Pemeriksaan Fisik Sistem Perkemihan

Summary

This transcript outlines a step-by-step guide for performing a physical examination of the urinary system, focusing on kidney palpation. It explains the proper positioning of the patient and the techniques for palpating both the right and left kidneys, including the use of both hands and instructions for the patient to breathe during the examination. The script also covers signs of abnormalities such as kidney enlargement, tumors, or other conditions like glomerulonephritis and hydro nephrosis. Additionally, it addresses how to assess for pain and includes guidelines for documenting findings and planning further diagnostic tests if necessary.

Takeaways

• 😀 Greet the patient with a formal greeting and introduce yourself before starting the examination.
• 😀 Inform the patient about the physical examination process to ensure they are comfortable.
• 😀 Instruct the patient to lie down in a relaxed position and ensure they remove any necessary clothing for the examination.
• 😀 Warm your hands by rubbing them together before performing any palpation on the kidneys.
• 😀 For the right kidney palpation, place the left hand on the posterior side and the right hand on the anterior side, palpating while the patient inhales deeply.
• 😀 For the left kidney, use the right hand to lift the kidney from below while the left hand palpates the upper quadrant of the abdomen.
• 😀 A normal kidney is mobile and moves about 3 cm downward during inspiration, with the right kidney typically easier to palpate.
• 😀 Enlarged kidneys can indicate conditions such as hypertrophy, agenesis, hypoplasia, atrophy, or tumors, and should be checked for irregularities.
• 😀 Tumors in the kidney are often firm, irregular, and may be attached to surrounding tissues, while hypertrophic kidneys may have a smooth surface.
• 😀 If the patient experiences pain during palpation, especially in the costovertebral angle, it may indicate conditions like pyelonephritis or urinary tract obstruction.
• 😀 Percussion over the costovertebral angle with the ulnar side of the fist can help detect tenderness, which may point to nephritis or obstruction.
• 😀 An enlarged bladder may be felt as a solid mass in the pelvic region, and it will shrink once the bladder is emptied.
• 😀 Accurate documentation of kidney palpation findings, including any pain or abnormality, is crucial for the patient's medical record and further diagnostic decisions.

Q & A

What is the first step in conducting the physical examination of the urinary system?

The first step is to introduce yourself to the patient and explain the procedure. This helps in building rapport and ensuring the patient is aware of what will happen during the examination.

What should be the patient's position during the examination?

The patient should be in a relaxed supine position, lying flat on their back, with their clothing adjusted to allow for palpation of the abdominal area.

Why is it important to warm the examiner's hands before palpation?

Warming the hands helps to increase patient comfort, as cold hands can cause discomfort and may make the examination more difficult.

How is the right kidney palpated?

The right kidney is palpated by placing the left hand on the posterior abdominal wall and the right hand on the anterior wall. The patient is asked to breathe deeply, and during the peak of inhalation, both hands gently palpate the kidney area.

What is considered a normal finding during the palpation of the right kidney?

A normal right kidney should be mobile and move about 3 cm during inspiration. It may be easier to palpate because it is lower in position compared to the left kidney.

What could abnormal findings during kidney palpation indicate?

Abnormal findings such as a non-mobile kidney or the presence of a mass could indicate conditions such as kidney hypertrophy, tumors, hydronephrosis, or kidney removal.

How is the left kidney palpated differently from the right kidney?

The left kidney is typically harder to palpate because it is positioned higher. The examiner uses their left hand to palpate laterally to the left of the rectus abdominis while the right hand presses upwards.

What might indicate an enlarged kidney during palpation?

An enlarged kidney may feel like a mass with a smooth or irregular surface. It could be due to conditions like hypertrophy, infection, or tumors.

What is the significance of costovertebral angle tenderness during the examination?

Tenderness at the costovertebral angle, identified by percussion, may indicate kidney issues like acute pyelonephritis, urinary tract infection, or obstruction.

When would further diagnostic tests, such as an ultrasound or X-ray, be recommended?

Further tests like urinalysis, ultrasound, or X-ray may be needed if the physical examination reveals abnormalities such as non-palpable kidneys, abnormal tenderness, or suspected masses.