Auscultation is ... Palpation, percussion, auscultation

Palpation, percussion, auscultation are objective examination methods used by doctors around the world in the process of diagnosing various diseases. These methods are used in conjunction with biochemical and other types of analyzes, instrumental research, apply technologies, of which there are a large number. Interestingly, an objective examination plays a decisive role in the diagnosis.

Auscultation is the most comprehensive and informative method. It is used for diagnosis in surgery, therapy, obstetrics, pediatrics. Using this method, the fetal heartbeat is heard , the presence of pneumonia, bronchitis, cardiac defects and many other pathologies in children and adults is determined.

Auscultation of an adult heart

Along with high information content, it is also the most difficult of the methods of objective examination. It requires perfect hearing, a sense of rhythm and constant practice, as it has a large number of nuances. Diagnosis in medicine by auscultation allows you to determine heart disease and pulmonary pathology at an early stage of development.

Listening to the heart is performed while lying or standing. Some diseases are characterized by a change in heart rate after exercise, so sometimes, for an accurate diagnosis, the patient is taken out of a state of physical rest. The auscultation method requires compliance with some rules:

• isolation from ambient noise;
• listening to the heart is carried out with a breath hold (if possible), as well as separately on inhalation and exhalation;
• it is necessary to use a phonendoscope and a stethoscope for auscultation of high and low tones;
• First of all, the presence and characterization of sounds is determined at various points, and then pathological or physiological noises are heard.

Heart percussion

It is used to determine the boundaries of the organ and absolute cardiac dullness. Recently, this method has receded into the background. Some experts completely abandoned it, because the results of percussion are not very accurate and have a large percentage of subjectivity. This method was replaced by x-ray and ultrasound, which give a complete picture of the size and position of the organ.

Palpation of the heart

Widely used in diagnostics. Palpation of the heart is carried out in order to more clearly determine the position and strength of the apical impulse by pressing the finger to the corresponding area. In some diseases, a slight tremor of the chest, or "feline purr syndrome," is characteristic.

Ability to listen and hear

The heart does not listen in a chaotic manner. There are projections of cardiac valves on the chest. There are four of them.

1. Mitral - IV rib, to the left of the sternum.
2. Aortic - III rib, to the right of the sternum.
3. Pulmonary valve - III intercostal space on the left.
4. Tricuspid - IV intercostal space on the right.

Nevertheless, the auscultation points are slightly different from the direct projections, since the sound in these places is more clear and understandable.

1. At the top of the heart is the mitral valve.
2. II intercostal space, from the sternum to the right - aortic.

An important sign of serious illness is cardiac murmur, which can be constant or appear after a certain load. You must be able to listen very well and hear all the deviations from the normal heart rate. It is important to determine not only the noise, but also the character, as well as the place of its formation. It can occur in systole or diastole.

Pathological or physiological may be not only noise, but also the working phases. Auscultation of the heart helps in the diagnosis. Listening points are similar to those described above. The formation of III and IV additional tones that appear under various conditions (time period, first to second lobe of systole or diastole) is possible.

Little heart is a big responsibility

Pediatric auscultation is a very important part of the diagnosis. A child, especially a small one, cannot, due to age, report his problems. A pediatrician should have a fine ear and a high degree of literacy, as the tones of a child’s heart change along with its growth. Functional or pathological murmurs may be determined. It is important to make a comparative characteristic between the first and second tones in strength or accent. Any violation indicates a number of pathological processes in the children's body.

Differential diagnosis of heart disease in children using the auscultation method

In addition to accents, weakening of heart sounds or their bifurcation is possible. Auscultation objectively characterizes this if the doctor knows how to listen.

Pregnancy and auscultation

The heart sheet is laid and begins to contract already in the third week of pregnancy, and at six it is heard on ultrasound. Diagnosis of the body of the mother and fetus is mandatory for the entire period and especially during childbirth. The number and filling of tones is constantly changing in proportion to intrauterine development.

Auscultation of the fetus is the simplest and most effective method for determining its viability. To perform this simple operation, an obstetric stethoscope is required (photo below). If necessary, use a phonendoscope.

It is possible to conditionally divide the entire gestation period into several periods (according to the rate of fetal heart contractions, as well as by the nature of their fullness).

Interestingly, at the 6th week after conception, the heart rate of the child coincides with the mother. The difference can be 3 hits up or down. Further, the number of cuts begins to grow. Given that daily heart rate increases by 3 strokes, it is permissible to determine the age of the fetus histologically.

After two months of pregnancy, the heart itself is divided by partitions into 4 chambers - the atria and ventricles. This structure has an adult organ. At the beginning of the 9th week, the heart of the embryo makes approximately 175 beats per minute. Further, the frequency decreases and, starting from the second trimester, the norm for the fetus becomes 140-160 strokes. Any deviations from it indicate hypoxia, with tachycardia characterizing the initial degree of oxygen deficiency, and bradycardia a severe stage requiring immediate intervention.

Palpation of the fetus

Palpation in the second half of pregnancy can determine the position of the fetus and its individual parts in the uterus. In addition, the gestational age is determined by the height of the uterine fundus, as well as by the baby’s head: if it is firmly pressed to the entrance to the small pelvis, these are the first precursors of childbirth. In obstetrics, the Leopold method is used, which consists of four basic techniques.

