Hydronephrosis physical examination: Difference between revisions

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__NOTOC__
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{{Hydronephrosis}}
{{Hydronephrosis}}
{{CMG}}; {{AE}} {{VKG}}
{{CMG}}[[hydronephrosis]]; {{AE}} {{VKG}}


==Overview==
==Overview==
Patients with hydronephrosis complain presence of pain based on the site of the obstruction and the degree of the obstruction. Patients commonly present with abdominal distension, palpable kidney, costovertebral tenderness and palpably bladder may be seen.
Patients with [[hydronephrosis]]<nowiki/>complain presence of pain based on the site of the obstruction and the degree of the obstruction. Patients commonly present with [[abdominal distension]], [[palpable]] kidney, [[Costovertebral angle|costovertebral]] tenderness and palpable [[bladder]] may be seen.


==Physical Examination==
==Physical Examination==
Physical examination of patients with [disease name] is usually normal.


OR
Physical examination of patients with [[hydronephrosis]]<nowiki/>is usually remarkable for [[abdominal distension]], [[palpable]] kidney, [[Costovertebral angle|costovertebral]] tenderness and palpable [[bladder]]. The appearance of the patients with [[hydronephrosis]] usually appear normal.<ref name="pmid12809872">{{cite journal |vauthors=Lam JS, Cooper KL, Greene TD, Gupta M |title=Impact of hydronephrosis and renal function on treatment outcome: antegrade versus retrograde endopyelotomy |journal=Urology |volume=61 |issue=6 |pages=1107–11; discussion 1111–2 |date=June 2003 |pmid=12809872 |doi= |url=}}</ref>


Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
=== Vital Signs ===
 
* High-grade / low-grade [[fever]] when positive for infection.
OR
* [[Tachycardia]] with a regular pulse because of the fever which is due to infection.
 
* [[High blood pressure]] due to salt retention.
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
 
OR
 
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
 
===Appearance of the Patient===
*Patients with [disease name] usually appear [general appearance].
 
===Vital Signs===
 
*High-grade / low-grade fever
*[[Hypothermia]] / hyperthermia may be present
*[[Tachycardia]] with regular pulse or (ir)regularly irregular pulse
*[[Bradycardia]] with regular pulse or (ir)regularly irregular pulse
*Tachypnea / bradypnea
*Kussmal respirations may be present in _____ (advanced disease state)
*Weak/bounding pulse / pulsus alternans / paradoxical pulse / asymmetric pulse
*High/low blood pressure with normal pulse pressure / [[wide pulse pressure]] / [[narrow pulse pressure]]


===Skin===
===Skin===
* Skin examination of patients with [disease name] is usually normal.
* Skin examination of patients with [[hydronephrosis]]<nowiki/>is usually normal.
OR
*[[Cyanosis]]
*[[Jaundice]]
* [[Pallor]]
* Bruises
 
<gallery widths="150px">
 
UploadedImage-01.jpg | Description {{dermref}}
UploadedImage-02.jpg | Description {{dermref}}
 
</gallery>


===HEENT===
===HEENT===
* HEENT examination of patients with [disease name] is usually normal.
* HEENT examination of patients with [[hydronephrosis]]<nowiki/>is usually unremarkable.
OR
* Abnormalities of the head/hair may include ___
* Evidence of trauma
* Icteric sclera
* [[Nystagmus]]
* Extra-ocular movements may be abnormal
*Pupils non-reactive to light / non-reactive to accommodation / non-reactive to neither light nor accommodation
*Ophthalmoscopic exam may be abnormal with findings of ___
* Hearing acuity may be reduced
*[[Weber test]] may be abnormal (Note: A positive Weber test is considered a normal finding / A negative Weber test is considered an abnormal finding. To avoid confusion, you may write "abnormal Weber test".)
*[[Rinne test]] may be positive (Note: A positive Rinne test is considered a normal finding / A negative Rinne test is considered an abnormal finding. To avoid confusion, you may write "abnormal Rinne test".)
* [[Exudate]] from the ear canal
* Tenderness upon palpation of the ear pinnae/tragus (anterior to ear canal)
*Inflamed nares / congested nares
* [[Purulent]] exudate from the nares
* Facial tenderness
* Erythematous throat with/without tonsillar swelling, exudates, and/or petechiae


