Pyelonephritis physical examination: Difference between revisions
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==Overview== | ==Overview== | ||
Pyelonephritis is a medical emergency and requires a thorough physical examination after getting a detailed history and review of symptoms. Typically the patient has acute onset of high grade [[fever]], [[dysuria]] and pain radiating to the flank.A sonopalpation test, which is ultrasound guided palpation is usually positive and helpful in detecting the exact anatomical structure as the cause of tenderness.<ref name="pmid28032258">{{cite journal| author=Ramzan MM, Sandstrom CK| title=Core curriculum illustration: acute pyelonephritis. | journal=Emerg Radiol | year= 2016 | volume= | issue= | pages= | pmid=28032258 | doi=10.1007/s10140-016-1474-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28032258 }} </ref><ref name="pmid28050884">{{cite journal| author=Faust JS, Tsung JW| title=Eliciting renal tenderness by sonopalpation in diagnosing acute pyelonephritis. | journal=Crit Ultrasound J | year= 2017 | volume= 9 | issue= 1 | pages= 1 | pmid=28050884 | doi=10.1186/s13089-016-0056-6 | pmc=5215196 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28050884 }} </ref> | Pyelonephritis is a medical emergency and requires a thorough physical examination after getting a detailed history and review of symptoms. Typically the patient has acute onset of high grade [[fever]], [[dysuria]] and [[Flank pain|pain radiating to the flank]]. A sonopalpation test, which is an ultrasound guided palpation, is usually positive and helpful in detecting the exact anatomical structure and position as the cause of tenderness.<ref name="pmid28032258">{{cite journal| author=Ramzan MM, Sandstrom CK| title=Core curriculum illustration: acute pyelonephritis. | journal=Emerg Radiol | year= 2016 | volume= | issue= | pages= | pmid=28032258 | doi=10.1007/s10140-016-1474-2 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28032258 }} </ref><ref name="pmid28050884">{{cite journal| author=Faust JS, Tsung JW| title=Eliciting renal tenderness by sonopalpation in diagnosing acute pyelonephritis. | journal=Crit Ultrasound J | year= 2017 | volume= 9 | issue= 1 | pages= 1 | pmid=28050884 | doi=10.1186/s13089-016-0056-6 | pmc=5215196 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28050884 }} </ref> | ||
==Physical Examination== | ==Physical Examination== | ||
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===General Appearance === | ===General Appearance === | ||
*Patients with | *Patients with pyelonephritis are usually in distress | ||
*Patient may have hands on abdomen or back at the area of tenderness | *Patient may have hands on abdomen or back at the area of tenderness | ||
| Line 17: | Line 17: | ||
*[[Fever]] may be present | *[[Fever]] may be present | ||
* | *[[High blood pressure|High Blood pressure]]-early finding of kidney involvement | ||
*[[Hypotension]] may also be seen if patient is in shock | *[[Hypotension]] may also be seen if patient is in shock | ||
===Abdomen=== | ===Abdomen=== | ||
* Costo-vertebral angle tenderness( | * Costo-vertebral angle tenderness(renal angle tenderness) | ||
* Positive sonopalpation test of the kidney<ref name="pmid28050884">{{cite journal| author=Faust JS, Tsung JW| title=Eliciting renal tenderness by sonopalpation in diagnosing acute pyelonephritis. | journal=Crit Ultrasound J | year= 2017 | volume= 9 | issue= 1 | pages= 1 | pmid=28050884 | doi=10.1186/s13089-016-0056-6 | pmc=5215196 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28050884 }} </ref> | * Positive sonopalpation test of the kidney<ref name="pmid28050884">{{cite journal| author=Faust JS, Tsung JW| title=Eliciting renal tenderness by sonopalpation in diagnosing acute pyelonephritis. | journal=Crit Ultrasound J | year= 2017 | volume= 9 | issue= 1 | pages= 1 | pmid=28050884 | doi=10.1186/s13089-016-0056-6 | pmc=5215196 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28050884 }} </ref> | ||
* | * Suprapubic tenderness | ||
===Digital rectal examination (DRE)=== | ===Digital rectal examination (DRE)=== | ||
A DRE is a physical exam of the prostate that is performed in the health care provider’s office. Anesthesia is not needed. To perform the exam, the health care provider asks the person to bend over a table or lie on his side while holding his knees close to his chest. The health care provider slides a gloved, lubricated finger into the rectum and feels the part of the prostate that lies in front of the rectum. | A DRE is a physical exam of the prostate that is performed in the health care provider’s office. Anesthesia is not needed. To perform the exam, the health care provider asks the person to bend over a table or lie on his side while holding his knees close to his chest. The health care provider slides a gloved, lubricated finger into the rectum and feels the part of the prostate that lies in front of the rectum. | ||
*Men with suspected pyelonephritis may | *Men with suspected pyelonephritis may require a DRE to determine whether a swollen prostate may be obstructing the neck of the bladder. | ||
===Genitourinary=== | ===Genitourinary=== | ||
