Positioned at a distance of 2-3 steps from the doctor. Gradually turning, the doctor examines the patient in direct and lateral illumination; Inspection of the thorax is best done in a vertical position and the abdomen in a vertical and horizontal position.
Topographic regions of the abdomen
Rules of patient ’ s inspection
General condition of the patient
General condition of the patient. enough weight and good mood. patients with chronic disease remission, favorable course of a disease, or during recovery). Medium severe condition (status ingravescens): in patients with recurrence of chronic diseases, acute diseases or due to trauma and poisoning).
EXCITED
Irritative disorder
DEPRESSED
Cloudiness Stupor
Sopor Coma
Clear consciousness
Cloudiness
Stupor
Sopor
Coma
Endotoxic coma
Endotoxic coma
Hepatic coma develops in patients with acute and subacute dystrophy and necrosis of the liver.
Exotoxic
The forms of abandoned consciousness Delirium is characterized with visual and acoustic hallucinations, inadequate emotions, anxiety,.
Posture of the patients
Sitting position - orthopnea (Gr. orthos – upright, pnoe – breath) – severe degree of shortness of breath. This position helps the accessory muscles and the diaphragm to participate in breathing, which encourages the expansion of the chest during. A state of restlessness, anxiety occurs in the patient due to stones in the urinary tract and nephrocalcinosis.
GAIT
HABITUS
Physique is determined by . morphological body characteristics and divided into two groups: .. a) correct habitus with well-proportioned body parts: . trunk, head, limbs without deformity;.
HEIGHT
Dwarfism can be caused by hypofunction of the anterior lobe of the pituitary gland (dwarfism) or the thyroid gland (cretinism). Gigantism can be caused by dysfunction and the progression of the pituitary gland or. The height of the patient and the length of his body are important for the assessment of both his physical growth and proportions of his.
WEIGHT
Overweight and obesity can be identified based on BMI. WHO classification for overweight and obesity in adults).
Weight gain can occur in individuals without weight control who have eating habits with an increased intake of carbohydrates, saturated fat and alcohol. Endocrine disorders may contribute to obesity (Gushing's syndrome, thyroid hypofunction, type 2 diabetes mellitus). Weight loss is observed in individuals during starvation, in patients with serious diseases, oncological pathology, endocrine dysfunction - hyperfunction of the thyroid gland.
FACE OF THE PATIENT
Face in patients with endocrine disorders
Face in patients with diseases of nervous
Face in patients with diseases of nervous system
This face is specific for the collapse due to the serious disease of abdominal organs, which is accompanied by peritonitis (rupture of gall bladder, perforated ulcer of the stomach or duodenum). Initially, it can be unilateral swelling, gradually becomes bilateral swelling due to the enlargement of the parotid gland.
Faces in patients with diseases of blood system
Faces in patients with another pathology
Examination of the skin
SKIN
COLOR OF THE SKIN
The light and red color of the skin related to the thickness, blood circulation, innervation and can be transient character in physiological condition. fear, high and low temperature of the air). The yellow, cyanotic and bronze color of the skin is due to the change of the chemical content of the blood and is observed only in pathological condition, except physiological jaundice in newborns.
Pale color of the skin ( cutis pallide )
Red color of the skin
Local erythema as bilateral redness is characteristic of mitral stenosis ("mitral beater fly" with cyanotic hue), lupus hemoglobin concentration erythematous ("lupus buffer fly") and tuberculosis. Constant diffuse erythema is observed with polycythemia (erythremia) - excessive production of bone marrow erythroid precursor and cousuquasly increases erythrocyte hemoglobin concentration in peripheral blood.
Cyanosis
The blue color appears on the lips, cheeks, earlobes, tip of the nose and fingers.
Yellow skin and mucosa
Addison's disease or bronze disease is caused by adrenal insufficiency in patients with hypofunction of the adrenal glands.
Decreased pigmentation
Eruptions of the skin
Turgor and elasticity of the skin
Edema can be the result of fluid penetrating through the capillary walls and accumulating in the tissues. To assess the level of subcutaneous fat, a fold of skin fold and fat should be taken.
Lymph nodes
Muscular system
Bones system
Hypocratic fingers or clubbing of the terminal phalanges of the fingers and toes, resembling bell glass. Scleroderma – connective tissue disorders characterized by fibrosis and degenerative changes in the skin and extremities. Claw foot” is characterized by the presence of a high medial arch and secondary metatarsal collositis with clawing of the toes.
