For this part of the examination, the patient should be seated. The examiner should make a fist and gently hit the area overlying the costovertebral angle on each side. Figure 17-31 demonstrates the technique. Patients with pyelonephritis usually have extreme pain even on slight percussion in these areas. If pyelonephritis is suspected, only digital pressure should be used. As is described in Chapter 22, Putting the Examination Together, this portion of the abdominal examination is usually performed when the posterior chest is examined.
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