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