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    Thorax To Rectum

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    dhainey
    The document provides guidance on performing a physical examination of the heart and abdomen in infants and children. It describes how to inspect, palpate, percuss, and auscultate different areas. Key steps include examining peripheral pulses, heart sounds, points of maximal impulse, thrills, and murmurs. Common physical findings related to heart failure or disease are also outlined. The examination of the abdomen focuses on the umbilical cord, liver and spleen size, signs of abdominal pain or tenderness, and hernias. Examination of the genitalia and rectum in infants and children is also covered.

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    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd

    Thorax To Rectum

    Uploaded by

    dhainey
    273 views35 pages
    The document provides guidance on performing a physical examination of the heart and abdomen in infants and children. It describes how to inspect, palpate, percuss, and auscultate different areas. Key steps include examining peripheral pulses, heart sounds, points of maximal impulse, thrills, and murmurs. Common physical findings related to heart failure or disease are also outlined. The examination of the abdomen focuses on the umbilical cord, liver and spleen size, signs of abdominal pain or tenderness, and hernias. Examination of the genitalia and rectum in infants and children is also covered.

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    Thorax to Rectum

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    The document provides guidance on performing a physical examination of the heart and abdomen in infants and children. It describes how to inspect, palpate, percuss, and auscultate different areas. Key steps include examining peripheral pulses, heart sounds, points of maximal impulse, thrills, and murmurs. Common physical findings related to heart failure or disease are also outlined. The examination of the abdomen focuses on the umbilical cord, liver and spleen size, signs of abdominal pain or tenderness, and hernias. Examination of the genitalia and rectum in infants and children is also covered.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    273 views35 pages

    Thorax To Rectum

    Uploaded by

    dhainey
    The document provides guidance on performing a physical examination of the heart and abdomen in infants and children. It describes how to inspect, palpate, percuss, and auscultate different areas. Key steps include examining peripheral pulses, heart sounds, points of maximal impulse, thrills, and murmurs. Common physical findings related to heart failure or disease are also outlined. The examination of the abdomen focuses on the umbilical cord, liver and spleen size, signs of abdominal pain or tenderness, and hernias. Examination of the genitalia and rectum in infants and children is also covered.

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    Download as PPT, PDF, TXT or read online from Scribd
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    PHYSICAL EXAMINATION OF

    THE HEART
    INSPECTION:
    > cyanosis
    - central or peripheral
    - cardiac or pulmonary?
    > bulge or deformity over chest
    PHYSICAL EXAMINATION OF THE
    HEART
    PALPATION:
    - peripheral pulses
    brachial a.- neonates & infants
    temporal a.
    femoral a.
    dorsalis pedis a.
    posterior tibial a.
    - pulses: sharp rise, firm, well localized
    PHYSICAL EXAMINATION OF THE
    HEART
    PALPATION:
    PMI (point of maximal impulse)
    neonate – 4th left ICS MCL
    > 2y.o. - 5th left ICS MCL

    precordial bulge – cardiac enlargement


    substernal thrust – R ventricular enlargement
    apical heave – L ventricular hypertrophy
    hyperdynamic precordium – large shunts
    - maybe normal in thin patients
    PHYSICAL EXAMINATION OF THE
    HEART
    PALPATION:
    - palms or base of fingers and not
    fingertips
    THRILL – palpable turbulence within the
    heart or great vessel
    APICAL THRILL – patient on left lateral decubitus
    BASAL THRILL – patient sitting up
    PHYSICAL EXAMINATION OF THE
    HEART

    AUSCULTATION:
    Rate
    newborn: 120-160/min
    Rhythm
    normal sinus dysrhythmia
    skipped beats (PACs, PVCs)
    PHYSICAL EXAMINATION OF THE
    HEART
    AUSCULTATION:
    Heart Sounds
    S1 – AV valve closure
    S2 – aortic v., pulmonic v.
    S3 – early filling and distension of ventricles
    S4 – atrial contractions
    - beginning phase of active
    ventricular filling
    PHYSICAL EXAMINATION OF THE
    HEART
    AUSCULTATION:
    MURMURS
    timing – systolic, diastolic, transient, continuous
    nature – soft, blowing, crescendo-decrescendo
    grade*
    duration
    point of maximal intensity
    degree and localization of transmission
    (ex. Grade 3 blowing holosystolic murmur heard best at the mitral
    area with radiation to the axilla)
    PHYSICAL EXAMINATION OF THE
    HEART
    AUSCULTATION:

    Grading of murmurs
    1/6 – soft, transient
    2/6 – soft, persistent
    3/6 – moderate intensity
    4/6 – loud, (+) thrill
    5/6 – extremely loud, still require stet
    6/6 – very loud, even with stet off the
    chest
    Heart sounds are louder due to thinner chest wall
    and with higher pitch

    1. innocent murmur
    = systolic, short duration
    grade 3 or less in intensity
    low-pitched
    vibratory, musical groaning quality

    = loudest along the left sternal


    = heard best in supine position
    = heard in the absence of any other
    demonstrable evidence of
    cardiovascular disease
    2. non-innocent or organic murmur
    = caused by congenital or acquired heart ds.

