Opsouria is a pathological condition in which copious urine discharge is observed not in the near future after consuming a large amount of fluid, but after 24 or more hours. It is found in heart failure, portal hypertension, hyperglycemia, hypernatremia, and some endocrine diseases. The cause of opsouria is established on the basis of complaints, anamnesis data, results of physical examination and additional diagnostic procedures. As part of the treatment, hormones, beta-blockers, nitrates, vasodilators and other drugs are prescribed. According to the indications, surgical interventions are performed.
Why opsouria occurs
Pathology is associated with a decrease in the pumping function of the myocardium, is a complication of a number of cardiac diseases. Fluid retention in the body and its subsequent delayed excretion through the kidneys are caused by circulatory disorders. Heart failure, accompanied by the development of opsouria, can be observed in the following pathologies:
- Coronary heart disease: severe angina pectoris, myocardial infarction, postinfarction cardiosclerosis.
- Rheumatic heart defects: mitral and aortic insufficiency, mitral and aortic stenosis, tricuspid insufficiency, combined and combined defects.
- Other causes: dilated cardiomyopathy, hypertension, symptomatic hypertension.
Patients with opsouria are also concerned about shortness of breath, swelling, tachycardia, fatigue, intolerance to physical exertion. There are violations on the part of the kidneys, respiratory system and gastrointestinal tract. In the later stages, ascites, hydropericardium, hydrothorax occur.
Polyethological condition with increased pressure in the portal vein system and concomitant disorders of venous blood flow. Opsouria is formed in the late stages of portal hypertension, combined with edema of the lower extremities against the background of violations of protein homeostasis. It can be detected in the following diseases:
- Cirrhosis: alcoholic, primary and secondary biliary.
- Acute and chronic hepatitis: alcoholic, viral (more often – hepatitis B and C), autoimmune, medicinal, specific (for example, against the background of echinococcosis).
- Neoplasia of the liver: hepatocellular carcinoma, cholangiocarcinoma, angiosarcoma, hepatoblastoma, less often – large benign neoplasms.
- Damage to the biliary tract: gallstone disease, ligation or accidental damage to the ducts during surgery.
- Tumors of the pancreas: cancer of the head of the pancreas.
- Vascular pathologies: thrombosis, developmental abnormalities, Budd-Chiari syndrome.
Along with opsouria, dyspepsia, jaundice, splenomegaly, weakness, fatigue are observed. Persistent ascites in combination with edema of the distal parts of the lower extremities are characteristic. Gastric and hemorrhoidal bleeding occurs. A network of dilated subcutaneous veins is revealed on the anterior surface of the abdomen.
Increased osmotic pressure
Opsouria on the background of hyperglycemia, as a rule, develops in patients with diabetes mellitus. Less often, the cause of this condition is hypercorticism in the disease or the Itsenko-Cushing syndrome, acromegaly on the background of somatotropinoma, some other endocrine pathologies, severe diseases of the central nervous system and internal organs, taking medications. The condition is accompanied by dry mouth, muscle weakness.
With hypernatremia, opsouria is provoked by excessive intake or reduced excretion of sodium, lack of fluid, taking medications. The violation may occur due to increased sweating, repeated vomiting, excessive administration of a hypertonic solution, the use of fluids for dialysis with a high sodium content. Etiological factors also include hyperaldosteronism, Conn’s syndrome, kidney and liver diseases, overdose of diuretics and ADH blockers.
Other endocrine pathologies
Opsouria can be observed in hypothyroidism. It is especially pronounced with myxedema. It is combined with swelling of the skin and subcutaneous tissue, a masklike puffy face, lethargy, chilliness, muscle weakness, slowing of movements and cognitive processes. The hydropexic syndrome is formed due to an increase in the level of ADH with disorders of the pituitary gland and hypothalamus, the release of vasopressin by tumors of other localizations. Opsouria against the background of hydropexic syndrome sometimes accompanies the following diseases:
- Hypothalamus lesion: with TBI, hemorrhages, encephalitis, meningitis.
- Hormone-producing neoplasia: bronchogenic cancer, thymoma, lymphosarcoma, pancreatic neoplasms.
- Mental disorders: depression, chronic stress conditions, psychotrauma, psychosis.
- Long-term medication: tranquilizers, neuroleptics.
Due to the polyethologicity of opsouria, the examination is carried out by specialists of different profiles. The primary diagnosis in case of planned treatment is carried out by a general practitioner, in case of emergency conditions – by an emergency medical doctor. Depending on the detected disorders, patients are referred to a cardiologist, gastroenterologist, endocrinologist, etc.
