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PHYSICAL EXAMINATION IN PEDIATRIC SURGERYDIKKI DRAJAT KUSMAYADI SpB.,SpBA
Dept. of Pediatric Surgery Hasan Sadikin HospitalMedical Faculty- Padjadjaran University
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)
PE in Pediatric Surgery
• Difference with adult : Use various trickChildren:– Enjoy beeing the center of attention– Distractable– Sometimes uncooperative
One must observe:
• Winching• Appearance • Reactions
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
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.
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
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
Abdomen
Inspection:• Abnormal venous pattern• Umbilical drainage• Scaphoid vs distention• Peristaltic waves• Etc.
Distention Vs Scaphoid
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
INVAGINATION=INTUSSUSCEPTION
• Pseudokidney mass/ banana like mass• Dance sign• DRE: portio like
Abdomen
• Auscultation:– Performed before palpation– Total absence intestinal sound: peritonitis/gangrene– Frequent high pitch sound : early obstruction infrequent low pitch : overdistended and worn out
Inguinal
Look for • Inguinal hernia, hidrocele or scrotal mass• Absence testicle in the scrotum (UDT)
INGUINAL/SCROTAL MASS
Hernia Inguinalis Lateralis vsHidrokel• Gargling sound• More Soft in palpation• Bowel sound
• GS (-)• More tension,cystic in
palpation• Transilumination
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.
Invag. prolaps Vs Rectal prolaps
Rectal Polyp prolaps
RECTAL POLYP PROLAPSSKIN TAGS
Sacrococcygeal Teratoma
OMPHALOCEL vs GASTROSCHIZIS
Gastroschizis vs Omphalocele
HIRSCHSPRUNG’S DISEASE•Temperature (+/-)•Dehidration(+/-)•Abd. Distention•Visible bowel contour/perist.•DRE: tight anal sphincter, explosive watery fecal matter
often misleaded as HD
Peritonitis
•Increasing Temperature•Hyperemia•Distension•Decreasing/negative bowel sound•Abdominal wall edema•Papable mass(+/-)
HYPOSPADIA
PENILE ABNORMALITIES
Esophageal Atresia- Tracheoesophageal fistula
•Scaphoid abd•Auscultation•Insert NG- tube
ANORECTAL MALFORMATIONFemale
ANORECTAL MALFORMATION
Male