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PHYSICAL EXAMINATION

Are the kidneys palpable in a normal patient?
The right kidney may be palpable in children and thin adults. The left kidney is difficult to palpate, as it lies higher within the retroperitoneum than the right kidney. Examination is best performed bimanually, with one hand behind the patient in the costovertebral angle and the other anteriorly just below the costal margin. With inspiration, the kidney may be felt as it moves downward. In neonates, examination is performed by palpating the flank between the thumb anteriorly and the remaining fingers posteriorly in the costovertebral angle. Both kidneys can be outlined reliably in this fashion.
 
What is the significance of an abdominal bruit?
Although not a specific finding, auscultation of a bruit in the epigastrium or upper abdomen may suggest the presence of renal artery stenosis in the appropriate clinical setting. This finding is particularly indicative when the bruit is continuous (systolic-diastolic). A bruit may vary in intensity with fluctuation of the systemic blood pressure, or disappear if renal artery stenosis progresses to near or total occlusion. An abdominal bruit may also occur in association with a renal artery aneurysm or arteriovenous malformation.
 
 

Where is renal pain usually localized on examination?

Renal pain due to inflammation or obstruction may result in vague, diffuse back discomfort. A renal source often can be identified by the finding of localized tenderness in the costovertebral angle, just late.ral to the sacrospinalis muscle and inferior to the twelfth rib. This is usually best elicited by percussion of the area with the fist.
 
At what filling volume can the adult bladder be detected on physical examination?
In the adult, a normal bladder cannot be palpated or percussed until there is a urine volume of at least 150 101. For the most part, percussion is SUj1S;rior to palpation when evaluating a patient for bladder distention. Patients with frank urinary retention may have visible bladder distention that may extend to the level of the umbilicus.
 
When is examination of the bladder under anesthesia important?
Bimanual examination under anesthesia is useful in assessing the local extent of carcinoma of the bladder and its mobility. In the female, this is done by compressmg the bladder between one hand on the abdomen and the other in the vagina. Male patients are examined with a hand on the abdomen and a finger in the rectum.

 
What is paraphimosis?
Paraphimosis is a condition that may arise when the foreskin of the penis has been retracted beyond the corona of the glans, and is not subsequently reduced. This can lead to constriction of the glans penis, resulting in pain, edema, and possible vascular compromise. Failure to reduce the foreskin after insertion of a urethral catheter is one situation in which paraphimosis may occur.

 
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