new hx€of genitourinary system - wordpress.com · 2016. 9. 10. · genitourinary system urinary...
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Hx ofGenitoUrinary
System
UrinarySymptoms
Hematuria
at beginning orend of micturition
urethral inflam.
trauma
prostatic dis.
on standing porphyria
other causes drugs (rifampicin)
severe muscle trauma
change inurinevolume orstream
polyuria, nocturia, anuria
hisetancy
size of stream
dribbling
urine retention
strangury (recurrent slow, painful urination)
pisendoux: desire to urinate after having done
double voiding (incomplete bladder emptying)
Urinaryincontinence
Causes
UTI
delerium
diuretics
immobility
atrophic urethritis or vaginitis
types
stressincontinence
after sudden inintraabdominal pressure
overactivityof detruser urge to urinate then leakage
underactivityof detruser frequency, nocturia
urethralobstruction
dribbling afterincomplete urination
urinary obstruction
common in elderly men (prostatism)
micturitionhesitancy (difficult starting)
size of stream
terminal dribbling
strangury, pisendoux
Causes
calculus
blood clot
prostatic mass
retroperitoneal fibrosis
uterine prolapse
dysuria
renal colic
fever, loin pain
urethral discharge
Genital Symptoms
Mensesimpotenceloss of libidoinfertilitypregnancyurethral or vaginal dischargegenital rash
ChronicRenalFailure(CRF)
symptoms are due to uremia
Causes
Glomerulonephritis
DM
systemic vascular dis.
analgesic nephropathy
reflux nephropathy
hypertensive nephrosclerosis
polycystic kidneys
obstruction
amyloid
Pathophysiology
dehydration >>nocturia
fail excrete Na>>hypertension
renal tubule damage >>Na loss>>hypotension
oliguria >>hyperkalemia(K excretion depend on urine volume)
fail acid excretion >>metabolic acidosis
fail hydroxylate vit. D3 >>vit. D deficiency>>2ry hyperparathyroidism>> Ca & P>>bone dis.
fail excrete erythropoietin>>normochromic normocytic anemia
Renal function
normal GFR 90120 mL/min.(estimated by creatinine clearance)
serum creatinine
serum urea
Symptoms
anuria (<50 mL/d), oliguria (<400 mL/d)nocturia, or polyuria
anorexia
vomiting
fatigue, hiccup, insomnia
pruritus, itching, edema
complications
bone pain
fractures
hypercalcemia
pericarditis
hypertension
cardiac failure,ischemic heart dis.
neuropathy
peptic ulcer
ask about dialysisask about renal transplantation
features suggestingchronic rather than acute
small kidney size
renal bond dis.
anemia
peripheral neuropathy
Menstrual &Sexual Hx
menarche
regularity of periods
dysmenorrhea, menorrhagia
vaginal discharge
gravidity, parity
contraception
Past Hx
recurrent UTI
renal calculi
pelvic surgery
Family Hx
polycystic kidney dis.(autosomal dominant)
Alport's syndrome(deafness with renal impairment)
Done by: Mohammad AlMarhoon [email protected]: Clinical Examination (Talley)WWW.SMSO.NET
General
hyperventilation <<metabolic acidosishiccupdrowsy, coma <<terminal renal failure
myoclonic jerks, tetany, seizures <<low Cahydration
Hands
nails
hypoalbuminemia
leuchonychia(white transverse opaque bands)Muehrcke's nails(paired white transverse lines)
renal failureMee's lines(single transverse white line)
chronic renal failure 1/2 & 1/2 nails
anemia with pallorasterixis in terminal chronic renal failure
AV fistula
Arms
bruising <<chronic renal failure
skin pigmentationscratch marks <<Ca deposition
peripheral neuropathymyopathy
Face
anemia, jaundice
band keratopathy (Ca depositionbeneath corneal epithelium)
uremic fetormucosal ulcers
Abdomen
inspectionscars
nephrectomytransplanted kidney
peritoneal dialysis
ascites
palpation
enlarged kidney bulges forward
perinephric abscess bulge backward
unilateral renal mass
renal cell carcinoma
hydronephrosispolycystic kidneyacute pyelonephritis
renal abscess
bilateral renal mass
polycystic kidneyshydronephrosis
nephrotic synd.infiltrative dis. (amyloid)
percussion shifting dullness
bladder
auscultation ofrenal bruit above umbilicus, 2 cm lateral to midline
in 50% of pt. with renal artery stenosis
Back
strike vertebral column for bony tendernessMurphy's kidney punchstrike renal angle
sacral edema
Legs
edema
purpurapigmentation
scratch marks
peripheral neuropathy & myopathygout arthropathy
Urine
colortransparency
smell
specific gravitynormal 1.0021.025
low >>chronic renal failure
high >>dehydration
Chemical analysis
pHnormal urine is acid
consistent alkaline early morning urine &cannot be acidified >>distal RTA
protein
glucoseDM
salicylates, ascorbic acidinability to absorb glucose (Fanconi synd.)
ketones
causesDKA
starvation
ketone bodiesacetone
Bhydroxybutyric acid
acetoacetic acid
bloodhematuria
hemoglobinuria
myoglobinuria
nitriteindicate bacterial infection
urine sediments
RBCsnormal <5
WBCsnormal <10
Casts
hyalineconsist of TammHorsfall mucoprotein
Granularconsist of hyaline materialusually with proteinuria
red cell casts1ry glomerular dis.
white cell castsbacterial pyelonephritits
fatty castsnephrotic synd.
Done by: Mohammad AlMarhoon [email protected]: Clinical Examination (Talley)WWW.SMSO.NET