Professional Documents
Culture Documents
Clinical Examination of The Patient With Renal Disease: Dr. A.D. Zugravu
Clinical Examination of The Patient With Renal Disease: Dr. A.D. Zugravu
SYMPTOMATIC PATIENTS
Disorders of micturition Disorders of urine volume Alterations of urine composition Pain Edema Impairment of renal function
12.06.2006
Clinical examination
Not only the urinary tract, but a full clinical exam! Vital signs!!!
BP (supine/standing), both hands HR/pulse (supine/standing) RR (respiratory rate), respiratory pattern (Kssmaul = acidotic) temperature
12.06.2006
Fluid status!!!
BP (supine/standing) HR (supine/standing) skin turgor eyeball turgor pitting enlarged jugular veins painful hepatomegaly
Inspection
12.06.2006
12.06.2006
Palpation
12.06.2006
Edema
Classification - location
Generalized:
renal cardiac hepatic
Stages
Pre-edema
daily weighing
Subcutaneous (4-5 L)
dependent pitting
Localised:
allergic inflammatory post traumatic
Serosal (5-7 L)
hydro-thorax, pericard, ascites
Pitting edema
Renal (nephrotic) edema usually white, puffy, recently appeared, easily pitting
12.06.2006
10
Glnard
12.06.2006
11
12.06.2006
12
Giordano maneuver
Elicits pain originating from a distended pyelon Warn the patient, then suddenly hit the lombar region; better executed starting from the midthorax, going downward towards the buttocks (to exclude the it hurts everywhere syndrome)
12.06.2006
13
Uretheral points
12.06.2006
14
15
16
Normal
Phymosis
Paraphymosis
Hydrocele
Hydrocele, transillumination
12.06.2006
17
Prostate examination
Prostate -usually 3x3 - 4x4 cm, chestnut-shaped, distinct median groove Abnormalities: enlarged; no median groove; hard nodule; painful area. Seminal vesicles palpable usually when chronically inflammation (non-specific/ tuberculosis)
12.06.2006
18
Vaginal examination
Check for uterine prolapse! Check for neoplasia! Urethral meatus:
polyps ( hematuria, frequency) strictures calculus
19
Percussion
12.06.2006
20
Distended bladder dullness, upper convexity Ascites shifting dullness, upper concavity (fluid wave,) Enlarged cardiac dullness pericarditis, CHF Grossly enlarged kidneys (ADPKD)
12.06.2006
21
Auscultation
12.06.2006
22
Arterial bruits:
abdominal aorta ( palpable aneurysm) femoral arteries (groins) renal arteries (anterior - periumbilically, bilaterally; posterior under the rib cage, in the loin, laterally in the flank) carotids + palpation of peripheral pulses bowel sounds
23
Abdominal auscultation
12.06.2006
24
25
Thank you
Prof. Tiberiu Nanea, MD, PhD, Caritas Clinical Hospital (my semiology attending) Assist. Prof. Simona Stancu, MD, PhD (my attending in Nephrology, mentor) Prof. Gabriel Mircescu (our boss, mentor, line drawings) Charlie Goldberg, UCSD ( photographs) and many more
12.06.2006
26