Auscultation is ... Palpation, percussion, auscultation

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

Auscultation is the most complete and informative method. It is used for diagnosis in surgery, therapy, obstetrics, pediatrics. With the help of this method, listen to the fetal heartbeat, determine the presence of pneumonia, bronchitis, cardiac defects and many other pathologies in children and adults.

Auscultation of the adult heart

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

Listening to the heart is done in a prone or standing position. Some diseases are characterized by a change in heart rate after exercise, so sometimes, for accurate diagnosis, the patient is taken out of a state of physical rest. The method of auscultation requires certain rules:

• Isolation from ambient noise;
• Listening to the heart is carried out with a delay in breathing (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;
• Firstly determine the presence and specificity of sounds at different points, and then listen to pathological or physiological noise.

Percussion of the heart

It is used to determine the boundaries of the body and absolute cardiac dullness. Recently, this method is receding into the background. Some specialists completely rejected it, as percussion results are not very accurate and have a high percentage of subjectivity. This method was replaced by radiography and ultrasound, which give a complete picture of the size and position of the organ.

Palpation of the heart

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

Ability to listen and hear

The heart does not listen in chaotic order. There are projections of cardiac valves on the chest. There are four in total.

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

However, the auscultation points differ slightly from direct projections, since the sound in these places is more clear and understandable.

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

An important sign of serious diseases is cardiac noise, which can be permanent or appear after a certain load. One must be able to listen very well and hear all deviations from the norm of the heart rhythm. It is important to determine not only noise, but also the nature, as well as the place of its formation. It can appear in systole or diastole.

Pathological, or physiological, can be not only noise, but also working phases. In the diagnosis helps auscultation of the heart. Listening points are similar to those described above. Possible the formation of III and IV additional tones that appear in different conditions (time interval, first-second share of systole or diastole).

A small heart is a big responsibility

Children's auscultation is a very important part of the diagnosis. The child, especially the small one, by virtue of age, can not report on his problems. The pediatrician should have a fine ear and a high degree of literacy, as the tones of the child's heart change with his growth. Functional or pathological noise can be determined. It is important to perform a comparative analysis between the first and second tones in terms of strength or emphasis. Any violation indicates a number of pathological processes in the child's body.

Differential diagnosis of cardiac diseases in children using the method of auscultation

Heart tone	Accent place	The revealed pathology (physiology)
First	The tip of the heart	Left atrioventricular aperture narrowed
Second	Aorta	Arterial hypertension or physiological characteristics of pubertal age
Second	Pulmonary artery	Open arterial duct, stenosis, bicuspid valve insufficiency, atrial or interventricular septal defect, pulmonary artery sclerosis, pulmonary fibrosis, myocarditis with congestive phenomena in the small circulatory system
First and second	At all points	A healthy heart after a load (physical or psychoemotional)

In addition to accents, it is possible to weaken the heart tones or their bifurcation. Auscultation is objectively characterized if the doctor is able to listen.

Pregnancy and auscultation

The cardiac leaf is laid down and begins to contract already in the third week of pregnancy, and at six it is audible on ultrasound. Diagnosis of the maternal and fetal organism is mandatory at all times and especially during childbirth. The number and filling of the tones is constantly changing in proportion to the intrauterine development.

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

It is possible to conditionally divide the entire period of pregnancy into several periods (according to the norm of cardiac contractions of the fetus, and also by the nature of their fullness).

It is interesting that at the 6th week after the conception of the heart rate the child coincides with the mother. The difference can be 3 blows to the greater or lesser side. Then the number of cuts begins to grow. If we take into account that daily heart rate is increased by 3 strokes, it is permissible to determine the age of the fetus histologically.

The heart itself after two months of pregnancy is divided into partitions into 4 chambers - the atrium and the ventricles. This structure has an adult organ. At the beginning of the 9th week, the heart of the embryo does about 175 beats per minute. Further, the frequency decreases and, beginning with the second trimester, the norm for the fetus becomes 140-160 strokes. Any deviation from it indicates hypoxia, and tachycardia characterizes the initial degree of oxygen deficiency, and bradycardia is a serious 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 length of pregnancy is determined by the height of the standing of the uterine fundus, and also by the head of the child: if it is firmly pressed against the entrance to the small pelvis, these are the first precursors of childbirth. In obstetrics, Leopold's method is used, which consists of four basic techniques.