    = before 3 years of age – congenital

    = after 3 years old – rheumatic valvulitis

    = caused by abnormal communications between


    the arterial and venous circuits of the heart
    and great vessels or by valvular deformities

    = usually coarse in character, systolic in timing


    and heard best at the base of the heart
    3. hemic murmur
    = caused by increase blood flow through the heart

    = occurs when the body’s tissues require more


    oxygen than usual (exercise)
    or when hemoglobin-depleted red blood cells
    are not delivering oxygen to tissues (anemia)
    PHYSICAL EXAMINATION OF THE
    HEART

    PERCUSSION:
    - cardiac area of dullness
    - not useful in pediatric patients except in
    cases of dextrocardia
    Physical indications of severe
    heart disease:
    • tachypnea
    • tachycardia
    • hyperdynamic precordium
    • cyanosis
    • clubbing
    • delayed development
    Heart failure:
    • venous engorgement
    • pulsus alterans
    = pulse alternates in amplitude
    from beat to beat though the
    rhythm is basically regular
    = indicates left ventricular failure
    • gallop rhythm
    • hepatic enlargement
    PHYSICAL EXAMINATION OF THE ABDOMEN

    INSPECTION:

    • protuberant – due to poorly developed abdominal


    musculature

    • concave – diaphragmatic hernia


    - displacement of some of the abdominal
    organs into the thoracic cavity
    PHYSICAL EXAMINATION OF THE ABDOMEN

    Umbilical cord

    -number of vessels present


    - two thick-walled umbilical arteries and
    one thin-walled umbilical vein
    - amniotic portion dries up within 1 week and falls
    off within 2 weeks
    • Diatasis recti = congenital weakness of the
    abdominal musculature or result from a
    chronically distended abdomen.
    = most are normal variants and disappear in
    early childhood
    Omphalocele = herniation of abdominal contents
    into the base of the umbilical cord
    Gastrochisis = centrally located, full thickness
    abdominal wall defect
    Auscultation:
    • Metallic tinkling every 10-30 seconds

    Percussion:
    • Test for fluid wave

    Palpation:
    • Hold legs, flex knees and hips
    • Start palpating low in the abdomen
    • liver edge and spleen tip palpable
    • both kidneys can be felt
    Early and Late Childhood:
    • ticklish = place child’s hand under
    examiner’s hand to reduce
    apprehension
    and increase relaxation of the
    abdominal
    musculature
    • Palpate lightly and then deeply in all
    quadrants
    • Examine last the area that the history
    suggests as the site of pathology
    PHYSICAL EXAMINATION OF THE
    ABDOMEN

    • liver and spleen easily palpated


    • liver edge 1-2 cm below the right
    costal margin
    • Size of liver is better determined by
    percussion than by palpation
    • Rovsing’s sign = press deeply and
    evenly the left lower quadrant
    – pain in the right lower quadrant

    • Referred rebound tenderness = right


    lower quadrant pain on quick
    withdrawal of left pressure
    • Psoas sign
    = place hand just above the patients right knee
    and ask the patient to raise the thigh against
    the examiner’s hand
    = ask the patient to turn to the left side and
    extend patient’s right leg at the hip
    = positive sign is pain on the abdomen
    Obturator sign = flex the patient’s right thigh at the hip with
    the knee bent and rotate the leg internally at
    the hip
    Expected liver span of infants, children and adolescents by
    percussion:
    • Age Males Females
    • 6 months 2.4 2.8
    • 1 2.8 3.1
    • 2 3.5 3.6
    • 3 4 4
    • 4 4.4 4.3
    • 5 4.8 4.5
    • 6 5.1 4.8
    • 8 5.6 5.1
    • 10 6.1 5.4
    • 12 6.5 5.6
    • 14 6.8 5.8
    • 16 7.1 6.0
    • 18 7.4 6.1
    • 20 7.7 6.3
    GENITALIA AND RECTUM
    Infancy:
    Boys:
    • Phimosis = tight prepuce that cannot be retracted
    over the glans
    Hypospadia = urethral orifice appears at some
    point along the ventral surface of
    the glans or shaft of the penis
    Epispadia = urethral orifice appears at the dorsal
    surface
    Circumcision
    difference between hydrocele and hernia : hydrocele does
    not transilluminate and not reducible

    HYDROCELE
    Inguinal hernia
    Umbilical Hernia
    Girls:
    • Inspect the perineal structures, the urethral
    orifice, the hymen, and the vaginal mucosa
    by separating the labia with the thumb and
    forefinger of one hand while pressing
    forward and downward from within the
    rectum with the index finger of the other
    hand.

    Early and late childhood:


    • size of the penis in early childhood and
    prepubescence is of little significance unless
    it is very large ( obese boys, fat pad over
    the symphisis pubis may envelope the
    penis)
    Cryptorchidism = undescended testicle,
    unilaterally or bilaterally, with the testicle remaining
    in the abdomen or within the inguinal canal
    • Fusion of the labia minora
    = may be partial, with only the
    posterior
    portion of the labia is fused
    = complete – both anterior and
    posterior portion is fused

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