Physical examination (examination): what is it. Physical examination Physical examination visual examination takes into account

Physical methods of examination of patients are an integral and important part of the diagnosis of vascular diseases both at the prehospital stage and in the hospital. A physical examination is a comprehensive medical examination of a patient with varicose veins. Despite technological progress and the active introduction of modern instrumental methods of examination, questioning and physical examination of patients continue to occupy an important place in the diagnosis, including varicose veins. For many years now, not a single modern doctor can do without an examination. The features of the physical and instrumental examination are different for everyone, but in clinical practice they are equally important for making the correct diagnosis and should complement each other.

What is the meaning of medical examination

Getting to the doctor during the initial or repeated visit for venous disease, the patient, in addition to communication and a thorough study of complaints and the history of the disease, is subjected to a rigorous examination. This work is called a physical examination. Physical examination methods include:

• Inspection.
• Palpation.
• Percussion.
• Auscultation.

Based on the analysis of complaints, anamnesis and examination, palpation, percussion and auscultation, a preliminary diagnosis is usually made, which is subsequently confirmed or refuted using laboratory and instrumental diagnostic methods. With varicose veins, an additional method of examination most often becomes ultrasound of the vessels of the lower extremities.

In medicine, there is a consonant expression - physical therapy. Otherwise, it is also called physiotherapy. Such treatment involves the impact on the patient of physical factors in order to stop a particular disease. Widely used, for example, different strength currents, magnetic fields. That is, there is no direct connection between such a concept as physiotherapy and a consonant examination (examination) of the patient. These words have a similar sound, but a completely different semantic load.

Appearance rating

The first thing the doctor does after talking with the patient and clarifying his complaints and anamnesis is an examination. This is an important part of the physical examination. Thus, a large amount of information can be obtained both about the general condition of the patient and about local changes in his body. During the examination, the patient's condition is first assessed (satisfactory, moderate, severe). In people with varicose veins, the condition is often satisfactory, but can be severe with the development of complications such as pulmonary embolism. Varicose veins complicated by deep vein thrombophlebitis can also cause a significant deterioration in the general condition due to pain and hyperthermia.

The examination of the patient always begins with a survey.

Further, during the examination, the appearance of the skin is assessed. The patient is examined completely, from head to toe, the presence of any damage to the skin (rash, hemorrhages, petechiae, hematomas, wounds, dermatitis, any other pathological changes) is noted. Skin color is assessed - general and local changes, the presence of visible subcutaneous formations, postoperative or other scars on the skin.

In a patient with varicose veins of the lower extremities, special attention is paid to examining the legs. The following symptoms are possible:

• The presence of vascular (venous) networks.
• Visual changes in the saphenous veins on the legs - their thickening, tortuosity, symmetry of changes, the presence of nodes and bumps.
• At later stages of the disease, during the examination, the presence of trophic ulcers can be noted as a complication of varicose veins.

During the physical examination, the level of consciousness is determined. The facial expression is noted, whether it is calm, whether there are signs of suffering and pain on the face, whether facial expressions are disturbed, whether there is swelling of the face, cyanosis of the nasolabial triangle (acrocyanosis) and other signs. Be sure to pay attention to the forced posture, the change of which brings pain or worsening of the patient's condition.

Palpation

If the examination is mostly performed visually, then palpation implies physical contact between the doctor and the patient - the doctor feels the organs, joints, damaged areas available for palpation.

With the help of palpation, you can get information about the condition of the skin, its moisture content, turgor, and assess the temperature. With the help of palpation, the pulse on the main arteries is determined.

Much information about the skin can be obtained by palpation.

Physical examination of the musculoskeletal system also involves palpation, during which the integrity of the skeleton, the presence of damage to the bones or joints, and pain on palpation are determined. After an injury, a damaged bone, joint or muscle is subjected to palpation. The doctor, after conducting a physical examination of the patient and his musculoskeletal system at the prehospital stage, can establish a preliminary diagnosis without using instrumental diagnostic methods.