The following findings may be found on genitourinary examination of a patient with Pyelonephritis.<ref name="pmid22010614">{{cite journal| author=Colgan R, Williams M| title=Diagnosis and treatment of acute uncomplicated cystitis. | journal=Am Fam Physician | year= 2011 | volume= 84 | issue= 7 | pages= 771-6 | pmid=22010614 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22010614 }} </ref><ref name="pmid20353145">{{cite journal |vauthors=Brill JR |title=Diagnosis and treatment of urethritis in men |journal=Am Fam Physician |volume=81 |issue=7 |pages=873–8 |year=2010 |pmid=20353145 |doi= |url=}}</ref><ref>{{cite book |last = Bennett |first = John |title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases |publisher = Elsevier/Saunders |location = Philadelphia, PA |year = 2015 |isbn=9781455748013}}</ref>. | The following findings may be found on genitourinary examination of a patient with Pyelonephritis.<ref name="pmid22010614">{{cite journal| author=Colgan R, Williams M| title=Diagnosis and treatment of acute uncomplicated cystitis. | journal=Am Fam Physician | year= 2011 | volume= 84 | issue= 7 | pages= 771-6 | pmid=22010614 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22010614 }} </ref><ref name="pmid20353145">{{cite journal |vauthors=Brill JR |title=Diagnosis and treatment of urethritis in men |journal=Am Fam Physician |volume=81 |issue=7 |pages=873–8 |year=2010 |pmid=20353145 |doi= |url=}}</ref><ref>{{cite book |last = Bennett |first = John |title = Mandell, Douglas, and Bennett's principles and practice of infectious diseases |publisher = Elsevier/Saunders |location = Philadelphia, PA |year = 2015 |isbn=9781455748013}}</ref>. | ||
*Renal angle tenderness | *Renal angle [[tenderness]] | ||
*Suprapubic tenderness | *[[Tenderness|Suprapubic tenderness]] | ||
*[[Urethral discharge]](if the cause is urethritis) | *[[Urethral discharge]](if the cause is urethritis) | ||
*Inguinal | *[[Lymphadenopathy|Inguinal lymphadenopathy]] | ||
*Examination of the scrotum and the pubic area must be done | *Examination of the scrotum and the pubic area must be done | ||
Revision as of 16:32, 31 January 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pyelonephritis is a medical emergency and requires a thorough physical examination after getting a detailed history and review of symptoms. Typically the patient has acute onset of high grade fever, dysuria and pain radiating to the flank. A sonopalpation test, which is an ultrasound guided palpation, is usually positive and helpful in detecting the exact anatomical structure and position as the cause of tenderness.[1][2]
Physical Examination
The following features can be found during a physical examination of a patient with pyelonephritis. The patient must be in supine position to facilitate a proper examination.[3][4][5][6]
General Appearance
- Patients with pyelonephritis are usually in distress
- Patient may have hands on abdomen or back at the area of tenderness
Vital Signs
The following variations in Vital Signs can be seen in Pyelonephritis.
- Fever may be present
- High Blood pressure-early finding of kidney involvement
- Hypotension may also be seen if patient is in shock
Abdomen
- Costo-vertebral angle tenderness(renal angle tenderness)
- Positive sonopalpation test of the kidney[2]
- Suprapubic tenderness
Digital rectal examination (DRE)
A DRE is a physical exam of the prostate that is performed in the health care provider’s office. Anesthesia is not needed. To perform the exam, the health care provider asks the person to bend over a table or lie on his side while holding his knees close to his chest. The health care provider slides a gloved, lubricated finger into the rectum and feels the part of the prostate that lies in front of the rectum.
- Men with suspected pyelonephritis may require a DRE to determine whether a swollen prostate may be obstructing the neck of the bladder.
Genitourinary
The following findings may be found on genitourinary examination of a patient with Pyelonephritis.[4][7][8].
- Renal angle tenderness
- Suprapubic tenderness
- Urethral discharge(if the cause is urethritis)
- Inguinal lymphadenopathy
- Examination of the scrotum and the pubic area must be done
Cardiovascular
Neurological
References
- ↑ Ramzan MM, Sandstrom CK (2016). "Core curriculum illustration: acute pyelonephritis". Emerg Radiol. doi:10.1007/s10140-016-1474-2. PMID 28032258.
- ↑ 2.0 2.1 Faust JS, Tsung JW (2017). "Eliciting renal tenderness by sonopalpation in diagnosing acute pyelonephritis". Crit Ultrasound J. 9 (1): 1. doi:10.1186/s13089-016-0056-6. PMC 5215196. PMID 28050884.
- ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 9781455748013.
- ↑ 4.0 4.1 Colgan R, Williams M (2011). "Diagnosis and treatment of acute uncomplicated cystitis". Am Fam Physician. 84 (7): 771–6. PMID 22010614.
- ↑ Chang SL, Shortliffe LD (2006). "Pediatric urinary tract infections". Pediatr Clin North Am. 53 (3): 379–400, vi. doi:10.1016/j.pcl.2006.02.011. PMID 16716786.
- ↑ Lee BE, Seol HY, Kim TK, Seong EY, Song SH, Lee DW; et al. (2008). "Recent clinical overview of renal and perirenal abscesses in 56 consecutive cases". Korean J Intern Med. 23 (3): 140–8. doi:10.3904/kjim.2008.23.3.140. PMC 2686968. PMID 18787367.
- ↑ Brill JR (2010). "Diagnosis and treatment of urethritis in men". Am Fam Physician. 81 (7): 873–8. PMID 20353145.
- ↑ Bennett, John (2015). Mandell, Douglas, and Bennett's principles and practice of infectious diseases. Philadelphia, PA: Elsevier/Saunders. ISBN 9781455748013.