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Auscultation

Auscultation performed by a physician during a physical exam can give the physician clues whether the body is performing as it should or help pinpoint problems that may be occurring. Immediate auscultation was a procedure used to assist the physician with diagnosis and dates back to possibly Ancient Egypt. This is where no instrument is used and the sounds are heard with the ear being placed upon the patient.

History
Ascultation is based on a Latin verb auscultare, which means to listen. The term was introduced by René-Théophile-Hyacinthe Laënnec and is still used today as one of the basic procedures in any physical exam to listen to the internal sounds of the body. Auscultation can give information on the patient’s circulatory system, respiratory system and the gastrointestinal system. Laënnec refined the procedure with his studies. He was able to link sounds with specific pathological changes in the chest. In his work he invented an instrument, the stethoscope, which is still used today. With the use of the tool, the procedure changed to mediate auscultation as opposed to immediate auscultation.

Where the sounds are heard
Physicians focus on three major areas when auscultating; the cardiovascular, respiratory and gastrointestinal systems. During their training, they receive clinical training that teaches them good sounds and possibly bad sounds. They also learn the pathology of the systems in order to understand what they are listening to as well.

When listening to the cardiovascular or circulatory system, the physician is looking to see if there are any abnormal sounds. Afflictions such as heart murmurs or poor valve performance and extra beats can be heard when listening to specific points across the chest wall. These points are where the heart valves meet the circulatory system in the chest and abnormalities can cause negative effects on the patient. An abnormal sound does not always mean that interventions are required.

The respiratory system is also auscultated in the chest but the physician is listening for air movement rather than blood movement. Many disease processes can occur in the lungs. They can cause constriction, blockage, inflammation and absence which can heard in the form of crackles, rhales, wheezes and rubs. There are four lobes within the lungs and it is important to not only listen to the front but also the back. Some diseases are localized and cannot be heard throughout. Most abnormal sounds heard during the respiratory auscultation are indicative of a problem.

And finally the gastrointestinal system is auscultated during the patient exam. The gastrointestional system starts at the nipple line and extends down to the lower abdomen. The presence of bowel sounds are noted and the rate at which they are produced. This tells the physician whether the system is functioning properly.

How often it should be performed
Auscultation is a form of evaluation that should be utilized by the physician or medical personnel each time an ailment presents or for normal routine well check. By recording these findings and comparing them with any changes made in the patient’s treatment plan, the physician can see the physical results of the treatment in place.

Image Caption: Laennec examines a consumptive patient with a stethoscope in front of his students at the Necker Hospital. Credit: Théobald Chartran/Wikipedia

Auscultation


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