Palpation of the abdomen makes it possible to determine changes in the internal organs, an increase in their size, a change in position relative to each other, pain when pressed, sometimes palpation can reveal volumetric formations.

With varicose veins, the doctor palpates the affected areas on the lower extremities. Assesses the presence of pain, inflammatory changes, if possible, determines the presence of blood clots, nodes. Palpation also determines the presence of edema, changes in local temperature. Thrombophlebitis of superficial venous vessels is accompanied by their thickening, soreness, and sometimes skin hyperemia. All these signs of vascular disease can be easily determined by the doctor with the help of palpation.

Percussion

During a physical examination without the use of any instruments or equipment, the doctor performs percussion. This method is based on the difference in the density of the organs, which determines their ability to conduct sound acoustically. It is performed by tapping with one finger (acting as a hammer) on the other finger, tightly attached to the patient's body area (the role of a plessimeter). As a result of tapping, a dull (liver) sound or a clear (pulmonary) sound is obtained. With the help of percussion, it is possible to determine the boundaries of internal organs, an increase in their size, the presence of pathological formations, and to suspect various diseases.

Physical examination may suggest the presence of poorly perfused areas.

With such a complication of varicose veins as pulmonary embolism, percussion of the lungs helps to suggest the presence of poorly perfused areas. These disorders occur due to blockage of the pulmonary vessels. Sometimes a heart attack-pneumonia develops, causing compaction of the organ site and dulling of the lung sound during percussion.

Auscultation

Auscultation is one of the physical methods of examining a patient, carried out using a stethophonendoscope and consisting in listening to the doctor's sounds made during the work of internal organs (heart, lungs, gastrointestinal tract). Auscultation helps to determine whether the internal organs are working normally, whether there are additional pathological noises.

For a patient who applied for varicose veins, the doctor will listen to the lungs and heart without fail. This will help identify concomitant diseases of the heart, blood vessels and lungs, as well as systemic complications of varicose veins.

Such important edema

Doing a physical examination, the presence of edema is separately assessed. Edema can be located on the face, upper limbs, in the area of ​​injury or fracture. Often, people have swelling of the lower extremities associated with varicose veins.

The presence of edema, in addition to visual assessment, is determined by pressing a finger on a certain area of ​​the skin close to the bone. With varicose veins, this is the front surface of the lower leg. In the presence of edematous syndrome on the skin, a notch or depression will remain at the place of pressure.

Small, barely noticeable swelling is called pastosity. One of the causes of edema in the legs is varicose veins of the lower extremities. Such vascular edema usually occurs in the evening and is accompanied by heaviness and fatigue in the legs. In the morning, the manifestations usually disappear. However, in the later stages of varicose veins, swelling can persist constantly, regardless of the time of day.

Varicose veins of the lower extremities can lead to swelling in the legs.

Physical examination of the patient is of great importance for the initial diagnosis and assessment of the dynamics of the course of varicose veins of the lower extremities. Some people underestimate such an examination, believing that laboratory and instrumental methods provide more accurate information about the state of health. A professional physical examination helps the doctor to get an idea of ​​the course of varicose veins, the condition of the vessels in the legs. Regular visits and examinations allow the specialist to assess the dynamics of the state of the veins of the lower extremities, the progression of vasodilation and the addition of complications. This is what underlies the successful rapid disposal of varicose veins.

Physical examination is a method widely used in the field of practical medicine for a preliminary assessment of the patient's condition and for making a primary diagnosis. The examination procedure is based on the sense organs of a specialist and does not imply the use of auxiliary medical instruments. Currently, physical research methods are gradually losing their relevance due to the instrumental and technical equipment of medical institutions. But in the absence of the possibility of using such, the method is the only way to make a diagnosis.

