Palpation, percussion, auscultation are methods of objective examination 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, technologies are used, of which there are a large number. Interestingly, an objective examination plays a crucial role in making a diagnosis.
Auscultation is the most complete and informative method. It is used for diagnostics in surgery, therapy, obstetrics, pediatrics. Using this method, they 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 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 identify heart disease and lung pathology at an early stage of development.
Auscultation of the heart is performed in the supine or standing position. Some diseases are characterized by a change in heart rate afterloads, therefore, sometimes, for accurate diagnosis, the patient is taken out of a state of physical rest. The auscultation method requires compliance with certain rules:
- isolation from ambient noise;
- listening to the heart is carried out while holding the breath (if possible), as well as separately on inhalation and exhalation;
- must use phonendoscope and stethoscope to auscultate high and low tones;
- first of all, they determine the presence and characteristic of sounds at various points, and then listen to pathological or physiological noises.
Heart percussion
Used to determine the boundaries of the body and absolute cardiac dullness. Recently, this method has faded into the background. Some experts completely abandoned it, since the results of percussion are not very accurate and have a large 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 diagnostics. Palpation of the heart is carried out in order to more clearly determine the position and strength of the apical impulse by pressing a finger to the corresponding area. Some diseases are characterized by a slight trembling of the chest, or "cat's purr syndrome".
The ability to listen and hear
The heart doesn't listen randomly. There are projections of the cardiac valves on the chest. There are four in total.
- Mitral - IV rib, to the left of the sternum.
- Aortic - IIIrib, to the right of the sternum.
- Pulmonary valve - III intercostal space on the left.
- Tricuspid - IV intercostal space on the right.
However, the auscultation points are slightly different from the direct projections, as the sound in these places is more clear and understandable.
- At the top of the heart is the mitral valve.
- II intercostal space, from the sternum to the right - aortic.
An important sign of serious illness is cardiac murmur, which may be permanent or appear after a certain load. You 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 the noise, but also the nature, as well as the place of its formation. It may appear in systole or diastole.
Pathological or physiological can be not only noise, but also working phases. Auscultation of the heart helps in the diagnosis. Listening points are similar to those described above. Perhaps the formation of III and IV additional tones that appear in different conditions (time interval, first-second fraction of systole or diastole).
Small heart - big responsibility
Children's auscultation is a very important part of the diagnosis. A child, especially a small one, due to age cannot report his problems. The pediatrician must have a keen ear and a high degree of literacy, since the sounds of the child's heart change along with his growth. Functional or pathological noises can be determined. It is important to compare betweenfirst and second tones according to strength or emphasis. Any violation indicates a number of pathological processes in the child's body.
Differential diagnosis of heart disease in children using the auscultation method
| Heart tone | Accent location | Identified pathology (physiology) |
| First | Top of the heart | Left atrioventricular orifice narrowed |
| Second | Aorta | Arterial hypertension or physiological characteristics of puberty |
| Second | Pulmonary artery | Open ductus arteriosus, stenosis, bicuspid valve insufficiency, atrial or ventricular septal defect, pulmonary artery sclerosis, pulmofibrosis, myocarditis with pulmonary congestion |
| First and second | At all points | he althy heart after exercise (physical or psycho-emotional) |
In addition to accents, weakening of heart tones or their bifurcation is possible. Auscultation objectively characterizes if the doctor knows how to listen.
Pregnancy and auscultation
The heart sheet is laid and begins to shrink already in the third week of pregnancy, and at six it can be 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 content of tones is constantly changing in proportion to intrauterine development.
Auscultation of the fetus is at the same timethe simplest and most effective method for determining its viability. For this simple operation, an obstetric stethoscope is required (photo below). If necessary, use a phonendoscope.
It is possible to conditionally divide the entire period of pregnancy into several periods (according to the rate of fetal heart rate, as well as the nature of their fullness).
Interestingly, at the 6th week after conception, the baby's heart rate coincides with the mother's. The difference can be 3 beats up or down. Further, the number of cuts begins to grow. Given that the heart rate increases by 3 beats daily, it is permissible to determine the age of the fetus histologically.
