PHYSICAL EXAMINATION

URINARY TRACT
IRENE FRANCES MADERA
Common or Concerning Symptoms
• The kidneys are
retroperitoneal. The ribs
protect their upper poles
• The costovertebral angle
(CVA) - defines where to
examine for kidney
tenderness, called
costovertebral angle
tenderness (CVAT).
-Aka. Murphy’s punch
sign,Goldflam’s sign
 A distended
bladder may be
palpable above the
symphysis pubis.
Palpation and Percussion
KIDNEYS – PALPATION
A normal left kidney is rarely palpable. A normal right kidney may be palpable,
especially when the patient is thin and the abdominal muscles are relaxed

Suspect an enlarged kidney if there is normal

tympany in the LUQ and you can probe with your
fingers between the mass and the costal margin,
but not deep to its medial and lower borders

• Causes of kidney enlargement

include hydronephrosis, cysts,
and tumors.
• Bilateral enlargement
suggests polycystic kidney
disease.
KIDNEYS - PERCUSSION
Check for costovertebral angle (CVA) tenderness

Pain with pressure or fist percussion

supports PYELONEPHRITIS if associated
with FEVER AND DYSURIA
The Bladder
• NOT PALPABLE unless it is distended
above the symphysis pubis.
• PERCUSS for dullness and the height
of the bladder above the symphysis
pubis.
• Bladder volume must be 400 to 600
mL before dullness appears
• PALPATION - the dome of the
distended bladder feels smooth and
round. Check for tenderness
BLADDER DISTENTION
• outlet obstruction from a
urethral stricture or
prostatic hyperplasia,
medication side effects,
and neurologic disorders
such as stroke or multiple
sclerosis.
SUPRAPUBIC TENDERNESS
• is common in bladder
infection
Suprapubic Pain
• Bladder disorders may cause suprapubic pain.
• In bladder infection- lower abdomen , dull and
pressure-like
• PAINFUL: In sudden overdistention of the bladder,
pain is often agonizing
• PAINLESS: chronic bladder distention is usually
painless
Dysuria, Urgency, or Frequency
DYSURIA – Diff. in
• Painful urination accompanies cystitis (bladder
voiding/pain on infection), urethritis, and urinary tract infections,
urination bladder stones, tumors, and, in men, acute prostatitis.
URGENCY- intense and • Women report internal burning in urethritis, and
external burning in vulvovaginitis.
immediate desire to
• URGENCY suggests urinary tract infection or irritation
void, sometimes leading from possible urinary calculi.
to involuntary voiding • FREQUENCY is common in urinary tract infection and
or urge incontinence bladder neck obstruction.
FREQUENCY- • In men, painful urination without frequency or urgency
suggests urethritis. Associated flank or back pain
abnormally frequent suggests pyelonephritis
voiding
Polyuria or Nocturia
CAUSES OF POLYURIA
• high fluid intake of psychogenic polydipsia and poorly controlled diabetes
• the decreased secretion of antidiuretic hormone (ADH) of central diabetes
insipidus
• the decreased renal sensitivity to ADH of nephrogenic diabetes insipidus
Urinary Incontinence
• STRESS INCONTINENCE, increased abdominal pressure causes bladder
pressure to exceed urethral resistance—there is poor urethral sphincter
tone or poor support of bladder neck.
• URGE INCONTINENCE, urgency is followed by involuntary leakage due to
uncontrolled detrusor contractions that overcome urethral resistance.
• OVERFLOW INCONTINENCE, neurologic disorders or anatomic obstruction
from pelvic organs or the prostate limit bladder emptying until the bladder
becomes overdistended
• FUNCTIONAL INCONTINENCE arises from impaired cognition,
musculoskeletal problems, or immobility.
• Combined stress and urge incontinence is MIXED INCONTINENCE.
Hematuria
• GROSS HEMATURIA
• MICROSCOPIC HEMATURIA

• Myoglobin from rhabdomyolosis can also tinge the

urine pink in the absence of red cells.
 Flank Pain and Ureteral Colic
• Flank pain, fever, and chills signal acute
pyelonephritis.
• Renal or ureteral colic - sudden obstruction of a
ureter. It may radiate anteriorly toward the
umbilicus.
• KIDNEY PAIN is a visceral pain usually produced by
distention of the renal capsule and typically dull,
aching, and steady.
• URETERAL COLIC is a dramatically different severe
colicky pain radiating around the trunk into the
lower abdomen and groin, or possibly into the
upper thigh, testicle, or labium.
Thankyou!