How it is carried out: features of the procedure

In fact, the entire procedure is based on the collection of anamnesis and assessment of the external condition of the patient. An experienced specialist conducting an examination, having only the indicated data at his disposal, can make an appropriate diagnosis and prescribe an adequate therapy. In the absence of a sufficient amount of data for diagnosis, a number of additional examinations are carried out, including not physical, but instrumental ones.

Examination of the patient provides for a visual and physical examination of the patient and includes a number of manipulations that are mandatory at the prehospital stage. Among them are the following:

• Assessment of consciousness.
• Inspection of the external condition of the skin and mucous tissues.
• Auscultation.
• Percussion.
• Palpation.

Inspection is almost always a preliminary stage of a complete examination, regardless of the use of instrumental methods and laboratory tests. The procedure allows obtaining basic objective data on the condition, which in some cases is sufficient to start emergency therapy.

Consciousness

The initial stage of the physical examination is the assessment of the patient's consciousness. In the presence of a number of diseases, the psychological component is often the most important point and requires mandatory therapeutic intervention. Otherwise, there is a possibility that the patient will injure himself due to an inadequate assessment of reality.

In the field of practical medicine, it is customary to distinguish four main stages of the pathology of consciousness, each of which is characterized by a set of certain disorders and some disorientation in space:

• Obscuration.
• Stupor.
• Sopor.
• Coma.

The first three stages of impaired consciousness are characterized, as a rule, by a slow reaction on the part of the patient to what is happening around, or by the complete absence of it. In this case, the face is almost always conscious. Coma is characterized by a complete lack of consciousness and is the most dangerous condition that entails irreversible changes.

The first thing the doctor examines is the consciousness of the patient.

The above disorders of consciousness are classified as so-called passive, while there are also opposite variants of violations. In such situations, a person not only lacks an adequate assessment of what is happening around, but also manifestations of aggression, a desire to escape, and more are possible. Identification of such violations is possible precisely with the help of a physical examination.

Skin

Evaluation of the condition of the skin and mucous membranes of the patient can also help in the collection of anamnesis for diagnosis. A significant part of the diseases is characterized by the presence of visual manifestations, including the appearance of a rash, redness, dryness and irritation. Together, these physical examination and physical examination factors can provide a more complete assessment.

Additional Features

Among the additional signs, determined upon examination by the method of physical examination, include such, for example, as the presence or absence of puffiness and swelling, facial expression, the state of the lymph nodes. Each of these aspects, determined visually, has a certain value in making a preliminary diagnosis.

The absence of visual signs of any diseases, as well as the preservation of consciousness, are not an indicator of the absence of pathologies. However, in such situations, to identify the disease and make a preliminary diagnosis, additional methods are required, consisting in a more complete examination of the patient.

In this case, the features of the physical and instrumental examination are to involve such techniques as inspection, palpation, percussion, auscultation. These methods of examining the patient allow for a more complete examination and show an accurate and complete picture of his well-being, the presence or absence of possible pathologies.

In the absence of visual signs of the disease, there is no guarantee that the patient is completely healthy.

Palpation

Palpation is a physical examination method that allows the specialist to get a fairly clear picture of the pathologies of the internal organs, as well as their position. This method of physical examination involves the direct impact of the palms or fingers of a specialist on the skin of the face.

Pressure and probing of the internal organs reveals their soreness, the correctness of the anatomical location, possible deformation and other signs that are not classified as normal variants. There are two types of palpation: superficial and deep. Often, these types of physical examinations are used if the internal organs or any muscle are damaged.

Percussion

Currently, percussion, often referred to in everyday life as "tapping", is used quite rarely, due to the emergence of more advanced techniques. In addition, perfect percussion technique is required to determine the condition of the face, but today the number of such physical examination specialists has significantly decreased.

The method is based on the implementation of light percussions that do not cause discomfort to the patient, and the subsequent analysis of recurrent sound phenomena. That is, an elementary sound can give a specialist a complete and clear picture of the state of the patient's internal organs.

