Urinary system
History and physical exam
Dr.Abdulkadir woliyi,MD
May,2011
Kidneys and urinary tract
Symptoms of renal and urological disease
Pain
Hematuria
Oliguria/anuria
Polyuria
Frequency
Nocturia
Dysuria
Cont…
Urgency , Incontinence & enuresis
Slow stream , hesitancy , terminal dribbling
Urethral discharge
1.Renal and Urinary pain
Renal pain _ felt in the flank or the loin, dull
aching,steady,eg.pyelonephritis
Ureteric colic :severe colicky pain originating at CVA
radiating to lower abdominal quadrant , thigh , testis ,
or labium eg . sudden obstruction of ureter by stones
or blood clots
pt prefers to pace about or thrash around
Suprapubic pain arises from bladder ,cystitis,urethritis
Vesical pain
Prostatic & seminal pain
Urethral pain
2.Hematuria
Presence of blood in the urine
Microscopic or gross hematuria
Initial , through out urinary stream or terminal
hematuria
Hematuria arising from parenchymal renal ds
is continuous , painless , often microscopic
Those from renal tumor is intermittent ,painful
, macroscopic
Menses vs hematuria , medication
3.Frequency
Due to incomplete bladder emptying as
prostatism, irritability of bladder by
inflammation ,UTI (cystitis),stone..
Cont…
4. OLIGURIA
passage of < 500 ml of urine per day
physiological in pts with low in take,normal GFR
Pathological (pre renal ,renal ,post renal)
Anuria- incomplete absence of urine flow
5.POLYURIA
High urinary flow rate >3 liter per day
Pyschologic polydypsia ,osmotic duiresis,CRF…
□ 6.NOCTURIA
Urinary frequency at night > 1
diurnal varation , polyuria of any causes
Cont…
7.DYSURIA
Pain before, during and after micturation
Burning , assd with freq,
Infection , neoplasm
8.URGENCY,INCONTINENCE,ENURESIS
Urgency_ desire to pass urine beyond the time
initially perceived
Incontinence - involantary passage of urine
Socialy embarassing , cause problem with
hygeine, urge I,sress I, overfow I ,functional I
Cont…
9.Slow stream , hesitancy , terminal dribbling
Seen in elderly men with BPH
Slow stream , reduced urine flow rate
Hesitancy , difficulty of initiatin of micturation
Terminal dribbling , in completing micturation
10.URETHRAL DISCHARGE
Usually noticed by men
Urethritis , STI
General questions for urinary history
Do you have any difficulty of passing urine?
How often do you go?
Do you get up at night?
How much urine do you pass at a time?
Is there any pain or burning ?
Do u ever have trouble getting to toilet in time?
Do you ever leak any urine? While coughing ,
sneezing , laughing?
Is there dribbling when u re through ? what is
the color of your urine?
Physical examination
Kidneys
Are not usually palpable
To palpate lt kidney move to pts lt side,
Rt hand behind pts abdomen
Lift the lt kidney anteriorly
Place lt hand in LUQ
Ask pt to take deep breath
Try to capture the kidney b/n two hands d’
deep inspiration
Cont…
Describe size , contour,tenderness by CVAT
for rt kidney proceed as before
Try to differenciate from enlarged spleen ,
liver
The bladder
Not palpable unless distended above
symphysis pubis , smooth,round
Tenderness
How to palpate kidney
CVAT
Galatooma !
