Generality
Auscultation is the term that usually refers to the use of the stethoscope, to hear the noises inside the human body.
Performed typically on the occasion of each physical examination, auscultation is therefore a medical test.
Without risks and contraindications, the auscultation test represents a fundamental step in the preliminary diagnosis of the suffering of organs such as: the heart, the lungs, the large vessels and the intestine; in fact, all these organs emit abnormal sounds when struck by an illness.
For the preliminary diagnostic power it has, auscultation is a test that, during an objective examination, should never be missed.
What is auscultation?
Auscultation is the diagnostic test, performed on the occasion of each objective examination, during which the doctor, by using a stethoscope, hears and analyzes the internal noises of the patient's body.
To understand the auscultation: what is the Objective Exam?
The physical examination, or physical examination, is the preliminary medical investigation, which consists in carefully observing the patient's body, looking for symptoms and signs correlated to a suffering of the organism or a real illness.
The physical examination includes a series of typical "diagnostic maneuvers"; these "diagnostic maneuvers" are:
- The inspection, which corresponds to looking at the body;
- The palpation, which corresponds to feeling the body with the help of the hands, fingers in particular;
- The percussion, which corresponds to testing the sonority of the body in particular points, through the touch of these;
- Auscultation, which, as stated earlier, corresponds to the internal noises of the body, through the use of the stethoscope.
The physical examination is an investigation whose execution makes the patient participate; the doctor, in fact, may require the latter to perform certain movements, cough, take particular positions, etc., all with the aim of gathering as much information as possible on the state of health.
Indications
In the presence of a suffering at their expense, the heart, the lungs, the most important arterial vessels of the body (eg, aorta and carotids) and the intestine produce abnormal or different sounds and noises.
Auscultation is the test that allows you to capture these sounds and evaluate their characteristics, so as to distinguish them from normality.
Auscultation is the test that allows a preliminary assessment to be made regarding the health of the cardiovascular system, the respiratory system and the gastrointestinal system, relying exclusively on the noises emitted by the organs constituting the aforementioned systems.
Usefulness of auscultation
Auscultation can provide the first information useful for diagnosing conditions, such as:
- Heart diseases .
Through auscultation, the doctor is able to identify the anomalies of the heartbeat (ie the so-called cardiac arrhythmias ), the heart murmurs resulting from the dysfunctions of the heart valves ( valvulopathies ) and, finally, the loss of fluidity of the pericardium due to inflammation of the latter ( pericarditis ).
- Lower airway diseases and lung diseases .
Auscultation allows the identification of rales and stridors, deriving from: tracheitis (inflammation of the trachea), bronchitis (inflammation of the bronchi), bronchiolitis (inflammation of the bronchioles), pneumonia (inflammation of the lungs), asthma, pulmonary edema, pulmonary emphysema, bronchopneumopathy chronic obstructive, pleurisy etc.
- Diseases of the large arterial vessels .
Thanks to auscultation, it is sometimes possible to identify the dangerous abnormal dilatations of the aorta, known as aortic aneurysms (or aneurysms of the aorta ), and obstructions of the carotid arteries, which are among the possible causes of stroke .
- Diseases of the intestine .
Among the bowel diseases suspected by auscultation, include: Crohn's disease, enteritis, spastic colitis (or irritable bowel syndrome ), colitis, ulcerative colitis, celiac disease, intestinal blockage, and diverticulitis .
The diseases of the intestine produce noises, which, upon auscultation, are very reminiscent of gorgoglii (" abdominal gurgling ").
Preparation
Auscultation does not require any special preparation for the patient.
Therefore, the patient can undergo auscultation even if: he has eaten recently, takes drugs, presents an allergy, etc.
Environmental Requirements for Effective Auscultation
For auscultation to provide reliable results, it is essential that the environment in which it takes place is:
- Silent . If the doctor performs auscultation in a noisy environment, he will not be able to adequately appreciate the internal noises of the human body, as he will experience an overlap of sounds.
- Warm enough . Since auscultation occurs with the chest bare, the patient, in an environment that is too cold, may suffer from chills that "pollute" the listening to the internal noises of the body.
- Properly lit. Proper lighting of the environment is essential, because it allows the doctor to accurately recognize the critical points on which to place the stethoscope on the patient's body.
Procedure
In practice, the basic steps of auscultation are, in order:
- The denudation of the patient, as regards the upper part of the body, and its accommodation on a special bed, according to the indications of the doctor, and
- The doctor's listening to the noises emitted by the thoracic and abdominal organs, through the stethoscope.
Listening to noise is the most important phase of auscultation; it foresees the support of the stethoscope in specific cutaneous areas, because only in this way the doctor has the possibility to clearly appreciate the noise emitted by the internal organ below.
During auscultation, placing the stethoscope in the right areas of the body is essential to clearly hear the noises of interest.
The Stethoscope: what is it?
Also known as a stethophonendoscope or phonendoscope, the stethoscope consists of two characteristic components:
- The disc-shaped component, which, once placed on the skin, has the function of picking up the noises emitted by the internal organs, and
- The earphone component, including two earphones (one for each ear) and metal tubes, covered in rubber, which connect the aforementioned earphones to the first component and which "carry" the noises up to the doctor's ears.
Invented by the French physician René Laennec in 1816, the stethoscope is one of a fact a sound frequency meter, which, through the particular shape of the disc-shaped component, captures and transports both low-frequency sounds and the ear to the ear. high frequency sounds.
Currently, there are two types of stethoscope: the acoustic stethoscope and the electronic stethoscope.
