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    Pemeriksaan Fisik Bedah Anak

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    Ignatia Clara Ratna
    This document provides guidance on performing physical examinations in pediatric surgery. It outlines key areas to assess including: - Taking a complete medical history from both parents and child and not being influenced by other stated diagnoses. - Using various tricks as children can be distractable and uncooperative at times. - Closely observing the skin, lymph nodes, head and neck, chest, abdomen, inguinal area, and rectal area for any abnormalities, masses, or signs of common pediatric surgical conditions. - Providing detailed examples of assessing the abdomen for distension versus scaphoid shape, signs of intussusception, inguinal hernias versus hydroceles, and other conditions.

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    Pemeriksaan Fisik Bedah Anak

    Uploaded by

    Ignatia Clara Ratna
    222 views27 pages
    This document provides guidance on performing physical examinations in pediatric surgery. It outlines key areas to assess including: - Taking a complete medical history from both parents and child and not being influenced by other stated diagnoses. - Using various tricks as children can be distractable and uncooperative at times. - Closely observing the skin, lymph nodes, head and neck, chest, abdomen, inguinal area, and rectal area for any abnormalities, masses, or signs of common pediatric surgical conditions. - Providing detailed examples of assessing the abdomen for distension versus scaphoid shape, signs of intussusception, inguinal hernias versus hydroceles, and other conditions.

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    Bedah Anak

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    This document provides guidance on performing physical examinations in pediatric surgery. It outlines key areas to assess including: - Taking a complete medical history from both parents and child and not being influenced by other stated diagnoses. - Using various tricks as children can be distractable and uncooperative at times. - Closely observing the skin, lymph nodes, head and neck, chest, abdomen, inguinal area, and rectal area for any abnormalities, masses, or signs of common pediatric surgical conditions. - Providing detailed examples of assessing the abdomen for distension versus scaphoid shape, signs of intussusception, inguinal hernias versus hydroceles, and other conditions.

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    222 views27 pages

    Pemeriksaan Fisik Bedah Anak

    Uploaded by

    Ignatia Clara Ratna
    This document provides guidance on performing physical examinations in pediatric surgery. It outlines key areas to assess including: - Taking a complete medical history from both parents and child and not being influenced by other stated diagnoses. - Using various tricks as children can be distractable and uncooperative at times. - Closely observing the skin, lymph nodes, head and neck, chest, abdomen, inguinal area, and rectal area for any abnormalities, masses, or signs of common pediatric surgical conditions. - Providing detailed examples of assessing the abdomen for distension versus scaphoid shape, signs of intussusception, inguinal hernias versus hydroceles, and other conditions.

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    PHYSICAL EXAMINATION IN

    PEDIATRIC SURGERY
    DIKKI DRAJAT KUSMAYADI SpB.,SpBA
    Dept. of Pediatric Surgery Hasan Sadikin
    Hospital
    Medical Faculty- Padjadjaran University

    PE in Pediatric Surgery
    Build an acquaintanceship
    Take complete history from both
    prnts and child
    Dont 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
    trick
    Children:
    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.)
    Caf au lait spot ( von reiclinghausens
    disease)
    Henoch schonleins 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=INTUSSUSCE
    PTION
    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 polyp
    DRE
    5TH finger or index finger ;bimanual
    Check for Sphincter tone, presacral
    tumors, fecal impaction, ovaries ,portio
    like app.

    Invag. prolaps Vs Rectal


    prolaps

    SKIN TAGS

    RECTAL POLYP
    PROLAPS

    Rectal Polyp
    prolaps

    Sacrococcygeal Teratoma

    OMPHALOCEL
    GASTROSCHIZIS

    Gastroschizis vs Omphalocele

    vs

    HIRSCHSPRUNGS 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/negat
    ive bowel sound
    Abdominal wall
    edema
    Papable
    mass(+/-)

    HYPOSPADIA

    PENILE ABNORMALITIES

    Esophageal AtresiaTracheoesophageal fistula


    Scaphoid abd
    Auscultation
    Insert
    NG- tube

    ANORECTAL
    MALFORMATION
    Female

    ANORECTAL
    MALFORMATION
    Male

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