Transcript pain in kidney area

PAIN
SYNDROME
COMPLAINTS:
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pain in kidney area: blunt, uni- or bilateral (at acute
kidney inflammation)
acute extreme pain, unilateral in kidney area with
duration of several hours (at kidney ischemia)
kidney colic - intensive pain with irradiation to
abdomen, from ureter to the bladder, amplify after
physical loadings (run, walk), after drinking, at jolting
(at obstruction of urinary tract by stone or tumor).
Pain has increasing character, decrease after
injection of atropin or after hot bath.
pain on area of ureter, on area of bladder (at damage
of ureter, bladder)
ANAMNESIS
 transferred
urinary tract infection
 trauma of flank area
 damage of kidney vessels
 tumor of kidneys
 vaccination
 insolation
 radiation
PALPATION
Kidney pain can be defined at palpation
of abdomen and area of costovertebral
corner. Sometimes there is enough
pressing by fingers for revealing pain in
this area.
 Pain at palpation on a course of ureter.
 Pain at palpation of area of bladder (lower
abdomen)
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PERCUSSION
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Symptom of Pasternatsky - doctor puts the left hand
on area of costovertebral corner and percuss by edge
of palm (right hand). In positive symptom the patient
feels pain.
Positive symptom of Rofilo: at situaton on a back the
patient bends a leg in iliofemoral joint and presses
thigh to a stomach. At presence of inflammation of
kidney pelvis the pain amplifies in lumbar area,
especially in deep sigh.
SYNDROME OF DISURIA
COMPLAINTS
Difficulties of urination: ishuria - delay of
urine in the bladder
 Pollakiuria - frequent urination, more than 6
times per day in variouse quantities
 Nocturia - prevalence of night diuresis above
day time (usually day time diuresis in3-4
times exeeds night)
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COMPLAINTS
Stranguria - urination by small portions of
urine (drops) accompanied by feeling
incomplete urine output, false desires on
urination, painful and frequent urination
 Main complaints: often imperative desires,
pain at urination, itch in urinary tract
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ANAMNESIS
Earlier transferred infection of urinary system
 radiation
 endoscopic manipulation in urinary tract
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PALPATION
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The painful points are defined at pressing
on lumbar area in the field of kidneys,
bladder, in projection of ureter
Percussion
Positive symptom of Pasternatsky on the
side of injury or on both sides.
 Positive symptom of Rofilo.
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LABORATORY TESTS AND INSTRUMENTAL
EXAMINATION
Common blood analysis - increase of WBCs,
increase of ESR
 urinalysis - presence of WBCs (leucocyteuria)
and bacteria in urine, it is possible RBCs
(hematuria), proteinuria, increase of number of
epithelial cells
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LABORATORY TESTS AND INSTRUMENTAL
EXAMINATION
Test of Nechiporenko - WBCs more than 4000
and bacterial counts - 100 000 organisms or
higher per 1 milliliter of urine, presence of
RBCs
 culturing bacteria in the urine specimen to
determine which bacteria are present and
sensitivity test to antibiotics
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LABORATORY TESTS AND INSTRUMENTAL
EXAMINATION
Ultrasound imaging of bladder - a
thickening of bladder’s walls, heterogenity
of contents
 Ultrasound imaging of prostate - increase of
size, heterogenity of structure, stones and
sites of fibrosis
 Cystoscopy - hyperemia and edema of
mucouse layer of bladder
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LABORATORY TESTS AND INSTRUMENTAL
EXAMINATION
Urethroscopy - reveals infiltration of urethra’
s walls
 Urethrography - spend at scarring strictures
 X- rays - demonstrate scarring of the
kidneys and ureters resulting from longstanding infection
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Syndrome of urinary tract
infection
DEFINITION
A
urinary tract infection (UTI) is an infection
that can happen anywhere along the urinary
tract - the kidneys, the ureters, the bladder,
or the urethra
COMPLAINTS
General: weakness, loss of appetite,
headache
 Specific: pain in lumbar area, often
unilateral, blunt character, with irradiation
in the lower abdomen, fever, difficulties of
urination, output of cloudy urine
sometimes with unpleasant smell.
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ANAMNESIS
Information about early transferred acute
urinary tract infection
 Women tend to get UTIs more often because
their urethra is shorter and closer to the anus.
 Elderly people and people with diabetes also
get more UTIs
 Pregnancy and menopause
 Kidney stones
 Sexual intercource
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ANAMNESIS
 Prostate
inflammation or enlargement
 Narrowed urethra
 Immobility
 Catheterization
 Inspection
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Pallor of the skin and mucouse layers, lost of
weight, swelling of the face
PALPATION
 pain
at palpation of lumbar area or at
palpation on a course of ureter
 Percussion
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Positive symptom of Pasternatsky on the side of
injury. Expansion of the heart border to the left (at
presence of arterial hypertesion).