Auscultation and childbirth

Deafness of cardiac contractions can be both a manifestation of pathology, and an elementary difficulty of listening. This happens when the mother's abdominal wall is thickened (obesity), the fetus is in an incorrect position (for example, the posterior view of the occipital or gluteal presentation), polyhydramnios, etc. Especially often the muffling of the tone of the heart beats occurs during the labor period. Diagnosis of the fetus at this time is of paramount importance.

One of the methods of 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. Points of listening are characteristic. If the heartbeat is determined more clearly above the navel of the mother, the fetus has a breech presentation, if lower - the head. The child can be hyperactive, turning over "from side to side" the entire gestation period. Listening to clear tones at the navel indicates a transverse position.

Auscultation in the diagnosis of pulmonary diseases

Auscultation is a method that plays a decisive role in the diagnosis of pulmonary diseases. Distinguish correct (or vesicular) breathing and various forms of abnormality. Also, a characteristic sign of various diseases are dry or wet rales, which have certain features of listening. The points of auscultation of the lungs are located symmetrically.

Physiologically altered vesicular breathing

If a person has good or, conversely, poorly developed muscle mass, there is a hypertrophied fatty tissue, a change in breathing can be either in the direction of attenuation or its strengthening. Listening takes place using a phonendoscope.

Strengthening vesicular breathing 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 with bronchitis is carried out in the usual way. When listening to an acute stage, vesicular breathing of a hard type is characteristic. This is the body's response to inflammation and constriction of bronchioles. Against the background of the rigidity of breathing 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 them with a secret. They are well audible in both phases of breathing.

As the bronchitis develops, the production of mucus in the airways increases, and with auscultation, mid-bubble rales are revealed.

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-points of auscultation-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 can be attached, for example, crepitation, which indicates the transition of inflammation to the lower respiratory tract.

Auscultation of the lungs is carried out in several stages: with normal and in-depth breathing and after coughing. Particularly detailed study points of auscultation, which are most "suspicious" for the doctor.

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 rigid, as in the acute stage. Sometimes chronic bronchitis provokes the development of a heavier disease - emphysema. In this case, breathing becomes "wadded." During an exacerbation, wheezing is heard all over the surface of the lungs.

Percussion of the lungs

Percutaneous examination can be carried out in three ways: tapping directly on the surveyed area, through a plate or a finger on the finger. Currently, the last one is the most applicable. This method does not require the doctor to have additional equipment, and in the lung examination it is quite informative.

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

There is a large number of shades and tones extracted when examining sounds. Normally, it should be loud, ringing and prolonged. If there is deafness, dull tone, metallic tint, box or tympanitis - this indicates that the patient has inflammatory or other processes in the lungs that require medical intervention.

Auscultation in the diagnosis of diseases of the digestive system

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

Auscultation is conducted on a comparative basis, that is, to obtain an adequate picture, it is required to listen at various points. To conduct a survey it is necessary in silence and, if possible, without pressing on the stomach.

Palpation of the abdomen

In the examination of the organs of the abdominal cavity the maximum informative value is borne by the method of palpation. It is carried out by soft pressure on the abdomen. Begin with the left inguinal area with warm hands, so as not to cause discomfort to the patient. This is required to exclude the reflex stress of the abdominal wall.

The examination is carried out by a method of comparative analysis of the right and left halves from the bottom up. Pressing on the epigastrium area is the final one. With the help of this, soreness is determined, in various organs, the tension of the abdominal wall, the presence of fluid in the abdominal cavity (syndrome of fluctuations).

Percussion of the abdomen

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

Absolute hepatic dullness is normally determined from the right side of the IV intercostal space according to the level of the midline of the nipple. If tympanic sound is found during examination of this area, this indicates the perforation of the organs, that is, there is liquid in the cavity.

Percutation of the spleen has no practical significance: its lower edge is easily palpated.