Physical examination methods include several main types of percussion, including percussion with one or more fingers or special instruments. Percussion is mainly used for the primary detection of pathologies of the digestive tract, lungs and heart.

Auscultation

The auscultation method, better known as the listening method, involves determining the state of the internal organs based on the sound vibrations they produce. In modern medicine, auxiliary instruments are often used, while earlier a similar method of physical examination was carried out without the presence of such.

The auscultation method is based on the sound vibrations of the internal organs.

The auscultation method provides for the identification of dynamics in the vibrations of sound produced by internal organs, the comparison of sounds, as well as other options for determining the presence or absence of possible pathologies. This examination is almost always carried out in conjunction with other, contact methods of physical examination.

Anamnesis

Questioning and physical examination of patients can help the specialist give a complete objective picture of their condition, identify diseases and possible pathologies. Moreover, it is the questioning or anamnesis that in this case is almost of paramount importance along with a visual examination.

Based on the oral data of the patient, the doctor can determine the duration of the course of the disease, its characteristic features, stage and possible complications. In addition, a similar study can be carried out by interviewing people who are in close proximity to the patient for a long period of time.

However, taking an anamnesis as a method of physical examination may be ineffective if the patient is in an unconscious state and does not have the opportunity to voice complaints about their own well-being. In this case, physical therapy at the prehospital stage is based solely on the examination of the face.

Most methods, including auscultation and percussion, require complete silence in the room where facial examination or other physical therapy is being performed. Otherwise, some errors and discrepancies with the real state of the patient are not excluded.

Despite the fact that the physical method of examination is losing popularity in proportion to the development of modern technologies, this method still has a right to exist. Specialists who are fluent in the technique of physical examination are able to draw up a complete picture of the patient's condition without using auxiliary tools and laboratory research methods. In emergency cases, the timely use of this type of examination can save the patient's life.

and in the position on the side with the lower leg extended and the leg slightly bent at the knee from above (Fig. 195). The mice should be as relaxed as possible. After superficial palpation, localization is more clearly defined. peaks big spit. Then, having gone down from it by 5-7 cm, they begin deep palpation according to the principle "from the periphery to the center". A similar palpation is carried out retreating from the trochanter to the sides by 5-7 cm. pay special attention to the posterior superior angle of the trochanter- the place of attachment to the trochanter of the tendon of the middle and small gluteal muscles, their tendons and synovial bags are located here.

In healthy patients, palpation of the greater trochanter is painless. Pain above the greater trochanter, below and in front of it indicates inflammation of the trochanter or synovial bags. Local pain at the posterior-superior angle of the trochanter is characteristic of the pathology of the tendons and synovial bags of the middle and small gluteal muscles. By using "anvil symptom"(Fig. 196) and weight load (standing on the interested leg), it is possible to exclude or confirm the pathology of the trochanter.

Rice. 196. Identification of pain in the hip joint by tapping on the heel of the outstretched leg (anvil symptom).

Rice. 197. Feeling the femoral head in the femoral (Skarpov) triangle.

The hip joint due to its deep location is almost inaccessible to palpation. Only in femoral triangle(it is bounded from above by the inguinal fold, from the outside by the inner edge of the sartorius muscle, from the inside by the outer edge of the long adductor muscle) it is possible to palpate part of the anterior surface of the femoral head, a narrow strip of the anterior edge of the acetabulum and partially the joint space. The palpated part of the joint is perceived like tight resistance to the fingers, trying to penetrate into the depth of the femoral triangle. Palpation carried out as follows (Fig. 197). The subject lies on his back on a hard surface. The doctor places the thumb of the right hand on the anterior surface of the ilium, the rest on the greater trochanter of the thigh. Then the thumb or II and III fingers move along the inguinal fold to the place where the femoral artery pulsates in depth - this is approximately the lower third of the ligament. After that, the fingers are slightly displaced outward from the femoral artery. In this place, when pressing inward, the fingers rest against the head of the femur, which lies outside the cavity, and a little more medially at the acetabulum there is a joint space, but it is not always possible to clearly palpate it. On palpation of the joint space, the fingers turn perpendicular to its edge. (Fig. 198).

