Pasternatsky's symptom is a sign of nephrological pathologies, which is a combination of pain in the kidney area with slight tapping of the lumbar region and an increase in the level (appearance) of red blood cells in the urine subsequently.

general information

Pasternatsky's symptom is named after the Russian doctor F.I. Pasternatsky, who developed a method of palpation examination, which allows diagnosing a number of kidney diseases.

Pasternatsky's symptom is detected by tapping on the lower back in the projection area of the kidneys. Three methods have been described:

The patient is standing or sitting. The doctor places his hand on his lower back and strikes it lightly with the fist of his other hand.
The patient is sitting. The doctor, without strong pressure, taps his fingers on the area located on the border of the lower back and the lower edge of the twelfth rib.
The patient lies on his back. The doctor puts his hand under his back, places it on the kidney area and makes a few pushes.

All manipulations are carried out on both sides. If, due to tapping, pain in one or two kidneys increases, the doctor notes Pasternatsky's symptom is positive on the right, left, or both sides. If the patient does not feel discomfort, then Pasternatsky's symptom is negative.

The classic examination technique according to Pasternatsky includes a urine test after palpation. With a positive symptom, it shows the appearance or a short-term increase in the level of red blood cells. Without this sign, pain when tapping (a symptom of tapping) can indicate not only kidney disease, but also pathology of the musculoskeletal system or gastrointestinal tract.

Causes

A positive symptom of Pasternatsky is detected in diseases such as:

acute and chronic pyelonephritis - an inflammatory process that affects the pelvis, calyx and kidney parenchyma;
apostematous nephritis - a purulent kidney disease caused by infectious foci in other organs;
paranephritis - purulent inflammation of the perirenal tissue;
nephrolithiasis - the formation of stones in the urinary tract;
kidney tumors - benign (cyst, adenoma, angiolipoma, fibroma) and cancerous (adenocarcinoma, renal cell carcinoma) formations;
glomerulonephritis is a disease involving glomeruli - renal glomeruli.

All these pathologies can affect one or both kidneys, so Pasternatsky's symptom can be positive on one or both sides.

If, after the examination, the doctor determined that Pasternatsky's symptom is negative on both sides, this does not mean the absence of the disease. The reasons for a false negative result are abnormal localization of organs and a latent chronic inflammatory process.

Diagnostics

A positive symptom of Pasternatsky is not a sufficient basis for making a diagnosis. In addition to palpation examination, other methods are used:

Collecting an anamnesis in order to determine the signs of the disease.
General and biochemical blood tests.
Urinalysis - general, samples according to Nechiporenko and Zimnitsky.
Ultrasound scan of the kidneys.
X-ray studies.
MRI, CT.
Biopsy (for tumors).

All these studies provide information about the state of the structural elements of the kidneys, their functioning and the presence of neoplasms in them.

Treatment

Therapy of diseases in which a positive symptom of Pasternatsky is found depends on the diagnosis and the general condition of the patient.

Pyelonephritis is treated with antibiotics - penicillins, aminoglycosides, fluoroquinolones, cephalosporins. Painkillers, anti-inflammatory and diuretic drugs are also prescribed.

Apostematous nephritis and paranephritis require high doses of antibiotics. If medicines do not help, an operation is performed to open the abscesses.

With nephrolithiasis, a diet is prescribed, depending on the type of stones. Medicines, lithotripsy, or surgery may be used to remove them.

The tactics of treating kidney tumors is determined by their type. Small benign formations that do not disturb patients are not amenable to therapy. If there are complaints, then they are operated on. Cancer tumors are removed, sometimes along with the kidney. In inoperable cases, anticancer drug treatment is prescribed.

Forecast

If a positive symptom of Pasternatsky is detected, the prognosis depends on the specifics of the disease.

The prognosis for acute pyelonephritis and paranephritis with timely treatment is favorable. Chronic forms of diseases require constant maintenance therapy.