===Neck===
===Neck===
* Neck examination of patients with [disease name] is usually normal.
* Neck examination of patients with [[hydronephrosis]]<nowiki/>is usually normal.
OR
*[[Jugular venous distension]]
*[[Carotid bruits]] may be auscultated unilaterally/bilaterally using the bell/diaphragm of the otoscope
*[[Lymphadenopathy]] (describe location, size, tenderness, mobility, and symmetry)
*[[Thyromegaly]] / thyroid nodules
*[[Hepatojugular reflux]]


===Lungs===
===Lungs===
* Pulmonary examination of patients with [disease name] is usually normal.
* [[Pulmonary]] examination of patients with [[hydronephrosis]]<nowiki/>is usually normal.
OR
* Asymmetric chest expansion / Decreased chest expansion
*Lungs are hypo/hyperresonant
*Fine/coarse [[crackles]] upon auscultation of the lung bases/apices unilaterally/bilaterally
*Rhonchi
*Vesicular breath sounds / Distant breath sounds
*Expiratory/inspiratory wheezing with normal / delayed expiratory phase
*[[Wheezing]] may be present
*[[Egophony]] present/absent
*[[Bronchophony]] present/absent
*Normal/reduced [[tactile fremitus]]


===Heart===
===Heart===
* Cardiovascular examination of patients with [disease name] is usually normal.
* [[Cardiovascular]] examination of patients with [[hydronephrosis]] is usually normal.
OR
*Chest tenderness upon palpation
*PMI within 2 cm of the sternum  (PMI) / Displaced point of maximal impulse (PMI) suggestive of ____
*[[Heave]] / [[thrill]]
*[[Friction rub]]
*[[Heart sounds#First heart tone S1, the "lub"(components M1 and T1)|S1]]
*[[Heart sounds#Second heart tone S2 the "dub"(components A2 and P2)|S2]]
*[[Heart sounds#Third heart sound S3|S3]]
*[[Heart sounds#Fourth heart sound S4|S4]]
*[[Heart sounds#Summation Gallop|Gallops]]
*A high/low grade early/late [[systolic murmur]] / [[diastolic murmur]] best heard at the base/apex/(specific valve region) may be heard using the bell/diaphgram of the otoscope
 
===Abdomen===
===Abdomen===
* [[Suprapubic tenderness]] (with or without a history of [[Urinary bladder|bladder]] outflow obstruction) along with a [[palpable]] bladder are strongly suggestive of [[Acute (medical)|acute]] [[urine|urinary]] [[retention]], which left untreated is highly likely to cause hydronephrosis.
* Suprapubic tenderness (with or without a history of [[Urinary bladder|bladder]] outflow obstruction) along with a [[palpable]] bladder are strongly suggestive of [[Acute (medical)|acute]] [[urine|urinary]] [[retention]], which left untreated is highly likely to cause hydronephrosis
* Upper urinary tract obstruction is characterised by pain in the [[flank]], often radiating to either the [[abdomen]] or the [[groin]]. Where the obstruction is [[chronic (medicine)|chronic]], [[renal failure]] may also be present. If the obstruction is complete, an enlarged kidney is often [[palpable]] on examination.
* Upper urinary tract obstruction is characterised by pain in the [[flank]], often radiating to either the [[abdomen]] or the [[groin]]
* Where the [[obstruction]] is [[chronic (medicine)|chronic]], [[renal failure]] may also be present. If the obstruction is complete, an enlarged kidney is often [[palpable]] on examination


 
*[[Abdominal distention]].
* Abdominal examination of patients with [disease name] is usually normal.
*A [[palpable]] distended bladder is noted
OR
*[[Kidney]] may be palpable in some cases
*[[Abdominal distention]]  
*[[Abdominal tenderness]] in the right/left upper/lower abdominal quadrant
*[[Rebound tenderness]] (positive Blumberg sign)
*A palpable abdominal mass in the right/left upper/lower abdominal quadrant
*Guarding may be present
*[[Hepatomegaly]] / [[splenomegaly]] / [[hepatosplenomegaly]]
*Additional findings, such as obturator test, psoas test, McBurney point test, Murphy test