The physical examination must be performed by a licensed physician, a nurse, and a physician's assistant. Vital signs (temperature, heart rate, blood pressure, respiration), complete examination, 12-lead electrocardiogram, stress test, heart murmurs, anthropometric measurements, laboratory (biochemical) data, neurological function test (including reflexes) and fitness assessment - all these are the components of such an inspection.

Before participating in organized sports in high school or college, athletes usually undergo a physical examination.

The specific objectives of the Preliminary Athlete Screening (PIC) are as follows;

Determine the general health of the athlete;

Identify any conditions that may limit an athlete's participation in sports or their predisposition to injury;

Determine the physical fitness of the athlete;

Assess the physical maturity of the athlete;

Give advice related to health and personal life;

Satisfy legal regulations and insurance issues.

POS should be carried out 4-6 weeks before the start of the competition season. This will allow problems identified during the physical inspection to be identified and any residual damage to be dealt with before the start of the season. ISAC requires only one PES on an athlete's first entry into a college athletic program.

Other inspection organizations

Other organizations recommend a comprehensive PIC whenever an athlete moves to a new “level”. Most athletic programs require athletes to complete a yearly health monitoring program to identify any problems that may have developed since the initial PIC.

POS is usually carried out using one or more methods: the athlete's personal physician, mass examination physician, or many physicians at the examination point. Which method to use depends on the specific objectives of the survey as well as the availability of time and resources. Grafe et al. and Hergenrolder give a detailed description of these methods and indications for their use.

The components of the pre-screening are similar to those specific to the health screening and medical determination of an adult athlete and are described above. At the preliminary examination of athletes, one should carefully review the anamnesis and nutritional history and pay special attention to previous sports injuries. For women athletes, a deep understanding of the history of menstruation is essential. In addition, all female athletes should be screened for erratic eating and/or abnormal weight control. While many schools do not have the means to provide women with bone mineral density testing, it is important to be aware of fractures.

POS should also include an assessment of the general condition of the body systems and a thorough examination of the musculoskeletal system, a general assessment of areas of increased risk of damage for specific sports, as well as an examination of the sites of previous injuries. Growth and maturity assessments are highly recommended for adolescent athletes. A detailed description of the POS components for athletes of various sports is available.

Physical examination is a technique for preliminary assessment of a person's condition in order to determine the primary diagnosis. The procedure does not involve the use of instrumental measures, it is based on the doctor's senses.

This type of research is currently relegated to the background by technical and instrumental medical equipment. But in the absence of such devices, physical examination is the only possible and affordable one.

Features of the

The principle of action lies in the collection of anamnesis and evaluation of the patient in appearance.

For an experienced doctor, the above actions will be enough to determine the diagnosis and prescribe appropriate therapy.

In the absence of the necessary data to determine the disease, the patient is prescribed an instrumental, laboratory examination.

In the process of physical examination, physical and visual contact occurs through a number of manipulations that are important for the prehospital stage:

• general assessment of consciousness;
• study of mucous tissues, skin;
• percussion;
• auscultation;
• palpation.

This examination precedes the full examination.

With its help, objective data concerning the general condition of a person are established.

In some cases, this is quite enough to provide emergency assistance.

Consciousness

Among the many types of examination of the heart, consciousness deserves special attention.

Often the psychological component is an important factor in which therapeutic intervention is indicated.

There are 4 stages of altered consciousness, characterized by spatial disorientation:

• coma;
• sopor;
• stupor;
• obscuration.

Coma represents the absence of any signs of consciousness. It is hazardous to health. It is the cause of irreversible processes.

