Head & Neck Examination of A SURGICAL PATIENT

FAHAD BAMEHRIZ FAHAD BAMEHRIZ MDMD

ASS. Professor & Consultant SurgeonASS. Professor & Consultant Surgeon

College of Medicine, KSUCollege of Medicine, KSU

PATIENT’S PROBLEM

HOW TO SOLVE IT?HOW TO SOLVE IT?

HISTORYHISTORY CLINICAL EXAMINATIONCLINICAL EXAMINATION CLINICAL DIAGNOSIS (dif-dx)CLINICAL DIAGNOSIS (dif-dx) INVESTIGATIONSINVESTIGATIONS FINAL DIAGNOSISFINAL DIAGNOSIS TREATMENTTREATMENT

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

IMPORTANT POINTS BEFORE EXAMINATION-TAKING Introduce yourselfIntroduce yourself Explain yourselfExplain yourself Take patient permission to do the examinationTake patient permission to do the examination Ideal exposureIdeal exposure Define the Position of both Define the Position of both

Treat with respectTreat with respect

CLINICAL EXAMINATION

Four basic techniques:Four basic techniques:• InspectionInspection

• PalpationPalpation

• PercussionPercussion

• AuscultationAuscultation

CLINICAL EXAMINATION

Observe while history takingObserve while history taking• General healthGeneral health• IntelligenceIntelligence• AttitudeAttitude• Mental stateMental state• Posture/ MobilityPosture/ Mobility

Ask for a nurse when examining femalesAsk for a nurse when examining females Patient’s permissionPatient’s permission

Essential points in H &N examination Exposure up to upper chestExposure up to upper chest

Patient sittingPatient sitting

Stand in front of the patient (inspection)Stand in front of the patient (inspection) Stand behind the patient (examination)Stand behind the patient (examination)

GENERAL ASSESMENT ScalpScalp Ear/ NoseEar/ Nose Head &Neck:Head &Neck: veins, swellings ( thyroid, veins, swellings ( thyroid,

lymph nodes)lymph nodes)

EXAMINATIONOF THE NECK (INSPECTION)

Exposure up to upper chestExposure up to upper chest Patient sittingPatient sitting Stand in front of the patientStand in front of the patient Anterior and posterior triangleAnterior and posterior triangle Site and number of the swellingSite and number of the swelling Discharge, sinuses, discolurationDischarge, sinuses, discoluration Does it move with swallowingDoes it move with swallowing Midline swelling- does it move with tongue Midline swelling- does it move with tongue

protrusionprotrusion

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 Trachea- standing in front of the patient Palpate with both hands standing behind the Palpate with both hands standing behind the

patient and flex the neck anterior patient and flex the neck anterior Determine: site, size,shape, number, tenderness, Determine: site, size,shape, number, tenderness,

temperature,consistency, attachment, movement, temperature,consistency, attachment, movement, pulsation, borderspulsation, borders

Determine: if swelling moves with swallowingDetermine: if swelling moves with swallowing Lymph nodesLymph nodes PulsePulse

EXAMINATION OF THE NECK

Percussion :Percussion : over the upper manubrium or over the upper manubrium or clavicles for retrosternal extension clavicles for retrosternal extension (standing in front of the patient)(standing in front of the patient)

Auscultation :Auscultation : over the swelling ( ask the over the swelling ( ask the patient to hold breath)patient to hold breath)

GENERAL ASSESMENT WeightWeight Pulse ratePulse rate Blood pressureBlood pressure TemperatureTemperature Respiratory rateRespiratory rate General body lymph nodesGeneral body lymph nodes Nails, SkinNails, Skin Mucous membrane/ TongueMucous membrane/ Tongue Anemia/ JaundiceAnemia/ Jaundice

EXAMINATION OF THE ABDOMEN

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

IMPORTANT POINTS BEFORE EXAMINATION-TAKING Introduce yourselfIntroduce yourself Explain yourselfExplain yourself Take patient permission to do the examinationTake patient permission to do the examination Ideal exposureIdeal exposure Define the Position of both Define the Position of both

Treat with respectTreat with respect

EXAMINATION OF THE ABDOMEN

Abdomen extends from the nipple level to Abdomen extends from the nipple level to the bottom of the pelvisthe bottom of the pelvis

Exposure: nipples to knees (ideal)Exposure: nipples to knees (ideal) Patient lying flat on a pillowPatient lying flat on a pillow Arms by the side ( not under the head!)Arms by the side ( not under the head!) Sit or kneel beside the patientSit or kneel beside the patient Adequate lightAdequate light

EXAMINATION OF THE ABDOMEN (Inspection)

Asymmetry Asymmetry (from the foot end of the bed)(from the foot end of the bed)

Movement with breathingMovement with breathing Scar, sinus, woundScar, sinus, wound Prominent veinsProminent veins Shape of the umbilicusShape of the umbilicus Cough impulse Cough impulse ( groin, umbilicus, scar)( groin, umbilicus, scar)

EXAMINATION OF THE ABDOMEN (Palpation)

Gentle palpation:Gentle palpation: for tendernessfor tenderness start away from the area of painstart away from the area of pain

Deep palpation:Deep palpation: for tenderness, masses, and organomegaly for tenderness, masses, and organomegaly

Guarding:Guarding: muscle contracted overlying the tender areamuscle contracted overlying the tender area

Rebound tenderness:Rebound tenderness: sudden release causes sharp painsudden release causes sharp pain

Organomegaly:Organomegaly: liver , spleen, kidneys liver , spleen, kidneys

Other masses: Other masses: site, size, tenderness, consistency, mobility, site, size, tenderness, consistency, mobility, margins, pulsation, intra-abdominal, parietal)margins, pulsation, intra-abdominal, parietal)

Cough impulseCough impulse Defect at hernia site Defect at hernia site

EXAMINATION OF THE ABDOMEN

PercussionPercussion• Organs and massesOrgans and masses• Liver spanLiver span• Ascites: Ascites: fluid thrill, shifting dullnessfluid thrill, shifting dullness

AuscultationAuscultation• Bowel sounds: Bowel sounds: normal, increased, absentnormal, increased, absent

• BruitBruit• Succussion splash Succussion splash

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

EXAMINATION OF THE ABDOMEN

External genitaliaExternal genitalia

Rectal examinationRectal examination: : left lateral position, hip left lateral position, hip flexed to 90º and knee flexed to less than 90°flexed to 90º and knee flexed to less than 90°

• InspectionInspection• PalpationPalpation

GENERAL ASSESMENT WeightWeight Pulse ratePulse rate Blood pressureBlood pressure TemperatureTemperature Respiratory rateRespiratory rate General body lymph nodesGeneral body lymph nodes Nails, SkinNails, Skin Mucous membrane/ TongueMucous membrane/ Tongue Anemia/ JaundiceAnemia/ Jaundice