting from decreased bladder capacity, frequency is a cardinal sign of... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
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... Hesitancy—difficulty starting a urine stream generally followed by a decrease in the force of the stream—can result from a urinary tract infection (UTI), a partial lower urinary tract... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching
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... Urinary incontinence, the uncontrollable passage of urine, can result from a bladder abnormality, a neurologic disorder, or an alteration in pelvic muscle strength. A common urologic sign, incontinence may be transient... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... A sudden compelling urge to urinate (urinary urgency), accompanied by bladder pain, is a classic symptom of a urinary tract infection (UTI). As inflammation decreases bladder capacity, discomfort... History and physical examination ... Medical causes ... Other causes ... Nursing considerations ... Patient teaching ... Pictures
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... Cloudy, murky, or turbid urine reflects the presence of bacteria, mucus, leukocytes or erythrocytes, epithelial cells, fat, or phosphates (in alkaline urine). It's... History and physical examination ... Medical causes ... Nursing considerations ... Patient teaching
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...
Dysuria is difficult or painful micturition. One could cover most of
the causes simply by considering the inflammatory lesions of the
genitourinary... Pictures
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...
Incontinence may be due to loss of voluntary control of urination, in
which case neurologic disorders are usually the cause, or it may result from
overflow of a distended
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...
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... Pictures
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...
Polyuria is an absolute increase in the urine output in a 24-hour
period. The average individual excretes 1,500 mL of urine a day. Many
physiologic conditions increase the output of urine (stress, exercise,... Pictures
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...
There are many causes of proteinuria. The mnemonic VINDICATE is a
helpful way of developing a list of possibilities.
V—Vascular category should call to mind... Pictures
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...
Pyuria is included here although it is not a symptom or a definitive
finding on physical examination. Examination of the urine, however, is so
frequently a part of every... Pictures
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...
Frequency of urination may be due to polyuria (increased output of
urine), obstruction to the output of urine (requiring frequent voiding to
get the urine out) because the... Pictures
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...
Apart from hematuria, red urine may signify hemoglobinuria or
myoglobinuria, suggesting the various hemolytic anemias, the march
hemoglobinuria,... Pictures
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...
Diminished output of urine (oliguria with less than 500 mL of output in
24 hours) and no output of urine (anuria) are best understood using
pathophysiology. The causes may be... Pictures
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...
By following the innervation of the bladder from its termination to the
spinal cord, brain, and “supratentorium,” one can develop an extensive
list of possibilities for this... Pictures
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