 Auscultation
 Deafness
of heart tones, accent of 2-nd tone
above aorta, arterial hypertension
LABORATORY TESTS AND
INSTRUMENTAL EXAMINATION
 Common
blood - anaemia, leucocytosis,
shift of WBSs formula to the left, increase of
ESR
 Urinalysis- urine cloudy, alcaline reaction of
urine, low density, moderate proteinuria,
microscopic hematuria, expressed
leucocyteuria, presence of bacteria in urine
LABORATORY TESTS AND INSTRUMENTAL
EXAMINATION
Bacterial counts in urine - 100 000 organisms
or higher per 1 milliliter of urine
 Prevalence of WBCs above RBCs - WBCs more
than 4000 in 1 milliliter of urine (test of
Nechiporenko)
 Test of Zimnitsky - decrease of urine density
within day
 3-glass test
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3-GLASS TEST
Damage of urethra – pathological urine
sediment (leucocytes, erythrocytes) revealed
in first portion of urine.
 Damage of kidneys, calices and pelvis or
ureter – pathological urine sediment in all
(3) portions of urine or in second and third
portions.
 Damage of the bladder – hematuria or
leucocyturia revealed in 3-rd portion of urine
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LABORATORY TESTS AND INSTRUMENTAL
EXAMINATION
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Reberg-Tareev`s test - estimation of glomerular
filtration rate (GFR)
GFR = (CrU/CrP)VxS. (N = 90-120ml/min)
Test with prednisolon for detecting of latent
inflammation
Intravenouse urography, pyelography - reveal
reduction of upper urinary tract tone`s, narrowing
and deformation of calices, pyeloectasiaes, presence
of pyelorenalis refluxes
LABORATORY TESTS AND INSTRUMENTAL
EXAMINATION
 Ultrasound
imaging of the kidneys asymmetry of the kidney sizes, expansion
and deformation of calyces and pelvis,
diffuse acustic heterogenity of renal
parenchyma, sometimes reduction of
thickness of renal parenchyma, kidney
stones, cysts.
SYNDROME OF ARTERIAL
HYPERTENSION
 Syndrome
of arterial hypertension – is a
complex of clinical signs and symptoms
connected with high blood pressure (systolic
b p - more than 140 mmHg, diastolic b p –
more than 90 mm Hg
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The basic reason of arterial hypertension in
kidney disease – acute and chronic glomerular
inflammation.
COMPLAINTS
Headache, heaviness, noise in ears,
 later- difficulties of breath, deterioration
of vision, weakness, fog before eyes, pain
in the field of heart
 Anamnesis: presence of accompanying
kidney damage. Transferred inflammation
of urinary tract, anomaly of kidney
development
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INSPECTION
Edema on the face and around eyes
Palpation
Apical beat is amplified and displaced to the
left, the pulse firm, intense and complete
Percussion
Displacement of heart borders to the left
AUSCULTATION
Deafness of I tone on the apex, accent of II tone
above aorta, systolic murmur in projection of
renal arteries
(at stenosis), increase of the level of blood
pressure
LABORATORY AND INSTRUMENTAL
EXAMINATION
In blood: increase of ESR, leucocytosis, anemia,
hypoproteinemia, hypoalbuminemia
 In urine: change characteristic for the basic
disease (glomerulonephritis, pyelonephritis)
 X-ray methods: renal angiography (stenosis and
atherosclerosis of renal arteries, anomaly of
development of renal vessels).
 Chest radiography: increase of heart sizes due to
left ventricular hypertrophy. Aorta is extended.
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ECG: Left ventricular hypertrophy (LVH)
There are many different criteria for LVH.
Sokolow + Lyon (Am Heart J, 1949;37:161)
S V1+ R V5 or V6 > 35 mm
Cornell criteria (Circulation, 1987;3: 56572)
SV3 + R avl > 28 mm in men
SV3 + R avl > 20 mm in women
Framingham criteria (Circulation,1990;
81:815-820)
R avl > 11mm, R V4-6 > 25mm
S V1-3 > 25 mm, S V1 or V2 +
R V5 or V6 > 35 mm, R I + S III > 25 mm
Left atrial abnormality (dilatation
or hypertrophy)
- M shaped P wave in lead II
- prominent terminal negative
component to P wave in lead V1
.
Ultrasound research of kidneys: changes of
calices and pelvis, revealing of tumours,
stones, increase of kidney sizes, anomalies of
kidney development, kidney cysts
 EchoCG – signs of LVH, cardiac doppler allows
the assessment of diastolic filling and can
suggest the presence of diastolic disfunction,
which may be associated with signs and
symptoms of heart failure.
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