===Back===
===Back===
* Back examination of patients with [disease name] is usually normal.
*[[Costovertebral angle|Costovertebral]] angle [[tenderness]] on the affected side is seen
OR
*Point tenderness over __ vertebrae (e.g. L3-L4)
*Sacral edema
*Costovertebral angle tenderness bilaterally/unilaterally
*Buffalo hump


===Genitourinary===
===Genitourinary===
* Genitourinary examination of patients with [disease name] is usually normal.
*[[Rectal]] examination should be performed in patients with [[hydronephrosis]] to assess
OR
**[[Sphincter]] tone
*A pelvic/adnexal mass may be palpated
**[[Prostate]]
*Inflamed mucosa
*Clear/(color), foul-smelling/odorless penile/vaginal discharge


===Neuromuscular===
===Neuromuscular===
* Neuromuscular examination of patients with [disease name] is usually normal.
* [[Neuromuscular]] examination of patients with [[hydronephrosis]] is usually normal.
OR
*Patient is usually oriented to persons, place, and time
* Altered mental status
* Glasgow coma scale is ___ / 15
* Clonus may be present
* Hyperreflexia / hyporeflexia / areflexia
* Positive (abnormal) Babinski / plantar reflex unilaterally/bilaterally
* Muscle rigidity
* Proximal/distal muscle weakness unilaterally/bilaterally
* ____ (finding) suggestive of cranial nerve ___ (roman numerical) deficit (e.g. Dilated pupils suggestive of CN III deficit)
*Unilateral/bilateral upper/lower extremity weakness
*Unilateral/bilateral sensory loss in the upper/lower extremity
*Positive straight leg raise test
*Abnormal gait (describe gait: e.g. ataxic (cerebellar) gait / steppage gait / waddling gait / choeiform gait / Parkinsonian gait / sensory gait)
*Positive/negative Trendelenburg sign
*Unilateral/bilateral tremor (describe tremor, e.g. at rest, pill-rolling)
*Normal finger-to-nose test / Dysmetria
*Absent/present dysdiadochokinesia (palm tapping test)
 
===Extremities===
===Extremities===
* Extremities examination of patients with [disease name] is usually normal.
*lower extremity [[edema]] may occur when [[hydronephrosis]] is [[bilateral]].
OR
*[[Clubbing]]  
*[[Cyanosis]]  
*Pitting/non-pitting [[edema]] of the upper/lower extremities
*Muscle atrophy
*Fasciculations in the upper/lower extremity




Latest revision as of 18:13, 12 August 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]hydronephrosis; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]

Overview

Patients with hydronephrosiscomplain presence of pain based on the site of the obstruction and the degree of the obstruction. Patients commonly present with abdominal distension, palpable kidney, costovertebral tenderness and palpable bladder may be seen.

Physical Examination

Physical examination of patients with hydronephrosisis usually remarkable for abdominal distension, palpable kidney, costovertebral tenderness and palpable bladder. The appearance of the patients with hydronephrosis usually appear normal.[1]

Vital Signs

  • High-grade / low-grade fever when positive for infection.
  • Tachycardia with a regular pulse because of the fever which is due to infection.
  • High blood pressure due to salt retention.

Skin

HEENT

  • HEENT examination of patients with hydronephrosisis usually unremarkable.

Neck

Lungs

Heart

Abdomen

  • Suprapubic tenderness (with or without a history of bladder outflow obstruction) along with a palpable bladder are strongly suggestive of acute urinary retention, which left untreated is highly likely to cause hydronephrosis
  • Upper urinary tract obstruction is characterised by pain in the flank, often radiating to either the abdomen or the groin
  • Where the obstruction is chronic, renal failure may also be present. If the obstruction is complete, an enlarged kidney is often palpable on examination

Back

Genitourinary

Neuromuscular

Extremities


References

  1. ↑ Lam JS, Cooper KL, Greene TD, Gupta M (June 2003). "Impact of hydronephrosis and renal function on treatment outcome: antegrade versus retrograde endopyelotomy". Urology. 61 (6): 1107–11, discussion 1111–2. PMID 12809872.

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