Pyelonephritis physical examination: Difference between revisions
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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.<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><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="pmid16716786">{{cite journal| author=Chang SL, Shortliffe LD| title=Pediatric urinary tract infections. | journal=Pediatr Clin North Am | year= 2006 | volume= 53 | issue= 3 | pages= 379-400, vi | pmid=16716786 | doi=10.1016/j.pcl.2006.02.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16716786 }} </ref><ref name="pmid18787367">{{cite journal| author=Lee BE, Seol HY, Kim TK, Seong EY, Song SH, Lee DW et al.| title=Recent clinical overview of renal and perirenal abscesses in 56 consecutive cases. | journal=Korean J Intern Med | year= 2008 | volume= 23 | issue= 3 | pages= 140-8 | pmid=18787367 | doi=10.3904/kjim.2008.23.3.140 | pmc=2686968 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18787367 }} </ref> | 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.<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><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="pmid16716786">{{cite journal| author=Chang SL, Shortliffe LD| title=Pediatric urinary tract infections. | journal=Pediatr Clin North Am | year= 2006 | volume= 53 | issue= 3 | pages= 379-400, vi | pmid=16716786 | doi=10.1016/j.pcl.2006.02.011 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16716786 }} </ref><ref name="pmid18787367">{{cite journal| author=Lee BE, Seol HY, Kim TK, Seong EY, Song SH, Lee DW et al.| title=Recent clinical overview of renal and perirenal abscesses in 56 consecutive cases. | journal=Korean J Intern Med | year= 2008 | volume= 23 | issue= 3 | pages= 140-8 | pmid=18787367 | doi=10.3904/kjim.2008.23.3.140 | pmc=2686968 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18787367 }} </ref> | ||
=== | ===Appearance of the Patient === | ||
*Patients with pyelonephritis are usually in distress | *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]]. | ||
===Vital Signs=== | ===Vital Signs=== | ||
| Line 17: | Line 17: | ||
*[[Fever]] may be present | *[[Fever]] may be present | ||
*[[High blood pressure|High Blood pressure]] | *[[High blood pressure|High Blood pressure]] as an early finding of kidney involvement | ||
*[[Hypotension]] | *[[Hypotension]] | ||
=== Skin === | |||
* Skin examination of patients with pyelonephritis is usually normal. | |||
=== HEENT === | |||
* HEENT examination of patients with pyelonephritis is usually normal. | |||
=== Neck === | |||
* Neck examination of patients with pyelonephritis is usually normal. | |||
=== Lungs === | |||
* Pulmonary examination of patients with pyelonephritis is usually normal. | |||
=== Heart === | |||
* [[Tachycardia]] | |||
===Abdomen=== | ===Abdomen=== | ||
* [[ | * [[Costovertebral 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 | * Suprapubic [[tenderness]] | ||
===Digital rectal examination (DRE)=== | ===Digital rectal examination (DRE)=== | ||
A [[digital rectal exam]] is a procedure performed in an office setting. The patient bends on a table or lays on one side with knees touching chest. The physician wears gloves, applies a lubricant to the gloved finger and enters it into the rectum to feel the prostate normally located in front of the rectum. | A [[digital rectal exam]] is a procedure performed in an office setting. The patient bends on a table or lays on one side with knees touching chest. The physician wears gloves, applies a lubricant to the gloved finger and enters it into the rectum to feel the prostate normally located in front of the rectum. | ||
*If pyelonephritis is suspected in men, a [[Digital rectal examination|DRE]] helps to differentiate if the obstruction is due to a swollen [[prostate gland]]. | *If pyelonephritis is suspected in men, a [[Digital rectal examination|DRE]] helps to differentiate if the obstruction is due to a swollen [[prostate gland]]. | ||
=== Back === | |||
* [[Costovertebral angle]] tenderness | |||
===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> | ||
*[[Tenderness|Suprapubic tenderness]] | *[[Tenderness|Suprapubic tenderness]] | ||
*[[Urethral discharge]](if the cause is urethritis) | *[[Urethral discharge]] (if the cause is urethritis) | ||
*[[Lymphadenopathy|Inguinal lymphadenopathy]] | *[[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 | ||
=== | ===Neuromuscular=== | ||
*[[ | * Patient is usually oriented to persons, place, and time. | ||
* The following neurological signs can rarely be witnessed in elderly: | |||
**[[Delirium]] | |||
**[[Hallucinations]] | |||
=== | === Extremities === | ||
* Extremities examination of patients with pyelonephritis is usually normal. | |||
* | |||
==References== | ==References== | ||
Revision as of 18:50, 11 June 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Usama Talib, BSc, MD [2]
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]
Appearance of the Patient
- 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 as an early finding of kidney involvement
- Hypotension
Skin
- Skin examination of patients with pyelonephritis is usually normal.
HEENT
- HEENT examination of patients with pyelonephritis is usually normal.
Neck
- Neck examination of patients with pyelonephritis is usually normal.
Lungs
- Pulmonary examination of patients with pyelonephritis is usually normal.
Heart
Abdomen
- Costovertebral angle tenderness
- Positive sonopalpation test of the kidney[2]
- Suprapubic tenderness
Digital rectal examination (DRE)
A digital rectal exam is a procedure performed in an office setting. The patient bends on a table or lays on one side with knees touching chest. The physician wears gloves, applies a lubricant to the gloved finger and enters it into the rectum to feel the prostate normally located in front of the rectum.
- If pyelonephritis is suspected in men, a DRE helps to differentiate if the obstruction is due to a swollen prostate gland.
Back
- Costovertebral angle tenderness
Genitourinary
The following findings may be found on genitourinary examination of a patient with pyelonephritis:[4][7][8]
- Suprapubic tenderness
- Urethral discharge (if the cause is urethritis)
- Inguinal lymphadenopathy
- Examination of the scrotum and the pubic area must be done
Neuromuscular
- Patient is usually oriented to persons, place, and time.
- The following neurological signs can rarely be witnessed in elderly:
Extremities
- Extremities examination of patients with pyelonephritis is usually normal.
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.