What is IPPA?
IPPA (Inspection, Palpation, Percussion, and Auscultation) is a systematic approach used during physical examination to assess a patient’s condition, often applied to various diseases. **Inspection** involves visually examining the patient for signs such as swelling, discoloration, or abnormal movement. **Palpation** involves feeling the body for tenderness, lumps, or abnormalities, helping assess pain or structural changes. **Percussion** uses tapping to assess underlying structures, such as organs or fluid levels, often in the chest or abdomen. **Auscultation** involves listening to internal body sounds, such as the heart, lungs, or bowel, using a stethoscope to detect abnormalities. This method helps clinicians gather essential information to form a diagnosis.
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Inspection:
The examination phase includes a thorough visual examination of the patient, focusing in general and especially on renal and cardiovascular symptoms.
– General Appearance:
– Oedema: Look for generalized swelling, especially around the eyes (periorbital edema), in the legs (peripheral edema), or swelling. These are common due to fluid retention due to kidney failure.
– Skin changes: Pallor may be prominent due to anemia (a complication of chronic kidney disease). Some patients may have dry, itchy skin (pruritus), especially in chronic cases.
– Symptoms of systemic disease: Fever or skin rash may indicate an underlying systemic disease such as systemic lupus erythematosus (SLE), which is associated with glomerulonephritis.
– Blood Pressure: Check for high blood pressure, which is common in glomerulonephritis as the kidneys struggle to regulate fluid and salt balance.
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Heartbeat:
Palpation is limited in glomerulonephritis, because the kidneys are retroperitoneal and cannot be directly palpated. However, palpation can help assess fluid overload and cardiovascular effects.
– Putting Edema: Palpate the legs and sacrum to assess for pitting edema, a sign of fluid retention.
– Abdominal palpitations: Tenderness in the costovertebral angle (CVA tenderness) may indicate inflammation in the kidneys.
– Liver palpitation: Hepatomegaly (enlarged liver) can sometimes occur with nephrotic syndrome due to fluid overload.
– PULSE AND EXTREMITIES: palpate the pulses (radial, dorsalis pedis) for any low flow due to peripheral vascular problems, and feel the extremities for coolness (which may reflect poor perfusion).
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Percussion:
Although percussion is not commonly used for the kidneys, it can be helpful in some aspects of the physical examination for glomerulonephritis.
– stomach bump:
– Skin: In advanced cases of severe fluid retention, you may notice abdominal distension or a wave of fluid, suggesting inflammation.
– costovertebral angle (CVA) laxity: This is usually assessed by gentle palpation of the CVA. Pain in this area may indicate inflammation or infection of the kidneys (such as pyelonephritis, but relevant in some forms of glomerulonephritis).
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Interpretation:
Auscultation is used to detect cardiac complications, as glomerulonephritis often affects blood pressure and heart function.
– Heart Sounds:
– S3 Gallop: This can indicate fluid overload or heart failure, which can occur in nephrotic syndrome or acute kidney failure.
– Murmur: An aortic or mitral valve murmur may indicate infective endocarditis, which may be associated with glomerulonephritis.
– Pericardial rub rub: In cases of severe uremia, pericarditis may develop, and rubs may be heard.
– Lung Sounds:
– Crackles/Rales: Lung sounds may reveal crackles, indicating pulmonary edema due to fluid overload or heart failure.
– Pleural Effusion: Decreased breath sounds at the lung bases can be a sign of pleural effusion, another possible complication of acute glomerulonephritis.
Additional medical considerations:
– Urine Examination: Although not part of the physical exam, it is important to check the urine for hematuria, proteinuria, or other abnormalities consistent with glomerulonephritis.
– LABORATORY FINDINGS: Important laboratory findings include elevated serum creatinine, decreased glomerular filtration rate (GFR), proteinuria, and abnormal electrolyte levels.
In the clinical setting, IPPA testing will guide further diagnostic testing and treatment plans for a patient with suspected glomerulonephritis.