GI 5 - Examine the kidneys Flashcards
Explains procedure to patient, positions and drapes (re-drapes as needed).
Explain procedure:
“Today I am going to be examining your kidneys. This will involve me touching and looking at your stomach. If at any point you feel uncomfortable or are in pain, please let me know.”
Perform a general inspection for systemic manifestation of kidney disease: (periorbital edema, generalized edema, uremic fetor, pallor, etc.
Periorbital Edema (edema around the eyes)- Nephrotic syndrome
Generalized edema- Hypertension
Uremic Fetor (bad breath due to buildup of urea in blood, urine like smell)-Chronic Kidney Disease
Pallor- anemia associated with chronic kidney disease → you get anemia because kidneys are damaged and there is no
production of EPO → bone marrow makes fewer RBCs
Inspects the abdomen and comments on findings: masses, asymmetry, etc.
“I’m going to begin by observing the general appearance of my patient lying quietly. (Standing on the right of the patient; you should be bending down so that you can view the abdomen tangentially) I will be inspecting the surface contours, and movements of my patient’s abdomen, looking for bulges or peristalsis. My patient’s abdomen appears (say what you see- symmetric, flat, rounded, protuberant, or scaphoid-markedly concave or hollow).
There is no visible peristalsis (normally peristalsis is visible in very thin people). Visible peristalsis could suggest intestinal obstruction.* (Color)* I’m noting no bruises, erythema, or jaundice. No scars are visible which could be due to any trauma or past surgeries. I’m noting no striae (stretch marks).
Abnormally colored striae (pink-purple) are a hallmark of Cushing syndrome. I’m also noting no signs of engorged veins (a few small veins may be visible normally). Visibly engorged veins could suggest portal hypertension from cirrhosis (caput medusa) or inferior vena cava obstruction. Also, the umbilicus doesn’t appear everted. An everted umbilicus suggests a ventral hernia. There appears to be no bulging of the flanks (full flanks are present). If bulging of the flanks were present this could suggest ascites.”
Auscultates for renal artery bruits. Comments on findings and significance
“Now, I will be switching to the bell of my stethoscope to auscultate for bruits which are lower frequency, *(abnormal blowing or swishing sounds resulting from turbulent flow due to narrowing stenotic) *or partially occluded artery.
First, I will be placing the bell above the umbilicus listening for aortic bruits. Next, I’ll place it 2-3 cm above the lateral umbilicus to listen for renal artery bruits, lateral to the umbilicus listening to the iliac artery bruits, and in the inguinal region listening for femoral artery bruits.”
[Present bruits could be indicative of a stenotic artery (ex. renal artery stenosis).]
Bimanual palpation with ballottement & attempted entrapment of kidneys on deep inspiration, comments on findings.
“Now I’m going to place my left hand behind the patient’s right loin between the 12th rib and iliac crest, and my right hand on the right side of the abdomen just below the level of anterior superior iliac spine. (Lift your left hand while trying to displace the kidney anteriorly). Can you please inhale for me? *(Press your hand firmly under the patient trying to capture the kidney).
*
To palpate left kidney, lean across the patient and place left hand around the flank into the left loin and then place right hand on the abdomen and try to palpate the kidney between the both hands. *(If palpable) *The kidney was smooth and non-tender (firm). A normal kidney is usually impalpable except in a thin patient. A large flank mass may represent marked splenomegaly or an enlarged left kidney.”
Palpate & percuss costovertebral angle for tenderness. Comments on findings.
“Next, I’m going to be checking the costovertebral angle* (the angle between the 12th rib and vertebral column) *for tenderness.
Can you please sit up? Do you have any pain right now in your back?”
“I’m going to place my palm at the costovertebral angle on the back (near 12th rib), and strike with the ulnar surface of my fist bilaterally. Did you feel any pain from that?”
“My patient was negative for any tenderness of costovertebral angle. If my patient was positive for costovertebral angle tenderness this would be due to Pyelonephritis, or trauma. ”