The heart itself, after two months of pregnancy, is divided by partitions into 4 chambers - atria and ventricles. This structure has an adult organ. At the beginning of the 9th week, the embryonic heart beats approximately 175 times per minute. Further, the frequency decreases and, starting from the second trimester, 140-160 strokes become the norm for the fetus. Any deviations from it indicate hypoxia, and tachycardia characterizes the initial degree of oxygen deficiency, and bradycardia is a severe stage requiring immediate intervention.
Fetal palpation
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 head of the child: if it is tightly pressed against the entrance to the small pelvis, these are the first harbingers of childbirth. Method used in obstetricsLeopold, which consists of four basic moves.
Auscultation and childbirth
Deafness of heart contractions can be both a manifestation of pathology and an elementary difficulty in listening. This happens when the mother's abdominal wall is thickened (obesity), the fetus is in an incorrect position (for example, posterior occipital or breech presentation), polyhydramnios, etc. Especially often muffled heart rate occurs during the birth period. Diagnosis of the fetal body 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. Listening points are typical. If the heartbeat is determined more clearly above the mother's navel, then the fetus has a breech presentation, if below - the head. The baby may be hyperactive, rolling over from side to side throughout the pregnancy. Listening to clear tones at the level of the navel indicates a transverse position.
Auscultation in the diagnosis of lung diseases
Auscultation is a method that plays a decisive role in the diagnosis of lung diseases. Distinguish between correct (or vesicular) breathing and various forms of deviation from the norm. Also a characteristic feature of various diseases are dry or wet rales, which have certain features of listening. Lung auscultation pointsarranged symmetrically.
Physiologically altered vesicular breathing
If a person has good or, conversely, poorly developed muscle mass, there is hypertrophied adipose tissue, the change in breathing can be either in the direction of weakening or strengthening it. Listening occurs with the help of a phonendoscope.
Intensification of vesicular respiration is typical in childhood. Its other name, which 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 response to inflammation and constriction of the bronchioles. Against the background of hard 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 fullness of their secret. They are well heard in both phases of breathing.
As bronchitis progresses, mucus production in the airways increases and mid-bubbly rales are detected on auscultation.
It is best to listen to the lungs 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 organs. There is a certain sequence of listening - auscultation points - lungs.
You need to start from the tops and then examine the front surface, then the sideand back. With prolonged bronchitis, additional noises may be added, for example, crepitus, which indicates the transition of inflammation to the lower respiratory tract.
Auscultation of the lungs is carried out in several stages: with normal and deep breathing and after coughing. Auscultation points, which are the most "suspicious" for the doctor, are examined in particular detail.
Diagnosis of chronic bronchitis is also based on auscultation data and laboratory studies of biological materials. When listening to the lungs, vesicular type breathing 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: by tapping directly on the area being examined, through a plate or with a finger on a finger. At present, the last one is the most applicable. This method does not require the doctor to have additional equipment, and it is quite informative in the examination of the lungs.
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 over them is duller than over he althy lung tissue.
There are a large number of shades and tones that are extracted when examining sounds. Normally, it should be loud, sonorous and long. If deafness, dullness of tone, metallic shade, box or tympanitis appear, 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 tract
Listening is used as a method of diagnosing a number of diseases of the gastrointestinal tract. The examination is carried out by a doctor using a stethoscope or by placing an ear against the abdominal wall. This method determines the presence (absence) of peristalsis in the intestines or stomach.
Auscultation is carried out according to the comparative principle, that is, to obtain an adequate picture, it is required to listen at various points. The examination should be carried out in silence and, if possible, without pressure on the abdomen.
Palpation of the abdomen
In the examination of the abdominal organs, the method of palpation is the most informative. It is carried out with gentle pressure on the abdomen. It is necessary to start from the left inguinal region with warm hands so as not to cause discomfort to the patient. This is required to eliminate the reflex tension of the abdominal wall.
The examination is carried out by the method of 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, tension in the abdominal wall, the presence of fluid in the abdominal cavity(fluctuation syndrome).
Abdominal percussion
The percussion method allows you to determine the boundaries of the liver and spleen, as 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 perforation of the organs, that is, there is liquid in the cavity.
Percussion of the spleen is of no practical importance: its lower edge can be easily felt by palpation.
