Auscultation, how to perform, positions of Auscultation, normal and abnormal sounds , percussion sounds, types of sounds and technique

1. 9th , Mar , 2016

2. Auscultation
 It is the technical term for listening to the
internal sounds of the body, usually using
a stethoscope.
Auscultation is normally performed for
the purposes of examining the:
cardiovascular system and
respiratory systems (heart and lung
sounds), as well as the gastrointestinal
system (bowel sounds).

3. Auscultation of the lungs and air passages
is the most critical of the physical
examinations made of the respiratory
system.
The examination should be performed in
as quiet an environment as possible.
-though it is often difficult to achieve a
silent listening environment in large
animal practice

4. Auscultation can be done by two ways:
1. Direct by placing the ear to the body
surface over the organ.
2. Indirect auscultation by a stethoscope is
the perfect technique.
Both the upper and lower parts of the
respiratory tract must be examined in every
case to assess the rate of air flow and the
volume of air sound to be heard over the
lungs.

5. The position of examination lungs on the
animal:
1. Anterior line:
Posterior angle of scapula end in to
olecranon process of ulna.
2. Dorsal line:
Begin in posterior angle of scapula to last
space interibs (external angle of the ilium).
3. Ventral line: (mid. 9&11 or 12)

9. Lung sounds:
Will not be heard if they are:
1-not generated (as a result of lack of
airflow in bronchi) or
2- Muffled by extensive accumulations of
fluid or fat between the lung and the
chest wall.

10.  Lung sounds are reduced in:
1. animals with airflow of low velocity in
large airways.
2. When the bronchial lumen filled with
fluid or tissue.(pneumonia).
Low sound occur in case of:
Animals at rest or animals have rapid but
shallow breathing.

11. BREATH SOUNDS
Terminology used to describe normal and
abnormal lung sounds. It is a useful
diagnostic aid.
The variables that must be noticed include:
1. The nature of the sounds (increased or
decreased, crackles or wheezes)
2. The timing of the sounds in the respiratory
cycle
3. Their anatomical location

12. Breath sounds are produced by air
movement through the tracheobronchial
tree.
Normal breath sounds vary in quality
depending on where the stethoscope is
placed over the respiratory tract. They are
loudest over the trachea and base of the
lung and quietest over the diaphragmatic
lobes of the lung.

13. Normal breath sounds are louder on
inspiration than on expiration because
inspiration is active with more rapid
airflow, whereas expiration is passive in
normal animals and associated with lower
rates of airflow. Breath sounds may be
barely audible in obese animals or in the
noisy surroundings common in field
conditions.

14. 1. Vesicular sound
2. Bronchial sound
Increased loudness of breath sounds is
heard in normal animals with increased:
1.respiratory rate
2.depth of respiration.

15. This can occur for physiological reasons
such as:
1.Exercise
2. excitement
3. a high environmental temperature.
They can also occur in abnormal states such
as:
1. Fever
2. Acidosis
3. Pulmonary congestion in early pneumonia
4. Myocardial disease.

16. Decreased loudness or complete absence
of breath sounds occurs:
- in pleural effusion or
- pneumothorax
- fluids.
- Space-occupying masses between the
lung and the thoracic

17.  Normal breath sounds:
1. Vesicular respiratory sound
-exaggerated
-attenuated
-muffled
2. Bronchial respiratory sound
Abnormal lung sounds:
1. Rales (Crakels, Wheeze):
-Coarse crackles are caused by air bubbling through,
and causing vibrations and secretions in large airways.
- Fine crackles are caused by sudden explosive
popping on closed airways during expiration. May be
detected in early or late inspiration.

18. Rales noticed in the following:
- exudative bronchopneumonia.
- tracheobronchitis.
- aspiration pneumonia.
- obstructive pulmonary disease.
Loud crackles:
may be audible in animals with interstitial
pulmonary emphysema

19. 2. Pleuritic friction sound:
This sound is not common .It is a combination of
continuous and discontinuous sounds produced
by the rubbing together of inflamed parietal and
visceral of pleura during the respiratory cycle.
- It is occur in cattle with severe diffuse
pulmonary emphysema
3.Miscellaneous
- unexpected sounds that are occasionally audible
over the thorax include:
-Peristaltic sounds:

20.  Skin and hair sounds caused by
the stethoscope.
- Crepitating sounds due to subcutaneous
emphysema and muscular tremor.
contractions.
Crepitations in Loud superficial crackling
sounds induced by subcutaneous tissues
movement of stethoscope over the skin
Peristaltic sounds Gurgling, grating,
rumbling, squishing sounds audible over the
lungs

21. Gastrointestinal sounds transmitted from
the abdomen:
- ruminal sounds in cattle.
- stomach and intestinal sounds in horse

23. Auscultation of the heart
HEART SOUNDS
In the horse it is not common to hear for
heart sounds on auscultation,
whereas two to three heart sounds are
heard in ruminants and camelids . With
cattle, sheep, goats and swine the sound is
located at a similar level but at the fourth
intercostal space. the left fifth intercostal
space in horse:

26. Heart sounds are detectable by
auscultation on the left side in animals of
all condition score

27. Percussion (tapping)
 The resonance of an organ can be
determined by the vibrations produced
within it by using a sharp force.
The sound produced depend on the shape,
size and density of the organ.
The sounds vary with the density of the
parts and may be classified as follows:
-Resonant:
This sound emitted by organs containing
air, e.g. normal lung

28. - Tympanic:
a drum-like note emitted by an organ
containing gas under pressure such as a
tympanic rumen or cecum.
-Dull:
This sound emitted by solid organs such
as heart and liver.
- Hyperresonant:
- In case of emphysema

29. Percussion can be performed with the
fingers using one hand as a plexor and
other as a pleximeter.
In large animals pleximeter hammer on a
pleximeter disc recommended for
consistency.

35.  Be aware for the thickness and consistency
of overlying tissues.
Percussion is a valuable aid in the diagnosis
of diseases of:
- The lungs
- Abdominal viscera of all large animals.
The increased of dullness over the thorax
indicates:
-Consolidation of the lung,
-A pleural effusion,
-Space-occupying lesion such as tumor or
abscess.

36. Increased resonance sound over the thorax
suggests:
- Emphysema or
- Pneumothorax.
The normal sounds in the different organs
per percussion are:
1. Percussion of the heart-
- Absolute dullness
2. Of the lung:
- Resonant in equine, cattle, goat and sheep
- Tympanic in dog and cat

37. 3. of rumen:
- Tympanic in upper part
-Dull in lower