1a. curs 1a (examenul clinic al pacientului cu afectare renala)

7/24/2019 1A. Curs 1A (Examenul Clinic Al Pacientului Cu Afectare Renala)

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EXAMENUL CLINIC ALEXAMENUL CLINIC ALPACIENTULUI CUPACIENTULUI CU

AFECTARE RENALAFECTARE RENAL

Dr. A.D. ZugravuDr. A.D. Zugravu

Spitalul Clinic d N!r"l"gi #Dr. Car"l Davila$%&'(&'%(()


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%&.(&.%(() Spitalul Clinic d N!r"l"gi *Dr. Car"l Davila* %

DE CE +INEDE CE +INE PAPACCIENTIENTULUL,,

Pr-ntara clinic a a!c/iunil"rPr-ntara clinic a a!c/iunil"r rnalrnalPacin/i aPacin/i a00ii1pt"1atic1pt"1aticii22dar la car 03adar la car 03adiagn"0ticat " an"1ali la 4a1nul clinic'diagn"0ticat " an"1ali la 4a1nul clinic'pr"5l paraclinicpr"5l paraclinic6767S1n 0au 0iS1n 0au 0i1pt"11pt"10ugr8nd " a!c/iun0ugr8nd " a!c/iunrnalrnal0u5iacnt0u5iacnt77

9"li 0i0t1ic cu a!ctar rnal9"li 0i0t1ic cu a!ctar rnal77I0t"ric !a1ilial d 5"al rnal c"ngnitalI0t"ric !a1ilial d 5"al rnal c"ngnital..


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%&.(&.%(() Spitalul Clinic d N!r"l"gi *Dr. Car"l Davila* :

PAPACCIENIEN;II;IISSIIMPT


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%&.(&.%(() Spitalul Clinic d N!r"l"gi *Dr. Car"l Davila* =

EE4a14a1nnululccliniclinic

S1nl vitalS1nl vital>>>>>>

? PAPA22clin"clin"''"rt"0tati01"rt"0tati016@6@la a15l 18inila a15l 18ini? A+A+'pul0'pul0ulul

22clin"clin"''"rt"0tati01"rt"0tati0166?

FF

R 2R 2

!rcvn/a!rcvn/a

r0pirat"rir0pirat"ri6@6@ tipul dtipul dr0pira/ir0pira/i22B001aul B001aul acid"acid"--66

? t1praturt1praturaa

Statu0ul licidianStatu0ul licidian>>>>>>

? PAPA22clin"clin"''"rt"0tati01"rt"0tati0166? A+A+22clin"clin"''"rt"0tati01"rt"0tati0166? tturg"rurg"rul cutanatul cutanat? tturg"rurg"rul gl"5ului "cularul gl"5ului "cular

? d1 car la0 g"dud1 car la0 g"du? di0tn0i vn ugulardi0tn0i vn ugular? pat"1galpat"1galii

durr"a0durr"a0

Nu d"ar al tractului urinar@ ci 4a1n clinic c"1plt>


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%&.(&.%(() Spitalul Clinic d N!r"l"gi *Dr. Car"l Davila* &

In0pcIn0pc/ia/ia


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%&.(&.%(() Spitalul Clinic d N!r"l"gi *Dr. Car"l Davila*

Ga5itu0 ? cu0ing"id 2prdni0"n>6Ga5itu0 ? cu0ing"id 2prdni0"n>6

M"di!icri al c"1p"-i/ii uriniiM"di!icri al c"1p"-i/ii urinii??1aturi1aturi22u. r"Hi35runu. r"Hi35run6@ pr"tinuri6@ pr"tinuri2u.2u.0pu1"a00pu1"a06@ p6@ piiuriuri2u.2u.tul5urtul5ur6@ c6@ ciiluria 2u.luria 2u.

lpt"a0lpt"a06@ 6@ ii0turia@ pnu1aturia.0turia@ pnu1aturia.Ed1Ed1

Rinici 1ariRinici 1ari229PRAD9PRAD@ tu1"r@ tu1"r66

UrtrUrtrll? n? n!!r"patr"patii cr"niccr"nic"50tructiv"50tructivl"5 v-icall"5 v-ical22pacin/ii 0la5ipacin/ii 0la5i66


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%&.(&.%(() Spitalul Clinic d N!r"l"gi *Dr. Car"l Davila* J


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%&.(&.%(() Spitalul Clinic d N!r"l"gi *Dr. Car"l Davila* K

PalpaPalparr


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%&.(&.%(() Spitalul Clinic d N!r"l"gi *Dr. Car"l Davila* )

Ed1Ed1ulul

nrali-nrali-atat? rnalrnal

? cardiaccardiac? paticpatic

L"caliL"cali-at-at?

alrgicalrgic

? in!la1at"rin!la1at"r? p"0t trau1aticp"0t trau1atic

Pr3d1Pr3d1? c8ntrir -ilnicc8ntrir -ilnic

Su5cutanSu5cutanatat2=3&2=3& ll66? dclivdcliv? la0 g"dula0 g"du

Sr"0 2&3JSr"0 2&3J ll66? iidr"3t"ra4@dr"3t"ra4@ 33pricard@pricard@a0cita0cit

+i0cral@ ana0arc+i0cral@ ana0arc

2&3%(2&3%( ll66

Cla0i!icar 3 l"cali-ar Stadii


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%&.(&.%(() Spitalul Clinic d N!r"l"gi *Dr. Car"l Davila* (

Ed1ul rnalEd1ul rnal

Ed1ul rnal 2n!r"tic6? d "5ici al5@ pu!"0@rcnt aprut@ la0 uH"r g"du.