Raynaud's disease is characterized by "dead fingers" - transient pallor of fingers and toes, sometimes nail fold infarction, leg ulcers or purpura. Chest deformity, cleft lip, Cherechewski-Turner syndrome, Marfan syndrome, Klinefelter syndrome, Edwards syndrome, mucopolysaccharidoses, Ehlers-Danlos syndrome.
Joints system
In clinical practice it is important to assess joints movements
Examination of the spine
A "square" head with "bossing" of the frontal and parietal bones and delayed closure of the anterior fontanel in childhood is characteristic of rickets. Bossing" of the skull, prominent malar bones and protruding teeth are developments in sickle cell anemia. Involuntary head shaking associated with hand tremors occurs in patients with Parkinson's disease.
Head shaking in sync with cardiac function (with pulse wave and head thrown back), termed as Musset's sign, is observed in aortic regurgitation. Movement of the eyeball is synchronous, fulfilled in a certain direction (horizontal, vertical, circular) due to the coordinate function of 6 muscle pairs. Narrowing of the palpebral fissure can be observed in acute glomerulonephritis, Quenke's edema, myxedema, peritonitis and congenital pathology.
SCLERA, CONJUNCTIVA , CORNEA OF THE EYE
Kayser-Fleischer rings at the junction of the cornea and sclera, which are characterized by a greenish-brown discoloration of the corneal edge that first appears on the upper periphery. These are the most important clinical sign for diagnosis and can be seen in most patients with Wilson's disease (hepato-lenticular degeneration) by slit-lamp examination.
PUPILS
MYOSIS – papillary constriction is observed in uremia, intracranial hemorrhages, brain tumor, neurosyphilis, typhus, chronic poisoning. MYDRIASIS – papillary dilatation is observed in patients with coma (except uremic and apoplectic), syphilis, sometimes with aortic aneurysm.
PUPILS
MOUTH
Microstomia has a hereditary origin and may be acquired (mouth in patients with scleroderma and hypoparathyroidism). Cheilietis - inflammatory process that often occurs in the corners of the mouth is a symptom of iron deficiency anemia and hypovitaminosis B2.
LIPS
Acheilia (absence of lips), sincheilia (adhesion of the lateral part of the lips), brachieilia (shortening of the middle part of the upper lip) are signs of congenital pathology. Cheiloshisis – cleft labial (“rabbit”-lip) is a symptom of congenital pathology (Bixler syndrome – hypertelorism, microtonia, facial cleft and conductive deafness; cleft lip with or without cleft palate, median facial cleft syndrome). Lumpy lips and tongue neuromas are seen in patients with multiple endocrine neoplasia (bilateral pheochromocytoma and medullary thyroid carcinoma).
COLOR OF THE LIPS
When inspecting the tongue, attention should be paid to the shape and size, area, movement, color and condition of the papillae. Macroglossia - enlargement of the tongue is a sign of congenital pathology (Daun's disease; Beckwith-Wiedeman syndrome - macroglossia, visceromegalia, ompalocele; glycogenosi type II - macroglossia, cardiomegaly, myotonia; cerebral gigantism). A flat tongue due to base atrophy resulted from ulcerative stomatitis and scarring of the soft palate and pharynx in secondary syphilis.
Coated in the middle and at the base, but clear, the tip and edges of the tongue are typical of typhoid fever. Glossitis may be a prominent feature of stomatitis due to nutritional deficiencies and antibiotic overdose. Atrophy of ink papillae causes smooth (as if polished) crimson tongue, Hunter's glossitis, which can be observed in patients with B12 deficiency anemia.
The local thickening of the tongue with chronic migratory superficial glossitis called as geographic tongue is found in patients with hyperacidity of gastric juice. Leukoplakia is white, firm, smooth patches that begin on the side of the tongue and later spread across the dorsum. In the early stages, the tongue is not painful, but later fissures split the spots with tenderness.
Neck
Prerugium syndrome - a fold of skin that is placed on the synocular surface of the mastoid process is a sign of Shereshevsky-Turner syndrome. Pulsation of the carotid artery (carotid shivering, saltus carotidum) appears as a result of the change of blood pressure and filling of arteries during systole and diastole in patients with aortic regurgitation, hyperthyroidism and fever. Swelling and pulsation of jugular veins is explained by problems with blood flow to the right atrium in tricuspid regurgitation, pericarditis and chronic lung diseases.
Coiter is a general term for an enlarged thyroid gland and is seen in Basedovica's disease (hyperthyroidism), autoimmune thyroiditis (Shasimoto's goiter) and endemic goiter. Diffuse expansion of the thyroid gland is observed in hyperthyroidism, thyroid cancer is characterized by special asymmetric nodules with uneven surfaces.
NAILS
