Head & Neck Examination of A SURGICAL PATIENT FAHAD BAMEHRIZ MD ASS. Professor & Consultant Surgeon College of Medicine, KSU

PATIENT’S PROBLEM HOW TO SOLVE IT? HISTORY CLINICAL EXAMINATION CLINICAL DIAGNOSIS (dif-dx) INVESTIGATIONS FINAL DIAGNOSIS TREATMENT

What are the five important points, you have to do, before examination-taking?????

IMPORTANT POINTS BEFORE EXAMINATION-TAKING Introduce yourself Explain yourself Take patient permission to do the examination Ideal exposure Define the Position of both Treat with respect

CLINICAL EXAMINATION Four basic techniques: Inspection Palpation Percussion Auscultation

CLINICAL EXAMINATION Observe while history taking General health Intelligence Attitude Mental state Posture/ Mobility Ask for a nurse when examining females Patient’s permission

Essential points in H &N examination Exposure up to upper chest Patient sitting Stand in front of the patient (inspection) Stand behind the patient (examination)

GENERAL ASSESMENT Scalp Ear/ Nose Head &Neck: veins, swellings ( thyroid, lymph nodes)

EXAMINATIONOF THE NECK (INSPECTION) Exposure up to upper chest Patient sitting Stand in front of the patient Anterior and posterior triangle Site and number of the swelling Discharge, sinuses, discoluration Does it move with swallowing Midline swelling- does it move with tongue protrusion

How do we examine the trachea. Is it from the front or behind How do we examine the trachea ? Is it from the front or behind? Is it by inspection, palpation, ….?

EXAMINATION OF THE NECK ( PALPATION ) Trachea- standing in front of the patient Palpate with both hands standing behind the patient and flex the neck anterior Determine: site, size,shape, number, tenderness, temperature,consistency, attachment, movement, pulsation, borders Determine: if swelling moves with swallowing Lymph nodes Pulse

EXAMINATION OF THE NECK Percussion : over the upper manubrium or clavicles for retrosternal extension (standing in front of the patient) Auscultation : over the swelling ( ask the patient to hold breath)

GENERAL ASSESMENT Weight Pulse rate Blood pressure Temperature Respiratory rate General body lymph nodes Nails, Skin Mucous membrane/ Tongue Anemia/ Jaundice

EXAMINATION OF THE ABDOMEN

What are the essential points before examination-taking????

IMPORTANT POINTS BEFORE EXAMINATION-TAKING Introduce yourself Explain yourself Take patient permission to do the examination Ideal exposure Define the Position of both Treat with respect

EXAMINATION OF THE ABDOMEN Abdomen extends from the nipple level to the bottom of the pelvis Exposure: nipples to knees (ideal) Patient lying flat on a pillow Arms by the side ( not under the head!) Sit or kneel beside the patient Adequate light

EXAMINATION OF THE ABDOMEN (Inspection) Asymmetry (from the foot end of the bed) Movement with breathing Scar, sinus, wound Prominent veins Shape of the umbilicus Cough impulse ( groin, umbilicus, scar)

EXAMINATION OF THE ABDOMEN (Palpation) Gentle palpation: for tenderness start away from the area of pain Deep palpation: for tenderness, masses, and organomegaly Guarding: muscle contracted overlying the tender area Rebound tenderness: sudden release causes sharp pain Organomegaly: liver , spleen, kidneys Other masses: site, size, tenderness, consistency, mobility, margins, pulsation, intra-abdominal, parietal) Cough impulse Defect at hernia site

EXAMINATION OF THE ABDOMEN Percussion Organs and masses Liver span Ascites: fluid thrill, shifting dullness Auscultation Bowel sounds: normal, increased, absent Bruit Succussion splash

Have we missed any important\ essential part to examine to complete the abdominal examination?

EXAMINATION OF THE ABDOMEN External genitalia Rectal examination: left lateral position, hip flexed to 90º and knee flexed to less than 90° Inspection Palpation

GENERAL ASSESMENT Weight Pulse rate Blood pressure Temperature Respiratory rate General body lymph nodes Nails, Skin Mucous membrane/ Tongue Anemia/ Jaundice