To establish the fact of opsouria, specify the moment of taking a large volume of fluid and the time interval before the appearance of copious urination. During the survey, other manifestations of the disease are detected, and the dynamics of its development are evaluated. In the process of physical examination, edema, jaundice, ascites and other external signs indicating the nature of the pathology are detected. As part of an additional examination, such procedures are prescribed as:
- Electrophysiological methods. In patients with suspected heart failure, an ECG is performed to determine arrhythmias, ischemia and myocardial hypertrophy. Additionally, stress tests (treadmill test, bicycle ergometry) are carried out to study the reserve capabilities of the heart muscle.
- Ultrasonography. Echography helps to assess the pumping function of the heart, to determine the cause of heart failure. With portal hypertension, ultrasound of the abdominal cavity is performed, as well as ultrasound of the liver and biliary tract, dopplerometry of liver vessels. With myxedema, an ultrasound of the thyroid gland is performed.
- Radiation techniques. Patients with heart failure are prescribed chest radiography to detect cardiomegaly and congestion in the lungs. Patients with portal hypertension undergo portography, cavagraphy, celiacography, splenoportography, angiography of mesenteric vessels. If a lesion of the hypothalamus and pituitary gland is suspected, CT or MRI is performed.
- Laboratory tests. With signs of heart failure, ABB, gas and electrolyte composition of blood, cardiospecific enzymes, creatinine, urea are determined. In the presence of portal hypertension, a blood test, a power analysis, blood biochemistry, a coagulogram, tests for serum immunoglobulins and antibodies to hepatitis viruses are prescribed. With hyperglycemia, the indicators of carbohydrate metabolism are examined. In endocrine pathologies, hormone tests are performed.
Depending on the causes of opsouria , the following conservative methods are used:
- Heart disease. A diet with salt and fluid restriction, cardiac glycosides, ACE inhibitors, vasodilators, nitrates, diuretics, beta-blockers, anticoagulants, potassium preparations, ascorbic acid, B vitamins are shown.
- Portal hypertension. Conservative treatment is effective only at the initial stage, it is carried out using nitrates, glycosaminoglycans, ACE inhibitors, beta-blockers. In the future, surgical interventions are necessary.
- Hyperglycemia. Patients are prescribed a special diet, hypoglycemic agents, insulin preparations. Regular physical activity is recommended to reduce glucose levels. In the drug-induced form, the withdrawal of the provoking medication is required.
- Hypernatremia. Therapy is carried out under the control of the amount of injected fluid and the level of electrolytes. Taking into account the cause of the violation, oral or intravenous hydration, loop diuretics, synthetic analogues of antidiuretic hormone are prescribed.
- Myxedema. They advise a diet with a restriction of salt and fats. With iodine deficiency, iodine-rich foods are added to the diet. Thyroid hormone preparations, glucocorticosteroids are used. If necessary, diuretics and antiarrhythmic agents, cardiotonics, nootropics are used.
- Hydropexic syndrome. Compliance with a low-calorie salt-free diet with a reduction in the amount of liquid, fat and carbohydrates is required. Drug therapy includes potassium-sparing diuretics, ADH antagonists, magnesium and potassium preparations. With neoplasms, chemotherapy and radiation therapy are performed.
Taking into account the cause of opsouria, the following operations are performed:
- Cardiac pathologies: balloon valvuloplasty, closed or open commissurotomy for mitral stenosis; shortening chord plasty, annuloplasty, prosthetics or valve plasty for mitral insufficiency; endovascular balloon dilation, valvuloplasty or prosthetics of the aortic valve for aortic defects.
- Portal hypertension: selective splenorenal, mesentericocaval or portocaval bypass surgery, splenectomy, reduction of splenic blood flow; sclerosing or ligation for bleeding from the veins of the stomach and esophagus; laparocentesis or drainage of the abdominal cavity as part of palliative care.
- Hyperglycemia: gastric banding or gastric bypass surgery in the presence of morbid obesity; bilateral removal of the adrenal glands in Cushing’s syndrome; transnasal adenomectomy for pituitary tumors.
- Hydropexic syndrome: pancreatoduodenal resection, choledochal stenting, endoscopic stricture augmentation, external drainage of the bile ducts for pancreatic neoplasia; thymectomy or thymomymectomy for thymomas; lobectomy, bilobectomy, pneumonectomy for bronchial cancer.