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Endo and Renal

Clinical Signs and Symptoms of Renal and Endocrine Pathology

Haematuria, dysuria, fever, suprapubic pain, moderate flank or back pain Urinary tract infection
Fever Prostatitis, pyelonephritis
Severe loin pain Renal calculi
Yellow urine Tetracycline
Red urine Rifampicin, severe muscle breakdown
Brown urine Nitrofurantoin
Orange urine Danthron laxatives
Falsely negative urine blood test Vitamin C intake
Nitrites in the urine specimen Gram negative bacterial infection
Leucocytes in the urine specimen Urine infection or contamination with vaginal secretion
Ketones in the urine specimen DKA, starvation
Easily palpable bladder with dullness in suprapubic region Bladder outlet obstruction
Hesitancy, dribbling, strangury and pis-en-deux Prostatism
Leakage of urine during times of exertion Stress incontinence
Overactivity of the detrusor muscle resulting in the intense urge to urinate and leakage of urine. Urge incontinence
Increased frequency, nocturia and leaking of small amounts of urine Underactivity of the detrusor muscle
GFR = 90-120ml/min Normal GFR
GFR > 90ml/min Stage 1 CKD - normal GFR but some kidney damage
GFR = 60-89ml/min Stage 2 CKD - mild GFR reduction
GFR = 30-59ml/min Stage 3 CKD - moderate GFR reduction
GFR = 15-29ml/min Stage 4 CKD - severe GFR reduction
GFR = <15 ml/min Stage 5 CKD - End stage renal failure
Hyperventilation Metabolic acidosis in late renal failure
Hiccuping Uraemia
Myoclonic jerks and tetany Hypocalcaemia in late renal failure
Leuconychia Hypoalbuminaemia
Ecchymoses Nitrogen retention causing impaired prothrombin consumption.
Scratch marks and pruritis Uraemia and hyperphosphataemia
Renal bruit Renal artery stenosis
Carotid bruits Generalised atherosclerotic disease
Costovertebral angle tenderness Renal infection (perinephric abscess, pyelonephritis, renal calculi)
Resonant suprapubic area Normal
700-2500mls of urine per day Normal adult urine output
Less than 400mls per day Oliguria
Increased frequency with normal volume High fluid intake, glycosuria, diuretics, defects in urinary concentration, renal disease, diabetes insipidus.
Increased frequency with reduced volume Bladder outlet obstruction, small bladder, urinary tract infection.
Perineal pain Prostatitis, prostadynia, urethral trauma
Dysuria UTI or lower urinary tract trauma
Less than 50mls per day Anuria
Abnormal smelling urine UTI, antibiotics, asparagus
Urinary infections/enuresis as a child Vesicoureteric reflux
Elevated JVP Right sided heart failure caused by fluid overload from renal failure
Bilateral pitting oedema Hypoalbuminaemia or cardiac disease
Capillary refill of 2-3 seconds in adults Normal capillary refill
Capillary refill of 2-4 seconds in the elderly Normal capillary refill
Sunken fontanelles Dehydration
Increase of 8-12 bpm Normal postural increase in heart rate
Increase of more than 30bpm Hypovolaemia
A reduction of SBP of at least 20mmHg or diastolic of at least 10mmHg. Orthostatic hypotension
A systolic reduction of 3-4mmHg when standing Normal
A diastolic increase of 3-7mmHg when standing Normal
Waist:hip of 1.0 Increased risk for men
Waist:hip of 0.85 Increased risk for women
Waist circumference of 94cm Increased risk for men
Waist circumference of 80cm Increased risk for women
Waist circumference of 102cm Greatly increased risk for men
Waist circumference of 88cm Greatly increased risk for women
Polyuria, polydipsia, hyperglycaemia, Kussmaul respiration (laboured and deep), abdominal pain, nausea and vomiting. Diabetic ketoacidosis
Severe dehydration, decreased mental function, sensory or motor impairments, increased risk of thrombosis, highly elevated BG. Hyperosmolar, Hypertonic State
Weakness, lethargy, tremors, morning headaches, irritability, dizziness, hunger, sweating, numbness around the lips and fingers. Hypoglycaemia
Bronze diabetes and haemochromatosis Deposition of iron in the pancreas
Charcot's joints Diabetic neuropathic arthropathy
Symmetrical plaques on the shins with a yellow appearance and waxy feel in diabetic patients Necrobiosis lipoidica
Increased appetite with weight loss Hyperthyroidism or uncontrolled diabetes mellitus
Increased appetite with weight gain Cushing's syndrome
Decreased appetite with weight loss Adrenal insufficiency or Addison's disease
Decreased appetite with weight gain Hypothyroidism
Constipation Hypothyroidism, hypercalcaemia
Diarrhoea Hyperthyroidism, adrenal insufficiency
Hirsutism Excess androgens in females
Loss of axillary and pubic hair in females and males Decrease in adrenal androgens caused by hypogonadism, hypopituitism or adrenal insufficiency
Lethargy Hypothyroidism, Addison's disease, diabetes mellitus
Xanthelasma Hypothyroidism, diabetes mellitus
Coarse,pale and dry skin Hypothyroidism
Spontaneous ecchymoses and purple striae Cushing's syndrome
Onycholysis and pretibial myxoedema Graves' disease
Dry and scaly skin Hyperparathyroidism
Acanthosis nigricans Insulin resistant states - Cushing's syndrome, diabetes mellitus, acromegaly
Increased pigmentation Adrenal insuffiency, acromegaly, cushing's disease (excess ACTH)
Decreased pigmentation Hypopituitism
Vitligo Autoimmune conditions such as Hashimoto's disease and Addison's disease as well as hypothyroidism
Impotence Primary hypogonadism, diabetes mellitus, hyperprolactinaemia, hypopituitism, thiazide diuretics, beta blockers
Amenorrhoea Hyperthyroidism, excess androgen production, pituitary dysfunction
Menorrhagia Hypothyroidism
Carpal tunnel syndrome Acromegaly, hypothyroidism
Increased sweating Hyperthyroidism, phaeochromocytoma, hypoglycaemia or acromegaly
Exophthalmos >18 mm, specific to Graves' disease
Proptosis <18mm, specific to Graves' disease
Lid lag and lid retraction Signs of hyperthyroidism not specific to Graves' disease
Pallor of the palmar creases and peripheral neuropathy Hypothyroidism - due to vitamin B12 deficiency
Systolic murmurs Hyperthyroidism
Pericardial effusion and pleural effusion Hypothyroidism
Dull percussion of upper manubrium Retrosternal goitre
Soft thyroid Normal
Firm goitre Simple goitre
Rubbery hard goitre Hashimoto's thyroiditis
Stony hard goitre Carcinoma, calcification in a cyst, fibrosis or Riedel's thyroiditis
Neck lump rises during swallowing Goitre or thyroglossal cyst
Neck lump moves upwards if the patient pokes their tongue out Thyroglossal cyst
Thyroid bruits Hyperthyroidism
Hung up ankle reflex Hypothyroidism
Non-pitting ankle oedema Hypothyroidism
Chvostek's and Trousseau's sign Hypocalcaemia
T10-T11 Renal colic
T11-L1 Ureteric pain
Reduced visual field and headache Acromegaly
Hepatomegaly, splenomegaly and renal enlargement Acromegaly
Yellow skin Hypercarotenaemia in hypothyroidism
Galactorrhoea Hyperprolactinaemia
Tapping gently over the 7th cranial nerve results in tetany Hypocalcaemia
Virilisation The appearance of male secondary sexual characteristics due to excessive androgens
Created by: Epoot