Apostematous nephritis and cancerous tumors in many cases become the reasons for the removal of one of the kidneys. With these pathologies, the risk of death is high.

Conservative treatment of nephrolithiasis most often has an unfavorable prognosis: the stones continue to increase in size. Their surgical removal leads to an improvement in the condition, but the risk of recurrence remains.

Pasternatsky symptom I Pasternatsky symptom (F.I. Pasternatsky, domestic, climatologist and balneologist, 1845-1902)

the appearance of pain with a slight tapping in the lumbar region. P.'s definition with. is mandatory for general clinical examination of the patient.

The symptom is detected by applying gentle pushes with the edge of the palm or the ends of the fingers in the costal-lumbar angle on the right and left. It is better to define P. with. in the position of the patient standing or sitting, but it is also possible in the position of the patient on the back (in this case, the hand is brought under the lumbar region and shocks are applied from the bottom up).

Pasternatsky's symptom is positive in many inflammatory and non-inflammatory diseases and damage to the kidneys and perirenal tissue. Positive P. with. may also be due to a disease of adjacent organs and tissues (lumbar muscles, ribs, vertebrae, pleura, liver, gallbladder, pancreas, intestines, appendix, spleen, large vessels). P. s. may be negative in kidney disease if they are located outside the lumbar region, for example, with pelvic dystopia.

II Pasternatsky's symptom (F.I. Pasternatsky, 1845-1902, father-in-law)

soreness in the kidney area when tapping in the lumbar region; a sign of pyelonephritis, nephrolithiasis, hydronephrosis, paranephritis.

1. Small medical encyclopedia. - M.: Medical Encyclopedia. 1991-96 2. First aid. - M.: Great Russian Encyclopedia. 1994 3. Encyclopedic dictionary of medical terms. - M.: Soviet Encyclopedia. - 1982-1984.

See what the "Pasternatsky symptom" is in other dictionaries:

- (F. I. Pasternatsky, 1845 1902, father internist) soreness in the kidney area when tapping in the lumbar region; a sign of pyelonephritis, nephrolithiasis, hydronephrosis, paranephritis ... Big Medical Dictionary

- (named after the Russian therapist F. I. Pasternatsky, 1845–1902) - a sign of kidney disease (in particular, renal colic): soreness in the kidney area when tapping in the lumbar region, followed by a short-term appearance or ... ... Wikipedia

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paranephritis- PARANEPHRITIS, paranephritis (from the Greek. para about and nephron kidney), inflammation of the perirenal tissue (fatty capsule paranephron); first described in 1839 (Ray er). In 1896, Kuster (Kuster), on the basis of a large casuistic collected by him ... ... Big Medical Encyclopedia

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Increasingly, patients come to the doctor with complaints of lumbar pain, which reflexively spread to the area of the legs and small pelvis. Many people, out of ignorance and inexperience, attribute their condition to osteochondrosis or sciatica and try to get rid of their self-diagnosis, exacerbating the situation.

In most cases, discomfort indicates kidney disease. In order to correctly diagnose, a competent doctor is required to carry out a number of procedures, including a test (symptom) of Pasternatsky. Pain in the lower back can be a sign of various pathologies, in particular, nearby organs.

Definition of SP

This is a research method that allows you to identify certain pathologies of the kidneys of different stages (chronic, acute). The information content of this method is based not only on tapping and patting in the area of \u200b\u200bthe ribs, but also on a urine sample. With existing diseases, the analysis will have an increased number of erythrocytes and leukocytes, a protein may also be present (indicates pyelonephritis).

Positive Pasternatsky's symptom does not always indicate the presence of urolithiasis. It occurs with a disease of the musculoskeletal system. Localization of pain occurs in the spinal column, increases with physical activity, lifting weights and movement. Advanced diagnostics will be required: consultation with an orthopedist, neurologist, CT and MRI.