The acoustic stethoscope represents the classical typology, deriving from the innovative idea of Laennec; the electronic stethoscope, on the other hand, constitutes the modern typology, the one that uses technology to capture sounds and send them to the ear.
How long is the auscultation?
Auscultation can last from a few minutes to even 10-15, if the doctor finds it difficult to recognize certain sounds or wants to hear them several times for a more accurate final evaluation.
Auscultation of the Heart
During auscultation of the heart, the doctor rests the stethoscope in 4 distinct areas of the chest, two of which slightly above the left breast and the other two slightly below.
The 4 zones tested during auscultation of the heart are called: aortic region, pulmonary region, tricuspid region and mitral region .
The aortic region is the auscultation area of the aortic valve and, anatomically, corresponds to a portion of the right sternal border between the 2nd and 3rd intercostal space of the right sternal border.
The pulmonary region is the area of pulmonary valve auscultation and, from the anatomical point of view, corresponds to the portion of the left sternal border between the 2nd and 3rd intercostal space of the left sternal border.
The tricuspid region is the area of auscultation of the tricuspid valve and, anatomically, corresponds to the portion of the left sternal border between the 3rd and 6th intercostal space (therefore it includes the 4th and 5th intercostal space).
The mitral region is the auscultation area of the mitral valve and, from the anatomical point of view, corresponds to the portion, which, along the hemiclavicular line, takes place between the 5th and 6th intercostal space.
During the heart auscultation, the doctor evaluates three things:
- What is the sound emitted by the heart during its beats,
- The time interval between heartbeats and
- How intense the sounds of heartbeats are.
In other words, therefore, the auscultation of the allows to appreciate the acoustic phenomena deriving from the activity of contraction of the heart.
Did you know that ...
There is a variant of the classic auscultation of the heart using a stethoscope: it is the auscultation of the heart by doppler ultrasound .
Particularly effective in detecting valve dysfunction, auscultation of the heart by doppler ultrasound evaluates the flow of blood within the heart, recording at the same time the noises deriving from this flow.
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Auscultation of the Lungs
During auscultation of the lungs, the doctor evaluates both the chest and the back at the same height as the chest with the stethoscope, proceeding in both circumstances from top to bottom.
In the course of this evaluation, compare the noise detected on the right (belonging to the right lung ) with that detected on the left (belonging to the left lung ), in order to establish whether there is and what is the difference between the two.
During the auscultation of the lungs, the doctor "feels": the so-called apex of the lungs, the upper lobes of the lungs, the lower lobes of the lungs and the middle lobe of the right lung (NB: the left lung lobe has only two lobes, while the right pulmonary lobe has three).
For the apex of the lungs, the anatomical evaluation area is 2 centimeters above the medial third of the clavicle.
For the upper lobes of the two lungs, the anatomical assessment zone is the 2nd intercostal space along the hemiclavicular line and, posteriorly, the space between the C7 and T3 vertebrae.
For the lower lobes of the two lungs, the anatomical assessment site is the 6th intercostal space along the mid-axillary line and, posteriorly, the space between the vertebrae T3 and T10.
Finally, for the middle lung lobe, the anatomical evaluation zone is the 4th intercostal space along the hemiclavicular line.
The auscultation of the lungs is, in fact, the listening of the noise generated by the air flow inside the lungs; when the air flow in the lungs is normal, it produces a characteristic noise, which is distinctly different from when it encounters something that hinders it (eg: mucus, excess liquid, inflamed pleura, etc.).
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Auscultation of the intestine
During auscultation of the intestine, the doctor tests with the stethoscope at least a couple of regions of the abdomen.
The sounds emitted from the intestine (abdominal gurgling) vary according to the type of condition present; the diagnostic doctor's task, while performing auscultation of the intestine, is to carefully detect and analyze every single abnormal sound.
After the Procedure
Auscultation in itself does not limit the patient's normal recovery of daily activities .
Its execution, in fact, does not involve the use of drugs that could somehow alter the concentration and does not even involve the use of invasive instruments that could have caused annoying injuries and wounds.
However, it should be pointed out that auscultation is part of a medical examination which could reveal the presence of a pathological condition worthy of appropriate treatment, which may include rest, abstention from strenuous activity, antibiotics, etc.
Risks and Complications
Auscultation is a completely safe test; therefore, its execution does not expose the patient to any kind of risk.
Contraindications
The auscultation does not present any contraindication ; therefore, it is executable in every patient.
Results
Auscultation is a very important test in the preliminary phase of a diagnosis, because it allows the doctor to get a general idea of what is happening inside the human body .
Execution of auscultation, then, is among the indispensable practices to establish with which more specific examinations to proceed, in the diagnostic research in progress.
For the preliminary diagnostic power it has, auscultation is a test that, during an objective examination, should never be missed.
Interpretation of Results
Summarizing most of the information provided so far, during the auscultation of the heart:
- An abnormal heartbeat could be a symptom of a cardiac arrhythmia;
- A heart murmur could be the symptom of a valvulopathy;
- The noise comparable to the rubbing of sandpaper could be the sign of a pericarditis.
During lung auscultation:
- Scrubs and squeaks might be the sign of a pleurisy;
- Rattles and crackles could be a sign of bronchitis, pneumonia;
- Wheezes could be the signal of all those lung diseases that lead to the abnormal accumulation of fluid in the lungs.
Finally, during bowel auscultation, gurgling could indicate a disease that compromises intestinal peristalsis.
