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EXAMINATION OF THE GUS

ISTIFANUS BALA BOSAN

PROFESSOR OF MEDICINE/NEPHROLOGY

AHMADU BELLO UNIVERSITY, ZARIA

February 2022

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Renal focused examination

  • General appearance
    • Well/unwell, Pallor, Tachypnoea, drowiness, Confusion
    • Pigmentation, Sallow skin, scratch marks, bruising, excoriations, rashes, uraemic frost, Nephrectomy or transplant scars, Urinary catheter/bag, Central venous line, Arterio-venous shunt

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  • Vital signs
    • Hypertension, Hypotension, Tachycardia, Small volume pulse, Uraemic fetor, Urine volume if on catheter, on oxygen or blood transfusion.

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  • Hands
    • Cold extremeties, brown nails, half and half nails, excoriations

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  • Pulse
    • Tachycardia, small volume pulse, cold extremities suggest, hypotension suggest hypovolaemia

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  • Face
    • Oedema, pallor, yellowish skin and mucus membranes, wetness/dryness of mucosa, bleeding gums

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  • Neck – check JVP, distended veins, central venous catheters

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  • Chest
    • Heart sounds, flow murmurs, basal crepitations, uraemic frost, echymosis

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  • Abdomen
    • Renal angle/loin tenderness, suprapubic dullness, palpable urinary bladder, palpable renal masses, pelvic kidney, transplant or nephrectomy scars

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Estimating fluid status�Clinical clues

Dehydration (water deficit)

  • Cold extremeties
  • Hypotension/postural hypotension
  • Capillary refill time > 2 sec
  • Sunken eyes
  • Reduced skin tugour
  • Dry mucous membranes
  • Dry axillae
  • Reduced urine output

Fluid overload (water excess)

  • Body swellings (peripheral oedema
  • Raised JVP
  • 3rd heart sound
  • Systolic flow murmur
  • Basal crepitations
  • Normal or reduced urine output

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  • Measure Central venous pressure
    • Normal CVP – 5-10 cm of water
    • Low CVP – dehydration/hypovolaemia
    • High CVP – Fluid overload

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  • Do Urinalysis
    • Protein, glucose, nitrite, pH, SG, Leucocytes, blood, bilirubin, urobilinogen, ketones, creatinine

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  • Digital rectal exam for prostate enlargement

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  • Vaginal exam for cystocoel/uterovaginal prolapse

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  • Adequately document your findings

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Thank you

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THE ROLE OF THE SIDE LAB IN CLINICAL MEDICINE

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  • The side laboratory is a simple laboratory within the area of clinical service.

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  • Easily accessed by the clinical service provider

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  • Provide instant results to help instant clinical service decision

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  • Clinical service provider should be competent enough to carry out such laboratory examinations

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  • Useful for medical students teaching and demonstration

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Test parameters commonly available in side labs

  • Urine
    • Urinalysis - Protein, glucose, nitrite, pH, SG, Leucocytes, blood, bilirubin, urobilinogen, ketones, creatinine
    • Sediment microscopy may be available (light or contrast) – casts, parasites, crystals, cells, bacteria.

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  • Stool
    • Occult blood – guaiac + acetic acid or guaiac impregnated card
    • Microscopy for ova, cysts, parasites (nematodes, cestodes, trematodes and protozoa

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  • Sputum – gram stain, AAFB

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  • Blood – PCV, Hb, ESR, viral screening tests, blood glucose

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  • Other body fluids
    • CSF, Pleural/pericardial effusion – glucose, proteins, gram stain, AAFB

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  • Less common parameters
    • Blood biochemistry – urea, creatinine, K+, uric acid, HCo3
    • Blood gases – arterial or capillary

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Thank you