Definition technique

It is impossible to independently evaluate Pasternatsky's symptom, this should only be done by a specialist. The method is carried out at rest in a sitting or standing position. With the fingers of the right hand, the doctor lightly taps the area of the ribs, thus assessing the intensity and localization of the pain syndrome. If the sensations are too pronounced, then a positive symptom is put. In addition, urine is taken for microscopic examination.

Symptom of Pasternatsky: a sign of pathologies

Often a positive result indicates the presence of an inflammatory process in the urinary tract and kidneys. Pain can spread throughout the spinal column, while there is no numbness of the skin and high temperature. Pasternatsky's symptom partly helps in making a diagnosis, it is necessary to conduct a blood test, urine test and instrumental examination.

On examination, the specialist observes accompanying signs, such as puffiness of the face. Puffiness appears at any stage of pyelonephritis. The chronic stage is characterized by hypertension, fatigue, fever. In pregnant women, the elderly and patients with diabetes, the disease is extremely difficult - severe pain in the back and when urinating, the presence of blood and pus in the urine.

It should be noted that such sensations appear in diseases of the abdominal cavity (pancreas, gallbladder, etc.). Sometimes they point to a pathological process that occurs in the lumbar muscles, gastrointestinal tract, spleen and blood vessels.

Should I be worried if Pasternatsky's symptom is negative?

It is generally accepted that if, with weak blows or a pat in the area of the ribs, the pain syndrome is absent or does not increase, then renal colic and inflammation are excluded. In fact, this is an erroneous opinion. Many chronic diseases are in a latent form and do not give themselves away until a certain point, so a more thorough diagnosis is required:

X-ray examination;

Ultrasound of the bladder and kidneys for inflammation, stones and other abnormalities;

Samples for blood and urine.

Do not ignore the pain and discomfort in the spine and hope for a sudden cure. It is advisable to seek help from a therapist.

Percussion over the region of the kidneys, covered in front by intestinal loops, normally gives a tympanic sound. However, with a significant increase in the kidney, it moves the intestinal loops away, as a result of which a dull sound may appear above it during percussion.

In the diagnosis of many kidney diseases, the tapping method is used - the definition of Pasternatsky's symptom. Assessing this symptom, the doctor puts his left hand on the area of \u200b\u200bthe XII rib to the right and left of the spine and with the edge of the palm (or the tips of bent fingers) of the right hand inflicts short, gentle blows on it. Pasternatsky's symptom is usually determined in the patient's standing or sitting position, however, if necessary, it can also be checked in the patient's lying position, putting his hands under the lumbar region and applying them with jolts.

Depending on whether the patient has pain at the time of the blows and how intense they are, Pasternatsky's symptom is regarded as negative, weakly positive, positive and sharply positive. A positive symptom of Pasternatsky is observed in urolithiasis (especially at the time of renal colic), acute pyelonephritis, paranephritis, etc. However, it should be borne in mind that a positive symptom of Pasternatsky can be observed in osteochondrosis of the spine with severe radicular syndrome, diseases of the ribs, lumbar muscles, and sometimes in diseases of the abdominal organs (gall bladder, pancreas, etc.).

The percussion method is also used to determine the position of the upper border of the bladder. At the same time, placing the finger-plessimeter horizontally, percussion is carried out along the midline in the direction from top to bottom, starting approximately from the level of the navel. In cases where the bladder is empty, the tympanic sound persists up to the pubic symphysis. When the bladder is full, percussion in the region of its upper border, a transition of a tympanic sound into a dull one is detected. The protrusion of the upper border of the bladder above the pubis is noted in cm.

Description of the results of the study of the urinary system in the history of the disease in the absence of any pathological changes is usually quite brief: Pasternatsky's symptom is negative on both sides. The bladder percussion does not protrude above the pubic symphysis.

Section 3. Auscultation Auscultation. Question history.

Auscultation (from the Latin auscultatio - listening) is listening to phenomena in the body perceived by our ear or directly applied to the body, or with the help of tools: a stethoscope, phonendoscope, etc. Thus, auscultation deals with sounds that are formed in the body on their own, in contrast to percussion, where the doctor studies sounds that he specifically caused.