The remaining states are expressed in the form of a slow reaction to everything that happens, its complete absence.

These are passive disturbances of consciousness, but there are also opposite ones. They are manifested not only by the lack of a sound assessment of what is happening. Accompanied by aggression, fear, obsession.

It is these violations that a physical examination reveals.

Dealing with the skin

When deciding how to check the heart, the doctor examines the mucous membranes of a person, the epidermis, which can be important when taking anamnesis.

Many pathological processes, and cardiovascular pathologies are no exception, rash, irritation, peeling and dryness, redness, cyanosis (cyanosis).

Such data complement the assessment of the patient's condition, indicate the correctness of the diagnosis.

Of the additional features

Such aspects, captured visually, are important for determining the preliminary diagnosis of the suspected disease.

If there are no changes, signs, consciousness remains clear, this does not indicate the absence of the disease. Additional methods will be needed for a detailed examination of a person and determining his condition.

Among these, auscultation, palpation, percussion differ in functionality. They complement the ongoing examination, indicate an accurate clinical picture.

The principle of palpation

Physical examination of the patient. In which the doctor can more specifically identify diseases after a study of the internal organs, the features of their position.

The action lies in the fact that the specialist examines with fingers, palms the skin in the area of ​​​​large arteries, veins, heart.

When pressing under a certain pressure on a particular organ, part of the body, the severity of pain is determined. Possible deformation in their location, other symptoms that are not the norm.

Palpation is deep and superficial. Most of all, it is effective in case of damage to muscles and internal organs.

More about percussion

In everyday life, this method of examination is called tapping. It is used in practice not so often, due to the presence of a huge number of modern methods.

In order to correctly determine the change on the part of the face, the specialist must be fluent in percussion, the technique is quite complex and multifaceted.

It is represented by light tapping of varying intensity and analysis of the responding return sounds. Does not cause pain or discomfort.

A true professional will determine the defeat of internal organs by sound alone.

The physical technique includes several types of percussion, when percussion is performed with one or more fingers. Sometimes a tool is involved.

In most cases, percussion is used in the diagnosis of pathologies of the heart muscle and lungs.

Sometimes suitable for examination of the digestive tract.

Auscultation

This procedure is also called listening, when the condition of the alleged damaged organ is determined by the emitted sound vibrations.

To this end, instrumental methods for studying the cardiovascular system are being used today. Previously, manipulation was performed manually, without additional devices.

The main task is to determine the dynamics of the oscillating sounds that come from the internal organ. In their comparison for deviations from the norm and the development of pathology.

A little history

A physical examination, along with a thorough questioning, helps to create a voluminous and complete clinical picture for the doctor. Decide on the final diagnosis.

Questioning about the diseases present in the anamnesis is of great importance. They tend to recur, manifest themselves in complex forms.

Based on verbally received information, a specialist can approximately assume the duration of the course of the pathological process, its main symptoms and characteristics of possible complications.

This method of research is convenient in that it is possible to interview other persons who have been surrounded by the patient for a long time. They have information about the diseases they have suffered.

It will not be possible to use the procedure for collecting an anamnesis if the person is unconscious. He cannot clearly indicate the states that concern him, state complaints in detail.

But here, too, there is a way out. A doctor with extensive experience in physical therapy may limit himself to examining the face in order to suggest one or another pathology from the cardiovascular system.

What are the indications for a physical examination?

We can safely say that it is carried out at any convenient moment by a specialist with certain skills and knowledge in this therapeutic area.

Today, such events are losing their relevance, being replaced by more accurate and convenient instrumental devices.

Real professionals in the shortest possible time with the help of physical methods can make an accurate diagnosis of a person, alleviate his general condition, or even save a life in emergency situations.

After all, situations often occur when specialized devices are not at hand, and it is impossible to conduct laboratory, instrumental diagnostics.

Useful video: How is the physical examination