1. No category

HISTORY TAKING OF RENAL PROBLEMS
RENAL COLIC
Dr Ibrahim Z.I. Abujarad
Clinical skills lab
25-27/2/2013
Outline
•
•
•
•
Review of renal system
Renal symptoms
Renal colic
History taking of a patient with renal stone
Renal complaints
• Urinary frequency
– This is the passing of urine more often than is normal for the patient.
Quantify this ”how many times in a day” and also ask about the
volume of urine passed each time (you are attempting to decide
whether the patient is producing more urine than normal or simply
feeling the urge to urinate more than normal).
• Urgency
– This is the sudden need to urinate, a feeling that the patient may not
be able to make it to the toilet in time.
Ask about the volume expelled.
• Nocturia
– Urination during the night.
Does the patient wake from sleep to urinate?
How many times a night?
How much urine is expelled each time?
• Oliguria and anuria
– Oliguria is scanty or low-volume urination and is defined as the
excretion of <300ml urine in 24 hours. Causes can be
physiological (dehydration) or pathological (intrinsic renal
disease, shock or obstruction).
– Anuria is the absence of urine formation and you should
attempt to rule out urinary tract obstruction as a matter or
urgency. Other causes include severe intrinsic renal dysfunction
and shock.
• Polyuria
– This is excessive excretion of large volumes of urine and must be
carefully differentiated from urinary frequency (the frequent
passage of small amounts of urine).
– Causes vary widely but include the ingestion of large volumes of
water (including hysterical polydipsia), diabetes mellitus (the
osmotic effect of glucose in the tubules encourages more urine
to be made), failure of the action of ADH at the renal tubule (as
in diabetes insipidus) and defective renal concentrating ability
(e.g. chronic renal failure).
• Urinary incontinence
– The loss of voluntary control of bladder emptying. Patients
may be hesitant to talk about this so try to avoid the
phrase “wetting yourself. You could ask about it
immediately after asking about urgency ˜Do you ever feel
the desperate need to empty your bladder? Have you ever
not made it in time? or by asking about a loss of control.
There are 4 main types of urinary incontinence:
– True: total lack of control of urinary excretion. Suggestive of a
fistula between the urinary tract and the exterior or a
neurological condition.
– Stress: leakage associated with a sudden increase in intraabdominal pressure of any cause (e.g. coughing, laughing,
sneezing).
• Giggle: incontinence during bouts of laughter. Common in young
girls.
– Urge: intense urge to urinate such that the patient is unable to
get to the toilet in time. Causes include over-activity of the
detrusor muscle, urinary infection, bladder stones and bladder
cancer.
– Dribbling or overflow: continual loss of urine from a chronically
distended bladder. Typically in elderly males with prostate
disease.
• Hesitancy
– Difficulty in starting to micturate. The patient describes
standing and waiting for the urine to start flowing. Usually
due to bladder outflow obstruction due to prostatic
disease or strictures.
• Terminal dribbling
– A male complaint and usually indicative of prostate
disease. This is a dripping of urine from the urethra at the
end of micturition, requiring an abnormally protracted
shake of the penis and may cause embarrassing staining of
clothing.
• Dysuria
– Pain on micturition usually described by the patient as
burning or stinging and felt at the urethral meatus. Ask
whether it is throughout the passage of urine or only at
the end (terminal dysuria).
• Hematuria
– The passage of blood in the urine.
Always an abnormal finding.
– Remember that microscopic hematuria will be
undetectable to the patient, only showing on dip-testing.
• Incomplete emptying
– This is the sensation that there is more urine left to expel
at the end of micturition. Suggests detrusor dysfunction or
prostatic disease.
• Intermittency
– The disruption of urine flow in a stop-start manner. Causes
include prostatic hypertrophy, bladder stones, and
ureterocoeles.
Renal pain (colic)
• Renal colic by renal stones:
• It is a common medical
problem (1-2%) of
population
• May be clinically silent
• Can be visible on plain x-ray
• Renal colic: colicky pain
superimposed on a constant
pain in the renal angle often
with radiation to the groin
Renal pain (colic)
• Fixed renal colic: located posteriorly
in the renal angle & anteriorly in
the hypochondrium, worsened by
movement
• Ureteric colic: starts suddenly as an
agonizing pain from loin to groin
causing the patient to move around
trying in vain to find comfort
• Colicky attack rarely lasts more than
8 hours, no pyrexia, pulse increase
due to the severe pain
• Pain is not related to the size of
stone
• Almost associated with hematuria
History taking of renal colic
S.No
1.
Response
HISTORY OF THE PRESENTING ILLNESS:
Pain in the back.
2.
3.
4.
0.5
DETAILS OF THE PRESENT ILLNESS:
Duration: Since 1 day
0.25
Site: Renal angle
0.25
Radiation: Radiation radiating to the groin
0.25
Character: Squeezing pain, Colicky pain, Comes in waves
0.25
Intensity: Due to pain ,Pt. Rolls in bed with agony
0.25
Aggravating factors: No
0.25
Relieving Factors: No
0.25
Associated symptoms: Nausea/Vomiting, Haematuria, frequency, Anorexia ,
fever and burning micturition (any 4 out of 6)
1.0
GENERAL HISTORY:
Loss of appetite: Present
0.25
Loss of weight:
0.25
No
HISTORY OF PAST ILLNESS:
No similar complaints before
5.
6.
Marks
0.25
PERSONAL HISTORY:
No Alcohol, No smoking, No recent travel
0.25
FAMILY HISTORY:
0.25
No other family member with similar complaints
7.
8.
PAST MEDICAL HISTORY:
No Diabetes, No hypertension, No previous history of
0.25
Enquired/ performed other system examination
0.25