Pyonephrosis physical examination

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

Overview

A patient with pyonephrosis usually appears uncomfortable and ill. Vital signs may be unstable if the patient is going into septic shock. On abdominal examination, costovertebral angle tenderness may be present. Digital rectal examination may reveal an enlarged prostate gland in an elderly male patient. The cardiovascular and pulmonary examination is usually within normal limits except for the presence of tachycardia.

Physical Examination

The following features can be found during a physical examination of a patient with pyonephrosis with the patient lying in supine position.[1]

Appearance of the Patient

  • A patient with pyonephrosis usually appears uncomfortable and ill.
  • Patient may have their hands on the abdomen or back at the area of tenderness.

Vital Signs

  • Fever may be present
  • Hypotension[2][3]

Skin

  • Skin examination of patients with pyonephrosis is usually normal.

HEENT

  • HEENT examination of patients with pyonephrosis is usually normal.

Neck

  • Neck examination of patients with pyonephrosis is usually normal.

Lungs

  • Pulmonary examination of patients with pyonephrosis is usually normal.

Heart

  • Tachycardia

Abdomen

  • Costovertebral angle tenderness
  • Positive sonopalpation test of the kidney[4]
  • Palpable abdominal mass[5]
  • Suprapubic tenderness

Digital rectal examination (DRE).

  • DRE helps to differentiate if the obstruction is due to obstruction due to an enlarged prostate gland in men.

Back

  • Costovertebral angle tenderness

Genitourinary

The following findings may be found on genitourinary examination of a patient with pyelonephritis:

  • Suprapubic tenderness
  • Examination of the scrotum and the pubic area must be done

Neuromuscular

  • Patient is usually oriented to persons, place, and time.

Extremities

  • Extremities examination of patients with pyonephrosis is usually normal.

References

  1. Colgan R, Williams M, Johnson JR (2011). "Diagnosis and treatment of acute pyelonephritis in women". Am Fam Physician. 84 (5): 519–26. PMID 21888302.
  2. Sakai H, Tomita Y (2005). "[A case of pyonephrosis with septic shock in a hemodialysis patient treated successfully by retroperitoneal drainage]". Hinyokika Kiyo. 51 (12): 801–3. PMID 16440727.
  3. Takao A, Nakayama Y, Ichikawa T, Saegusa M, Asano S, Aramaki K (2001). "[Septic shock due to pyonephrosis-calculosa: a case report]". Nihon Hinyokika Gakkai Zasshi. 92 (4): 530–3. doi:10.5980/jpnjurol1989.92.530. PMID 11449705.
  4. 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.
  5. Erol A, Coban S, Tekin A (2014). "A giant case of pyonephrosis resulting from nephrolithiasis". Case Rep Urol. 2014: 161640. doi:10.1155/2014/161640. PMC 4106088. PMID 25105051.

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