A comprehensive clinical examination is the basis for selecting further diagnostic steps:
- General physical examination – including blood pressure, pulse, body temperature, body weight, body height; furthermore:
- Inspection (viewing).
- Skin, mucous membranes and sclerae (white part of the eye).
- Examination of the lungs (due todifferential diagnosis: pneumonia (pneumonia)):
- Auscultation (listening) of the lungs.
- Bronchophony (checking the transmission of high-frequency sounds; the patient is asked to pronounce the word “66” several times in a pointed voice while the doctor listens to the lungs)[increased sound conduction due to pulmonary infiltration/compaction of lung tissue (e.g., in pneumonia) the consequence is, the number “66” is better understood on the diseased side than on the healthy side; in the case of reduced sound conduction (attenuated or absent: e.g., in pleural effusion). The result is, the number “66” is barely audible to absent over the diseased part of the lung, because the high-frequency sounds are strongly attenuated]
- Voice fremitus (checking the transmission of low frequencies; the patient is asked to say the word “99” several times in a low voice, while the doctor puts his hands on the chest or back of the patient)[increased sound conduction due to pulmonary infiltration / compaction of lung tissue (eg, in pneumonia) the consequence is, the number “99” is better understood on the diseased side than on the healthy side; in the case of reduced sound conduction (greatly attenuated or absent: in pleural effusion). The consequence is, the number “99” is barely audible to absent over the diseased part of the lung, because the low-frequency sounds are strongly attenuated]
- Palpation (palpation) of the abdomen (abdomen) (pressure pain?, tapping pain?, coughing pain?, defensive tension?, hernial orifices?, kidney bearing tapping pain?) [due todifferential diagnosis: appendicitis (appendicitis)]
- Palpation of the renal region [flank pain; renal bed palpitations (usually unilateral)]
- Digital rectal examination (DRU): examination of the rectum (rectum) and adjacent organs with the finger by palpation: assessment of the prostate in size, shape and consistency[due topossible causes:
- Benign prostatic hyperplasia (benign prostate enlargement).
- Chronic intestinal inflammation such as ulcerative colitis or Crohn’s disease (can also lead to pyelonephritis via the blood route (hematogenous))]
- Inspection (viewing).
- If necessary, cancer screening [due topossible cause:
- Plasmocytoma (multiple myeloma) – malignant tumor disease from the group of non-Hodgkin’s lymphomas. Its origin is in the lymphoid tissue, as in all lymphomas; many (multiple) tumors originating in the bone marrow (myeloma)]
- If necessary, gynecological examination[due topossible cause:
- Pregnancy]]
[due todifferential diagnosis: adnexitis (inflammation of the fallopian tubes and ovary)]
- If necessary, neurological examination [due topossible cause: neurogenic bladder emptying disorders, e.g. due to multiple sclerosis].
- Urological/nephrological examination[due topossible causes:
- Narrowing of the urethra
- Urolithiasis (urinary stones)
- Cystitis (urinary bladder infection)]
[due todifferential diagnoses:
- Emphysematous pyelonephritis – form of chronic pyelonephritis with spontaneous gas formation – by gas-producing aerobes and facultative anaerobes – in the renal parenchyma; very rare – occurs practically only in diabetics.
- Papillary necrosis – destruction of the renal papillae with deposition of pigment and shrinkage of the renal parenchyma.
- Perirenal abscess – encapsulated accumulation of pus in the tissue surrounding the kidney.
- Renal abscess – encapsulated collection of pus in the kidney.
- Xanthogranulomatous pyelonephritis – special form of chronic pyelonephritis with formation of pus or granulomas]
Square brackets [ ] indicate possible pathological (pathological) physical findings.