Auscultation was known in ancient times. So, already Hippocrates heard the sound of splashing during a concussion of the chest - succussio Hippocratis. In the future, auscultation is mentioned in the writings of the Greek physician Areteus; in the 17th century it was handled by Hooke; however, it was René Laennec who first developed this method in detail and scientifically. That is why the history of auscultation, as a scientifically based clinical method for examining a person, dates back to 1818, when the work of Laennec entitled "Traite de l'auscultation mediate et des poumons et du coeur" appeared.

There are two types of auscultation: direct, by applying the ear to the body, and mediocre - with the help of devices of various types and types, bearing the general name of stethoscopes.

For the first time, Laennec began to use a stethoscope, and his first model was a tube made of rolled paper. Laennec himself believed that the stethoscope not only conducts sound, but also amplifies it. When it became known that an ordinary stethoscope is only a conductor of sound, stethoscopes began to be made that amplify sound by resonance. Such stethoscopes with resonators in the form of a hollow capsule with an amplifying membrane, which is applied to the body of the subject, are called phonendoscopes.

The question of which auscultation to give preference to - mediocre or direct was repeatedly discussed. Obviously, it is necessary to give preference to the first, because, firstly, it is more hygienic, in particular in patients who are contagious and untidy; secondly, it makes it possible to accurately localize auscultatory phenomena; finally, not all places can be heard directly with the ear, such as the pulmonary apices.

Auscultation: Basic breath sounds

Diagnosis of emphysema

Study of the function of external respiration. Types of ventilation disorders.

obstructive type.

Mixed (combined) type.

Bronchodilatory test

Assessment of the bronchodilation test

Bodyplethysmography

Load tests. Tests with physical activity.

Degrees of respiratory failure:

Auscultation: side breath sounds.

Classification of pneumothorax

Pulmonary heart

Clinic

Decompensated.

Chapter 3

I. Algorithm for local inspection and palpation.

III. Examination of the precordial region.

II.. Algorithm for percussion of the borders of the relative dullness of the heart and vascular bundle.

III. Algorithm for percussion of absolute dullness of the heart.

IV. Search and evaluation of additional heart sounds.

V. Search and evaluation of noise.

Examination of arterial and venous vessels and properties of the pulse

Muscular-elastic type A.S. Muscular type A.S. Elastic type A.S. Parenchyma cells

Arterioles

capillaries

II. Identification of typical complaints in patients with vascular lesions of the arterial bed.

1. Identification of the main groups of complaints in patients with lesions of peripheral arterial vessels.

2. Identification of the main groups of complaints in patients with lesions of the central, brachiocephalic arteries.

III. Identification of typical complaints in patients with lesions of the vessels of the venous bed.

IV. Collecting anamnestic data and conducting a general examination of patients with damage to the vessels of the arterial and venous bed.

V. Palpation and auscultation of the vessels of the arterial and venous bed with an assessment of the properties of the pulse.

1. Palpation of arterial vessels and assessment of the properties of the pulse.

3) Pulse properties:

VI. Diagnostic significance of assessing the state of the areerial and venous bed

1. Cardiovascular system without pathology:

4. Syndrome of acute thrombosis of the artery of the lower limb:

5. Syndrome of atherosclerosis of arteries of the lower extremities:

Abdominal aorta 26%

9.Syndrome of narrowing (stenosis) of the mouth of the aorta:

10. Arterial hypertension syndrome:

24. Syndrome of cerebrovascular accident:

25. Ischemic stroke syndrome:

VII. Instrumental methods for studying the vessels of the arterial and venous bed:

SD on the upper limb

2) Ultrasound duplex scanning of arteries:

3) Myography

4) Polarography

7). Method of laser Doppler flowmetry.

14) Oscillometry and oscillography.

16) Method of laser Doppler flowmetry.