4.

perform complete physical examination in a patient

with dysuria.

Abdominal exam
Inspection
Surgical scars
Distension (enlarged kidney, obstructive
uropathy, bladder distension)
Dilated veins, bruising
Asymmetry
Umbilicus( flat, everted )

Palpation
Area of tenderness ( 4 quadrants)
Renal balloting (if palpable- assess size,
surface, consistency) (Enlargement- renal
tumour, hydronephrosis )
Renal punch/ Costovertebral angle(CVA)
tenderness
Test for ascites( may be found in nephrotic
syndrome or patients having peritoneal
dialysis)
Percussion
Percuss for bladder(upper abdomen in
midline and down towards pubic symphysis)

Auscultation
Bruits from renal
arteries
Bowel sounds

CVS Examination
BP measurement (often
elevated in renal disease)
Assess JVP( raised in
pericardial tamponade due
to uraemic pericarditis)
Oedema
( hypoalbuminaemia)
Apex beat- may be displace
in fluid overload and heart
failure.Heaving in patients
with lf ventricular
hypertrophy or secondary to
HPT.
Added heart sound( in fluid
overload , heart failure)
Pericardial friction rub ( in
uremic pericarditis)

Respiratory examination
RR- assess for kussmaul
breathing (deep and
sighing) (Increased rate)
Percuss to detect pleural
effusion
Auscultate for bilateral basal
lung crackles indicating
fluid overload or heart
failure
NS Examination
Level of
consciousness( altered or
coma is a feature of
advanced CKD)
Examine optic fundi( signs
of HPT and DM- retinopathy)