Kindey PE

Inspection :

1) Informed consent
2) TTV : BP , HR , pola napas (Kussmaul -> hiperventilasi karena metabolik acidosis, singultus ->
persistent hiccups karena meningkatnya kadar ureum yang mengiritasi diafragma)
3) Hydration status (AKI -> dehydration) , cek mukosa mukus, mata, dorsum palmaris dan dahi
pada orang tua, atas sternum pada anak-anak
4) Face : Uremis frost -> depresi , moon face -> steroid, malar rash -> SLE
5) Skin turgor : pucat, pigmentasi, gatal-gatal, kering -> penebalan hiperkeratosis
6) Edema -> periorbital (nephrotic syndrome)
7) Abdomen -> scar, hernia (biasa umbilicalis), mass (kanker ginjal), bladder distention (di
suprapubis ada benjolan)

Auscultation :

1) Aorta
2) Renal artery : kanan sedikit lebih bawah dari artery renalis kiri (2-3 jari dari linea medial ke
lateral)
3) Heart sounds

Percussion :

1) Shifting dullness
2) Effusi pleura di thorax
3) Bladder -> perkusi suprapubis : redup jika kantung kemih penuh dan timpani bila kosong
4) CVA -> nyeri (pyelonephritis)

Palpation :

1) Renal palpation
2) Ballotement ginjal
3) Umbilical hernia
4) Testicular palpation
5) Pretibial edema

History taking prostatitis

Perkenalan

Nanya keluhan, SOCRATES

Common guiding questions :

1) pernah sakit atau sulit berkemih ?

2) Pernah terbangun saat tengah malam untuk berkemih ? jika ya, berapa sering?
3) Pernah ada dribbling air kencing saat mau selesai berkemih?

4) Frekuensi berkemih berlebih atau berkurang

5) hesistancy saat berkemih

6) incontinence seperti urge incontinence -> sulit menahan berkemih, stress incontinence ->
berkemih saat tertawa atau tekanan berlebih

Common symptoms in prosatitis :

 Fever, malaise, arthralgia and myalgia.

 Urinary frequency, urgency, dysuria, nocturia, hesitancy, and incomplete voiding.
 Low back pain, low abdominal pain, perineal pain and pain in the urethra. In chronic prostatitis the
most consistent finding is that of chronic pelvic pain.
 Pain on ejaculation is commonly reported, especially in CPPS, but it has been very poorly
investigated.[6]
 Urethral discharge.

Differential diagnosis :

 Cystitis.
 Benign prostatic hyperplasia.
 Urinary tract stones.
 Foreign body in the urinary tract.
 Bladder neoplasia.
 Prostatic abscess.
 Enterovesical fistula.

Pada urethral discharge : tanya mengenai dysuria dan riwayat hubungan seksual

Tersticular pain : jika ada , tanya riwayat trauma, onset, gejala kanker

Past history : Hypertension (renal disease) , DM (diabetic nephropathy or renovascular disease) ,

vascular disease, past history of urinary stones or surgery, recurrent infections, anemia

Drug History : NSAIDS , digoxin , drugs that are excreted renally etc

Family history : renal disease like adulf polycystic kidney disease , alport syndrome (hematuria,
proteinuria, renal failure) , etc