History and Physical exam for the urologic patient
Published byModified over 4 years ago
Presentation on theme: "History and Physical exam for the urologic patient"— Presentation transcript:
1 History and Physical exam for the urologic patient Mohammad Al Omar, MD, FRCS (Canada)Assistant professorConsultant UrologistEndourologist, Laparoscopic and Robotic UrologistKKUH, KSU
2 IntroductionMost diagnosis can be reached by a complete history, and a thorough physical examinationChallenges in HistoryCommunication (anxiety, language, educational background )Make the patient feel comfortablecalm, caring, and competent imageFamily member
3 Introduction Time Listen carefully sufficient to express their problems and the reasons for seeking your careListen carefullywithout distractions in order to obtain and interpret the clinical information provided by the patient
4 History Major components Chief complaint History of the present illnessPast medical historyFamily historyReview of systemsMedicationsAllergiesSocial History
5 Chief Complaint and Present Illness The chief complaint is a constant reminder as to why the patient initially sought care.This issue must be addressed even if subsequent evaluation reveals a more serious or significant condition that requiresDurationSeverityChronicityPeriodicityDegree of disabilityExample
6 PainCan be severeurinary tract obstructioninflammationInflammation of the GU tract is most severe when it involves the parenchyma of a GU organPyelonephritisProstatitisEpididymitisInflammation of the mucosa of a hollow viscus usually produces discomfortCystitisUrethritis
7 Pain Tumors: No pain unless obstruction extend beyond the primary organ to involve adjacent nerves
8 Pain Renal Pain Acute distention of the renal capsule Site: ipsilateral costovertebral angle just lateral to the sacrospinalis muscle and beneath the 12th ribAcute distention of the renal capsule
9 Pain Associated symptoms Gastrointestinal symptoms Nausea Vomiting Ileusbecause of reflex stimulation of the celiac ganglion and because of the proximity of adjacent organs
10 PainRenal pain may also be confused with pain resulting from irritation of the costal nerves, most commonly T10–T12 which is:not colicky in nature.Severity of radicular pain may be altered by changing position
11 Ureteral pain Usually acute and secondary to obstruction Midureter ( Rt side): referred to the right lower quadrant (McBurney's point) and simulate appendicitisMidureter (Lt side) :referred over the left lower quadrant and resembles diverticulitis.Scrotum in the male or the labium in the female.Lower ureteral obstruction frequently produces symptoms of bladder irritability( frequency, urgency, and suprapubic discomfort)
12 Vesical PainVesical pain is dueOverdistentioninflammation
13 Prostatic PainInflammation with secondary edema and distention of the prostatic capsulepoorly localizedlower abdominalInguinalPerinealLumbosacralrectal pain.irritative urinary symptoms ( frequency and dysuria)acute urinary retention.
14 Penile PainPain in the erect penis is usually due to Peyronie's disease or priapismPain in the flaccid penisusually secondary to inflammation in the bladder or urethrareferred pain that is maximally at the urethral meatusparaphimosis
15 Testicular Pain Acute pain Chronic scrotal pain epididymitis torsion of the testicleChronic scrotal painhydrocelevaricocele,dull, heavy sensation that does not radiateReferred pain: kidneys or retroperitoneum
16 Hematuria Hematuria : the presence of blood in the urine In adults, should be regarded as a symptom of urologic malignancy until proved otherwiseIs the hematuria gross or microscopic?Timing: (beginning or end of stream or during entire stream)?Is it associated with pain?Is the patient passing clots?If the patient is passing clots, do the clots have a specific shape?
17 Hematuria Initial hematuria: Total hematuria Terminal hematuria usually arises from the urethraleast commonusually secondary to inflammation.Total hematuriamost commonbladder or upper urinary tracts.Terminal hematuriathe end of micturitionsecondary to inflammation bladder neck or prostatic urethra.
19 Obstructive Symptoms Decreased force of urination Urinary hesitancy IntermittencyPost void dribblingStraining
20 Enuresis Urinary incontinence that occurs during sleep Mostly in children up to 5 years
21 Urethral DischargeUrethral discharge is the most common symptom of venereal infection.
22 Fever and ChillsUsually inPyelonephritisProstatitisEpididymitis
23 Past Medical History Systemic diseases that may affect the GU system diabetes mellitus.multiple sclerosisTBSchistosomiasis
24 Family History prostate cancer Stones( cystine) Renal tumors (some types)
25 Previous Surgical Procedures it is worthwhile obtaining as much information as possible before any intended surgery, because most surprises that occur in the operating room are unhappy ones.
26 Smoking and Alcohol Use Cigarette smokingurothelial carcinoma, mostly bladder cancerErectile dysfunction.Chronic alcoholismimpaired urinary functionSexual dysfunction.testicular atrophy, and decreased libido.
27 PHYSICAL EXAMINATION General Observations visual inspection of the patientCachexiaMalignancy, TBJaundice or pallorGynecomastiaendocrinologic diseasealcoholismhormonal therapy for prostate cancer
28 Kidneys Palpation of the kidneys supine position The kidney is lifted from behind with one hand in the costovertebral angleIn neonates, palpating of the flank between the thumb anteriorly and the fingers over the costovertebral angle posteriorly
30 Abnormal Physical Examination Findings—Kidneys The most common abnormality detected on examination of the kidneys is a massIn neonates and younger children, the transillumination helps to distinction between cystic and solid
36 Scrotum and Contents Painful Painless TorsionEpididymitis firm or hard area within the testis should be considered a malignant tumor until proved otherwisePainlessSpermatoceleHydroceleVaricoceleTransillumination : Cystic vs. solidPainless solid testicular mass is tumor until proven otherwise