Auscultation and childbirth

Deafness of heart contractions can be either a manifestation of pathology or an elementary difficulty in listening. This happens when the abdominal wall of the mother is thickened (obesity), the fetus is in the wrong position (for example, the posterior view of the occipital or gluteal previa), polyhydramnios, etc. Muffling of the tone of heart contractions is especially common in the labor period. Diagnosis of the fetus at this time is of paramount importance.

One of the methods for examining a pregnant woman is palpation. It helps to determine the location of the fetus, its presentation. But the same result can be achieved when auscultation of the heart is used to diagnose intrauterine development. Listening points are characteristic. If the heartbeat is determined more clearly above the navel of the mother, the fetus has a gluteal previa, if lower, the head. The child can be hyperactive, turning "from side to side" the entire period of pregnancy. Listening to clear tones at the navel level indicates a transverse position.

Auscultation in the diagnosis of pulmonary diseases

Auscultation is a method that is crucial in diagnosing pulmonary diseases. Distinguish between correct (or vesicular) breathing and various forms of deviation from the norm. Also a characteristic sign of various diseases are dry or wet rales, which have certain listening characteristics. Auscultation points of the lungs are located symmetrically.

Physiologically Modified Vesicular Respiration

If a person has good or, conversely, poorly developed muscle mass, there is hypertrophied adipose tissue, a change in breathing can be both in the direction of weakening, and its strengthening. Listening occurs using a phonendoscope.

Strengthening of vesicular respiration is characteristic in childhood. Another name that can be heard in medical circles is puerile. There is one characteristic feature - the same breathing in symmetrical areas on the right and left sides.

Diagnosis of bronchitis by auscultation

Auscultation for bronchitis is carried out in the usual way. When listening to the acute stage, vesicular breathing of a hard type is characteristic. This is the body's reaction to inflammation and narrowing of the bronchioles. Against the background of hardness of breath, dry rales are determined, and they can be different in tone, and also resemble buzzing and whistling. It depends on the size of the bronchi and the degree of filling with their secret. They are clearly audible in both phases of breathing.

As bronchitis develops, the production of mucus in the airways increases, and with auscultation, medium bubbling rales are detected.

Listening to the lungs is best when the patient is standing. It is necessary to compare the sounds of breathing and wheezing at the same points of the right and left organ. There is a certain sequence of listening - auscultation points - of the lungs.

You need to start from the tops and then examine the front surface, then the side and back. With prolonged bronchitis, additional noise may be attached, for example, crepitus, which indicates the transition of inflammation to the lower respiratory tract.

Auscultation of the lungs is carried out in several stages: during normal and in-depth breathing and after coughing. Auscultation points, which are the most “suspicious” for the doctor, are examined in detail.

Diagnosis of chronic bronchitis is also based on auscultation data and laboratory studies of biological materials. When listening to the lungs, respiration of the vesicular type is determined in the presence of a longer exhalation or hard, as in the acute stage. Sometimes chronic bronchitis provokes the development of a more serious disease - emphysema. In this case, the breath becomes "cotton". During an exacerbation, wheezing is heard over the entire surface of the lungs.

Lung percussion

Percussion examination can be carried out in three ways: tapping directly on the examined area, through a plate or with a finger on a finger. Currently, the last one is most applicable. This method does not require the presence of additional equipment at the doctor, and in the examination of the lungs it is quite informative.

Percussion can be comparative or have a topographic orientation. The most popular is the first option, which is used to determine pathological foci. They are seals, so the percussion sound above them is more deaf than over healthy lung tissue.

There are a large number of shades and tones extracted during the examination of sounds. Normally, it should be loud, sonorous and long-lasting. If deafness, dullness of tone, metallic shade, boxed or tympanitis appeared, this indicates the patient has inflammatory or other processes in the lungs that require medical intervention.

Auscultation in the diagnosis of diseases of the digestive tract

Listening is used as a diagnostic method for a number of diseases of the gastrointestinal tract. The study is conducted by a doctor using a stethoscope or putting an ear to the abdominal wall. Using this method, the presence (absence) of peristalsis in the intestine or stomach is determined.

Auscultation is carried out according to a comparative principle, that is, to obtain an adequate picture, listening is required at various points. Examination should be in silence and, if possible, without pressing on the stomach.

Palpation of the abdomen

In the examination of the abdominal organs, the method of palpation is the most informative. It is carried out by soft pressure on the stomach. You need to start with the left inguinal region with warm hands so as not to cause discomfort to the patient. This is required to exclude the reflex tension of the abdominal wall.

The examination is carried out by comparative analysis of the right and left half from the bottom up. Pressure on the epigastric region is final. With the help of this, pain is determined in various organs, the tension of the abdominal wall, the presence of fluid in the abdominal cavity (fluctuation syndrome).

Percussion abdomen

The percussion method allows you to determine the boundaries of the liver and spleen, since they have an absolutely dull sound (femoral). In addition, comparing gastric and intestinal tympanitis, the doctor can make a diagnosis of obstruction of any of the departments.

Absolute hepatic dullness is normally determined on the right side in the IV intercostal space at the level of the midline of the nipple. If a tympanic sound is detected during examination of this area, then this indicates a perforation of organs, that is, there is fluid in the cavity.

Percussion of the spleen has no practical value: its lower edge is easily palpated.