pemeriksaan fisik bedah anak
DESCRIPTION
Bedah AnakTRANSCRIPT
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PHYSICAL EXAMINATION IN PEDIATRIC SURGERYDIKKI DRAJAT KUSMAYADI SpB.,SpBA
Dept. of Pediatric Surgery Hasan Sadikin HospitalMedical Faculty- Padjadjaran University
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PE in Pediatric Surgery
• Build an acquaintanceship• Take complete history from both prnts and
child• Don’t be influenced by “other stated
diagnosis”• Inquire detailed hx/ of mother pregnancy and
delivery (for younger children)
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PE in Pediatric Surgery
• Difference with adult : Use various trickChildren:– Enjoy beeing the center of attention– Distractable– Sometimes uncooperative
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One must observe:
• Winching• Appearance • Reactions
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SKIN
• Complete inspection of the skin– Hemangioma– Pigmented spot on palm and mucous membrane
( peutz jeghers syndr.)– Café au lait spot ( von reiclinghausen’s disease)– Henoch schonlein’s purpura (with abdominal pain)– Hyperaemia of abdominal skin (peritonitis)– Decrease turgor Sign of dehidration
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Lymph Nodes
• Small, discrete nontender, 3-5 mm at cervical, axillary, epitrochlear, inguinal and occipital are normal
• Until the age 12 yrs up to 1 cm still normal• Abnormal : larger,isolated ,indurated,fixed or
reddened.
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Head and Neck• Head asymmetry : torticolis• Bulging fontanelle: high intracranial pressure• Low set ear : chromosomal defect• Absence of iris : Wilm tumor• Telecanthus,protruding tongue flat occiput : Down Syndr.• Tyroglosal duct sinuses or cyst,• Branchial cleft remnants• Thyroid nodule
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Chest
• Breast enlargement in boys and girls a months or two after birth is normal
This must not be biopsied !!!• Rapid shallow resp : peritonitis or dehidration• Look for : retraction,asymmetry, paradoxal
movement , etc.• Auscultation: look for any deviation from
normal
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Abdomen
Inspection:• Abnormal venous pattern• Umbilical drainage• Scaphoid vs distention• Peristaltic waves• Etc.
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Distention Vs Scaphoid
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Abdomen
• Palpation “Is an art that requires patience and practice”– Warm and gentle palpation– Start palpate well away from suspected area– Awaken from sleep when the sore spot is
touched : little doubt about the finding– No need for rebound tendernes test
Suspected Intussusception: Banana and dance sign
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INVAGINATION=INTUSSUSCEPTION
• Pseudokidney mass/ banana like mass• Dance sign• DRE: portio like
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Abdomen
• Auscultation:– Performed before palpation– Total absence intestinal sound: peritonitis/gangrene– Frequent high pitch sound : early obstruction infrequent low pitch : overdistended and worn out
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Inguinal
Look for • Inguinal hernia, hidrocele or scrotal mass• Absence testicle in the scrotum (UDT)
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INGUINAL/SCROTAL MASS
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Hernia Inguinalis Lateralis vsHidrokel• Gargling sound• More Soft in palpation• Bowel sound
• GS (-)• More tension,cystic in
palpation• Transilumination
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Rectal area
Look for :• Skin tag : Anal fissure• Mass, rectal prolapse, prolaps
intussusception, or rectal polypDRE• 5TH finger or index finger ;bimanual• Check for Sphincter tone, presacral tumors,
fecal impaction, ovaries ,portio like app.
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Invag. prolaps Vs Rectal prolaps
Rectal Polyp prolaps
RECTAL POLYP PROLAPSSKIN TAGS
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Sacrococcygeal Teratoma
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OMPHALOCEL vs GASTROSCHIZIS
Gastroschizis vs Omphalocele
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HIRSCHSPRUNG’S DISEASE•Temperature (+/-)•Dehidration(+/-)•Abd. Distention•Visible bowel contour/perist.•DRE: tight anal sphincter, explosive watery fecal matter
often misleaded as HD
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Peritonitis
•Increasing Temperature•Hyperemia•Distension•Decreasing/negative bowel sound•Abdominal wall edema•Papable mass(+/-)
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HYPOSPADIA
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PENILE ABNORMALITIES
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Esophageal Atresia- Tracheoesophageal fistula
•Scaphoid abd•Auscultation•Insert NG- tube
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ANORECTAL MALFORMATIONFemale
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ANORECTAL MALFORMATION
Male