Urinary system

History and physical exam

Dr.Abdulkadir woliyi,MD
May,2011
 Kidneys and urinary tract
Symptoms of renal and urological disease
 Pain

 Hematuria

 Oliguria/anuria

 Polyuria

 Frequency

 Nocturia

 Dysuria
 Cont…
 Urgency , Incontinence & enuresis
 Slow stream , hesitancy , terminal dribbling
 Urethral discharge
 1.Renal and Urinary pain
 Renal pain _ felt in the flank or the loin, dull
aching,steady,eg.pyelonephritis
 Ureteric colic :severe colicky pain originating at CVA
radiating to lower abdominal quadrant , thigh , testis ,
or labium eg . sudden obstruction of ureter by stones
or blood clots
pt prefers to pace about or thrash around
 Suprapubic pain arises from bladder ,cystitis,urethritis
 Vesical pain
 Prostatic & seminal pain
 Urethral pain
 2.Hematuria
 Presence of blood in the urine
 Microscopic or gross hematuria
 Initial , through out urinary stream or terminal
hematuria
 Hematuria arising from parenchymal renal ds
is continuous , painless , often microscopic
 Those from renal tumor is intermittent ,painful
, macroscopic
 Menses vs hematuria , medication
3.Frequency
Due to incomplete bladder emptying as
prostatism, irritability of bladder by
inflammation ,UTI (cystitis),stone..
 Cont…
 4. OLIGURIA
passage of < 500 ml of urine per day
physiological in pts with low in take,normal GFR
Pathological (pre renal ,renal ,post renal)
Anuria- incomplete absence of urine flow
 5.POLYURIA

High urinary flow rate >3 liter per day

Pyschologic polydypsia ,osmotic duiresis,CRF…

□ 6.NOCTURIA

Urinary frequency at night > 1

diurnal varation , polyuria of any causes
 Cont…
7.DYSURIA
 Pain before, during and after micturation

 Burning , assd with freq,

 Infection , neoplasm

8.URGENCY,INCONTINENCE,ENURESIS
 Urgency_ desire to pass urine beyond the time

initially perceived
 Incontinence - involantary passage of urine

 Socialy embarassing , cause problem with

hygeine, urge I,sress I, overfow I ,functional I

 Cont…
9.Slow stream , hesitancy , terminal dribbling
 Seen in elderly men with BPH

 Slow stream , reduced urine flow rate

 Hesitancy , difficulty of initiatin of micturation

 Terminal dribbling , in completing micturation

10.URETHRAL DISCHARGE
 Usually noticed by men

 Urethritis , STI
 General questions for urinary history
 Do you have any difficulty of passing urine?
 How often do you go?
 Do you get up at night?
 How much urine do you pass at a time?
 Is there any pain or burning ?
 Do u ever have trouble getting to toilet in time?
 Do you ever leak any urine? While coughing ,
sneezing , laughing?
 Is there dribbling when u re through ? what is
the color of your urine?
 Physical examination
Kidneys
 Are not usually palpable

 To palpate lt kidney move to pts lt side,

Rt hand behind pts abdomen

Lift the lt kidney anteriorly
Place lt hand in LUQ
Ask pt to take deep breath
Try to capture the kidney b/n two hands d’
deep inspiration
 Cont…
 Describe size , contour,tenderness by CVAT
 for rt kidney proceed as before
 Try to differenciate from enlarged spleen ,

liver
The bladder
 Not palpable unless distended above

symphysis pubis , smooth,round

 Tenderness
How to palpate kidney
CVAT
Galatooma !