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PalpaPalpararariniciuluiriniciului3 1t"d3 1t"d

u"n I0raOl

lnard


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##PuPunnccttrnalrnal$$ pp"0tri""0tri"aarr

c"0t"vrt5ralc"0t"vrt5ral

c"0t"1u0cularc"0t"1u0cular

c"0talc"0tal@ in!ri"r@ in!ri"r

CC"r0p"r0puundnd riniciuluiriniciului@@5a-intului Hi5a-intului Hi urtrurtruluiului0upri"r0upri"r..


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%&.(&.%(() Spitalul Clinic d N!r"l"gi *Dr. Car"l Davila* :

MManvranvraai"rdan"i"rdan"

Avrti-a/iAvrti-a/i papaccintintulul@@ ap"iap"iaplica/i " l"vitur 5ru0c Qnaplica/i " l"vitur 5ru0c Qn-"na l"15ar cu 1argina-"na l"15ar cu 1arginacu5ital a pal1i7 vntualcu5ital a pal1i7 vntual

Qncp/i 0a l"vi/i d laQncp/i 0a l"vi/i d lanivlul t"raclui@ 0pr !0@nivlul t"raclui@ 0pr !0@d0cndnt 2pntru a vitad0cndnt 2pntru a vita0indr"1ul #1 d"r t"at$6.0indr"1ul #1 d"r t"at$6.

Durra 0t gnrat dDurra 0t gnrat dcrHtra pr0iunii Qntr3uncrHtra pr0iunii Qntr3un5a-int d0tin0.5a-int d0tin0.


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%&.(&.%(() Spitalul Clinic d N!r"l"gi *Dr. Car"l Davila* =

Punct uPunct urtralrtral

.. PunctPuncturtral 0upri"rurtral 0upri"r29a-6329a-635a-int5a-int

%.%. PunctPuncturtralurtral 1il"ciu1il"ciu2Gall63 urtr l"15ar2Gall63 urtr l"15ar

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2Pa0tau6 3 acc0i52Pa0tau6 3 acc0i5iilld"ar prin tactd"ar prin tact rctal'rctal'vaginal>vaginal>


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%&.(&.%(() Spitalul Clinic d N!r"l"gi *Dr. Car"l Davila* &

Palpara gl"5ului v-ical

CCapacitapacitata v-icii urinarata v-icii urinar &( 1 &( 1ll2"rgan plvi2"rgan plvinn@@palpa5palpa5iilld"ar prin tactd"ar prin tactrctal'vaginalrctal'vaginal palparpalpar

a5d"1n cu calalta 18na5d"1n cu calalta 18n6.6.##l"5ul v-ical$l"5ul v-ical$ :(( 1 :(( 1ll2"50truc2"50truc/i/i'd'dii0!unc0!unc/i/inur"l"gicnur"l"gic66 dvindvin"rgan"rgan

a5d"1inal@ palpa5a5d"1inal@ palpa5iill cucu1argina1arginacu5italcu5itala 18iniia 18inii0t8ngi0t8ngi..


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%&.(&.%(() Spitalul Clinic d N!r"l"gi *Dr. Car"l Davila* J

N"r1al Fi1"- Para!i1"-

Gidr"cl Gidr"cl2tran0ilu1inar6


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%&.(&.%(() Spitalul Clinic d N!r"l"gi *Dr. Car"l Davila* K

E4a1nul pr"0tati

Pr"0tatPr"0tataa33n"r1aln"r1al:4: 3 =4=:4: 3 =4=c1@c1@ !"r1a!"r1a ca0tanca0tan@@Han/Han/1dian1dian di0tinctdi0tinct

AAn"r1aln"r1al 1rit1rit77 Han/Han/1dian1dian a50nta50nt77 n"dul durn"dul dur77-"n durr"a0 la palpar-"n durr"a0 la palpar..++--icicuullll001inal1inal??

palpa5palpa5iill d"ar Qnd"ar Qnin!la1ain!la1a/ia/iacr"niccr"nic22T9'T9'nn0pci!ic0pci!ic66


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%&.(&.%(() Spitalul Clinic d N!r"l"gi *Dr. Car"l Davila* )

E4a1nul ginc"l"gic' tactul vaginalE4a1nul ginc"l"gic' tactul vaginal

+ri!ica/i 4i0tn/a unui+ri!ica/i 4i0tn/a unui pr"lap0pr"lap0utrin>utrin>

+ri!ica/i 4i0tn/a uni+ri!ica/i 4i0tn/a uni n"plan"pla-ii-ii>>

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? calculcalculiiAAn"1liin"1liid d-v"ltard d-v"ltar3 vulva@ vagina3 vulva@ vagina

