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Acute abdomen in pregnancy
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Nicole Fearing, William L. Holcomb
Pain, usually in the flank but sometimes in the abdomen, is almost always the presenting complaint. Nausea, vomiting, dysuria, urgency, fever, or gross hematuria may be associated. About one patient in four will give a past history of urolithiasis (79,80). Costovertebral angle tenderness is almost always present. In one series, abdominal tenderness was elicited in 6 of 20 patients (79). Concomitant urinary tract infection may obscure the diagnosis of ureteral calculi.
Unexplained Fever In Urology
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
In the majority of patients, no local physical findings are present, while costovertebral angle tenderness may be elicited in some and palpable abdominal mass and crepitus in tissues overlying the affected kidney may exist in a few. The latter finding usually presages a dismal outcome.
Clinical evaluation: History and physical examination
Published in Jacques Corcos, David Ginsberg, Gilles Karsenty, Textbook of the Neurogenic Bladder, 2015
Examination of the back is easy to perform but can provide clues regarding previous surgery and pathology, which may have been missed during the history. Costovertebral angle tenderness should be assessed particularly in patients with history of UTIs and pyelonephritis but may not be reliable depending on the level of their neurologic disease. One should assess for midline skin dimples, which may be a sign of occult spinal dysraphism. In addition to assessing for scoliosis or abnormal spinal configuration, attention should similarly be paid to the presence of leg contractures as both can make operative patient positioning more challenging due to increased concern for pressure points and possibility of difficult access to the abdomen or pelvis.
Renal and perinephric abscesses involving Lactobacillus jensenii and Prevotella bivia in a young woman following ureteral stent procedure
Published in Journal of Community Hospital Internal Medicine Perspectives, 2020
Abhinav Mohan, Jacob Rubin, Priyank Chauhan, Juan Lemos Ramirez, German Giese
In the emergency department, she presented with fevers (38.3 ⁰C) and tachycardia (117). Significant right abdominal and costovertebral angle tenderness were present on the exam. Complete blood count showed mild leukocytosis (11.4). Urinalysis showed rare bacteria with negative leukocyte esterase, and urine culture was negative. CT abdomen/pelvis with contrast showed enlarged right kidney with a 4 cm renal cyst, as well as a complicated right-sided perinephric fluid collection, suspicious for abscess or hematoma (Figure 1). She was admitted for sepsis and started on cefepime and vancomycin. A percutaneous drain was placed into the renal cyst, and purulent fluid was removed. Cultures of the drained fluid grew Lactobacillus, Streptococcus viridans species, and ‘mixed anaerobes’. Blood cultures grew Lactobacillus jensenii on anaerobic media. This was confirmed by both rapid ANA sequencing and MALDI-TOF Mass Spectrometry.
Robot-assisted radical nephrectomy for primary renal mesenchymal chondrosarcoma: case report and literature review
Published in Renal Failure, 2019
Wen Deng, Jinxiu Zhou, Xiaoqiang Liu, Luyao Chen, Guanghua Guo, Bin Fu
A 62-year-old man, with no significant medical history, was hospitalized with left loin pain and intermittent gross hematuria. Nothing except for mild costovertebral angle tenderness was found abnormal on routine physical examination. The laboratory tests including hematologic studies and urinalysis are shown in Table 1. Abdominal contrast-enhanced CT scan revealed a 14 cm × 11 cm × 8 cm heterogeneous lobulated mass, which involved most of the left renal parenchyma, with the calcification foci and cystic spaces. Multiple patchy dense calcifications occupying the expanded renal pelvis and bar filling defect in left renal vein were also detected in the CT scan (Figure 1). A 0.7 cm lung nodule was identified at the left upper lobe on the chest X-ray. In a bone scan, nuclide was distributed evenly and meristicly over the body except for the 7th thoracic vertebra, which was considered as a metastatic lesion.
A risk prediction model of urinary tract infections for patients with neurogenic bladder
Published in International Journal of Neuroscience, 2021
Wenqiang Wang, Peng Xie, Jing Zhang, Wenzhi Cai
Clinical symptoms of UTI include urgency, frequency, dysuria, Lumbago, urination pain and urinary retention. Physical signs included fever, costovertebral angle tenderness/pain and suprapubic tenderness. Patients with an axillary temperature of > 37.5° were considered febrile. According to the above clinical manifestations, UTI diagnosis can be made if one of the following conditions is met and with one of above clinical manifestations [2]: (1) Positive urine culture. (2) Fresh urine specimens were centrifuged and examined by phase contrast microscopy (400 x). Bacteria were observed in half of every 30 visual fields. (3) UTI can be diagnosed if bacteria are found in the culture of urine aspirated by suprapubic puncture. (4) Diagnosis of UTI in medical records.