Pyelonephritis physical examination: Difference between revisions
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* The following neurological signs can rarely be witnessed in elderly: | * The following neurological signs can rarely be witnessed in elderly: | ||
**[[Delirium]] | **[[Delirium]] | ||
**[[Hallucinations]] | **[[Hallucinations]] | ||
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.