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Child with disorder of elimination

Clinical Discipline(s)/Organ System(s)
Paediatrics, General Practice, Psychiatry/Health Psychology
Progress Test Topic(s)
Child health
Description
A 7 year old NZ European boy is brought to see you as he wets his bed most nights and has some problems with constipation. His father says that he also wet his bed to age 6 years and there are no other medical concerns.
Applied Science for Medicine 
   - Embryology, structure, function and pathologies of gut and genitourinary system
   - Physiology of renal disease
   - Microbiology of urinary tract infection
   - Normal child development and skill acquisition
   - Pharmacology of desmopressin
Clinical and Communication Skills 
   - Knowledge of normal ages of acquisition of bowel and bladder control
   - Establish whether nocturnal enuresis or diurnal enuresis; establish if primary or secondary enuresis
   - Elicit important symptoms and signs: dysuria, weight loss, polydipsia, hairy patch over sacrum, neurological abnormalities of lower limb, abnormality of anal tone, signs of hypothyroidism
   - Elicit family history (primary nocturnal enuresis, renal disease)
   - Examination of the abdomen and genitals; blood pressure measurement
   - Assessment of growth, diet, fluid intake and developmental milestones
   - Interpretation of relevant laboratory data (blood glucose, urine microscopy, blood parameters for chronic disease, thyroid function)
   - Need for and interpretation of radiology (plain abdominal films, indications for ultrasound, cystourethrogram)
   - Common age-appropriate treatment methods of primary nocturnal enuresis; understand impact of constipation on the genitourinary system, behavioural interventions
   - Management of constipation: dietary, fluids, medications, behavioural (toileting programme, star chart, diary)
Personal and Professional Skills 
   - Communicate empathetically with child and caregivers
   - Evaluation of social and school history (any emotional or family/whānau stressors)
   - Beneficence and non-maleficence
   - Awareness of child’s age appropriate natural embarrassment of examination
   - Awareness of impact on family functioning and associated stress
Hauora Māori 
   - Awareness of whānau dynamics (who is/are carers) and where the child stays during the school week
   - Ability to cater for differential health literacy needs of Māori patients and whānau
   - Access to cultural/spiritual support for patient and whānau
Population Health 
   - Incidence of renal anomaly, urinary infections in children by age group, male/female differences
   - Incidence and age normals of nocturnal enuresis in the population
Conditions to be considered relating to this scenario
Common
primary nocturnal enuresis, delayed maturation, constipation
Less common but 'important not to miss'
diabetes mellitus, recurrent urinary tract infection, Hirschsprung disease
Uncommon
congenital anomaly (ectopic ureter), sexual abuse/emotional trauma, neurogenic bladder