In!la1aIn!la1a/ia glandl"r/ia glandl"r9art"lin'SYn9art"lin'SYn


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+-ica urinar d0tin0+-ica urinar d0tin0??1atitat1atitat@ c"nv4it@ c"nv4itatat0upri"ar0upri"ar

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ccardiacardiac? pricardit? pricardit@@in0u!icin/ cardiacin0u!icin/ cardiacRinici v"lu1in"Hi@Rinici v"lu1in"Hi@5"0la/i5"0la/i229PRAD9PRAD66


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%&.(&.%(() Spitalul Clinic d N!r"l"gi *Dr. Car"l Davila* %%

Au0cultaAu0culta/ia/ia


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%&.(&.%(() Spitalul Clinic d N!r"l"gi *Dr. Car"l Davila* %:

Su!luri artrialSu!luri artrial

? a"rta a5d"1inala"rta a5d"1inal22 an anvvrrii01 palpa501 palpa5iill66? artr rnalartr rnal2antri"r 3 pri2antri"r 3 pri""15ilical@ 5ilatral715ilical@ 5ilatral7p"0tri"rp"0tri"r l"15ar 0aul"15ar 0aulatral in !lanlatral in !lancuricuri66

? artrartrll!1!1uuralral? car"tidcar"tid palpa palpararapul0pul0uril"ruril"rpripri!!rricic

Zg"1"tl int0tinalZg"1"tl int0tinal

Su!luril cardiacSu!luril cardiacFrctura pFrctura pricardiricardicc UREN;UREN;>>


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%&.(&.%(() Spitalul Clinic d N!r"l"gi *Dr. Car"l Davila* %=

Frctura pricardic urgn/>>>

Au0culta/iaa5d"1nului


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%&.(&.%(() Spitalul Clinic d N!r"l"gi *Dr. Car"l Davila* %&

Urgene la pacientul renalUrgene la pacientul renal

GTA 1GTA 1alignalign0au0au0vr0vrIn0u!icin/a rnal acut cuIn0u!icin/a rnal acut cu"lig"anuri"lig"anuril"1rul"nl"1rul"n!!riritataaacutcut22QQn c"n c"pilripilri66Tul5urri idr"3lctr"litic 0Tul5urri idr"3lctr"litic 0vrvr@ 1ai al0@ 1ai al0iiprYalprYalii1ia1iaCC"lic"licaarrnalnalHiHi"ric "50truc/i acut d tract urinar"ric "50truc/i acut d tract urinar

Urgn/ cUrgn/ cardi"va0cularardi"va0cularHiHir0pirat"rr0pirat"riiii n nuud"ard"arIMAIMA@@ EPAEPA@@di0cdi0c/ia/ia a"rtica"rtic@ tc.@@ tc.@ ci Hici Hipricarditpricardita ur1ica ur1ic@@ 15"lia15"liapul1"nar la pacintulpul1"nar la pacintulnn!!r"tic@ 1"ptr"tic@ 1"pti-iai-ia0vr0vrQn 0d.Qn 0d.""dpa0tur""dpa0turTr"15"-a aTr"15"-a acutcutaa!i0tul!i0tuliiartri"vn"artri"vn"aa00GG1"rag1"ragii00vrvr? GDS la? GDS lapapaccinin/i cu IRA/i cu IRA@@ dupdup5i"p05i"p0iaiarnalrnal0au din0au din !i0tula artri"vn!i0tula artri"vn"a0"a0@ ruptur@ rupturaaacutacutaariniciuluiriniciului tran0planttran0plantatat@ 1"rag@ 1"ragiaiaintracraniaintracraniannprinprinrupturrupturddananvvrrii0101QQnn 9PRAD9PRADFF55rraa? in!c/ii d tract? in!c/ii d tracturinarurinar 0upri"r70upri"r7 0ptic1i0ptic1i77la pacin/iila pacin/iii1un"dpri1a/ii1un"dpri1a/i


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%& (& %(() Spitalul Clinic d N!r"l"gi *Dr Car"l Davila* %

Mul/u10cMul/u10c[[

Pr"!. Ti5riu Nana@Pr"!. Ti5riu Nana@ Spitalul ClinicSpitalul Clinic #Carita0$ 2#Carita0$ 2a0i0tntul 1ua0i0tntul 1ud la 01i"l"gid la 01i"l"gi66

DrDr. Si1"na Stancu 21nt"r. Si1"na Stancu 21nt"rul 1uul 1u66

Pr"!. a5ril Mirc0cu 2Pr"!. a5ril Mirc0cu 2pr"!0"rul n"0trupr"!0"rul n"0tru@ 1nt"r@ 1nt"rul 1uul 1u@@ \\d0nl din pr-ntard0nl din pr-ntar66

Carli "ld5rg@ UCSD 2Carli "ld5rg@ UCSD 2\\ !"t"gra!iil!"t"gra!iil66

Hi 1ult"r alt"raHi 1ult"r alt"ra[[

1a. curs 1a (examenul clinic al pacientului cu afectare renala)

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