Hydronephrosis physical examination

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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.

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

• Skin examination of patients with hydronephrosisis usually normal.

HEENT

• HEENT examination of patients with hydronephrosisis usually unremarkable.

Neck

• Neck examination of patients with hydronephrosisis usually normal.

Lungs

• Pulmonary examination of patients with hydronephrosisis usually normal.

Heart

• Cardiovascular examination of patients with hydronephrosis is usually normal.

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

• Abdominal distention.
• A palpable distended bladder is noted
• Kidney may be palpable in some cases

Back

• Costovertebral angle tenderness on the affected side is seen

Genitourinary

• Rectal examination should be performed in patients with hydronephrosis to assess
  • Sphincter tone
  • Prostate

Neuromuscular

• Neuromuscular examination of patients with hydronephrosis is usually normal.

Extremities

• lower extremity edema may occur when hydronephrosis is bilateral.