Constitution (body-build)

After the consciousness evaluation the physician assesses the constitution of the patient as to his constitution, nourishment, the shape of the body, degree of the muscles development and their tone. After that the constitution type should be determined.

Nourishment is assessed chiefly in accordance with the thickness of the subcutaneous fat. Its state is evaluated on inspection as well as by measuring the thickness of the skin fold in the area of the left hypochondrium.

If the thickness of the fold is >2 cm, development of the subcutaneous fat is abundant, if <0,7 cm, this is insufficient.

Frequent causes of weight loss are chronic diseases of the respiratory system (COPD, tuberculosis) or cancer.

The findings of the constitution investigation as well as measuring the stature and chest circumference allow determining the constitution type. Constitution is the entity of the congenital and acquired morphological and functional features of the person formed during the lifetime under the environmental influence. According to M.V. Chernorutsky, normosthenic, asthenic and hypersthenic types are distinguished.

In normosthenic constitution all parts of the body are proportional.

Asthenic constitution (habitus asthenicus) is characterized by the following features: longitudinal dimensions of the body prevail, the chest is narrow and flat, the neck is thin and long, the extremities are long and thin, the skull is long, the muscles are inactive, the shoulders are narrow, the subcutaneous fat is poorly developed.

In hypersthenic constitution (habitus hypersthenicus) transverse dimensions prevail, the patients are stocky, the chest is wide, the neck is short, the extremities are short and wide, the skull is wide, the muscles and subcutaneous fat are well-developed, early holding is typical.

Examination of the skin.

It is necessary to pay attention to the color, humidity, turgor, presence of hemorrhages, rashes, scars, the state of the body hair and venous system.

Color of the skin. The normal skin is pale pink due to development of the vascular network of the skin, the amount of the blood in the capillaries, morphological and chemical composition of the blood, skin thickness.

The skin can be cyanotic, pale, hyperemic.

In a number of respiratory diseases, i.e. pneumonia, emphysema, pneumosclerosis, pulmonary tuberculosis, supportive conditions of the lungs, as well as in patients with pulmonary insufficiency, the skin and mucous membranes are cyanotic. Acute development of cyanosis is seen in pulmonary embolism and spontaneous pneumothorax. The cause of cyanosis is disturbances of gas exchange in the lungs resulting in accumulation of increased amount of reduced hemoglobin.

A pale skin is observed in patients with exudation pleurisy. A pronounced paleness is present in excessive pulmonary hemorrhage, decaying lung tumor, cavities, bronchiectasis, vasculitis (Goodpasture's syndrome, Wegener's syndrome).

At the patients with pleuropneumonia, cyanotic face can be associated with hyperemia.

Increased humidity is observed in fever.

Turgor is skin elasticity. This is determined by touching the skin and depends on the degree of subcutaneous fat development and the amount of fluid in the skin. Decreased turgor is present in severely ill patients.

Lymph nodes. Peripheral lymph nodes (subclavicular, cervical, supraclavicular, submaxillary, axillary, elbow, inguinal) are not evident on inspection. They should be palpated. Palpation is accomplished symmetrically on the both sides strictly following the sequence: beginning from occipital, anterior and posterior cervical supra- and subclavicular lymph nodes. Attention should be paid to their size, consistence, tenderness, adhesions with the skin, scar formation after fistulas. Lymph node enlargement may be generalized or isolated.

Isolated enlargement of the axillary lymph nodes can be observed in breast cancer and suppurative processes on the upper extremities. Multiple generalized symmetrical enlargement of lymph nodes is noted in tuberculosis, cancer metastases. Dense lymph nodes with an uneven surface are characteristic for malignant tumors.

When examining the skeletal muscles it is necessary to determine the degree of development (good, moderate, weak), local hypertrophy, atrophy, tenderness, spasms. Muscular tone is determined by palpations, this can be preserved, decreased, increased. Muscular tone is decreased can be at the chronic diseases of lights, cancer. Muscular atrophy is developed at the COPD patient.

The digits are inspected for clubbing (abnormal enlargement of the distal phalanges). Clubbing is a nonspecific finding often associated with chronic respiratory diseases (cystic fibrosis, bronchiectasis, hypoplasia, fibrosing alveolitis, mesothelioma), lung cancer and some chronic cardiac disorders (e.g., congenital cyanotic heart disease). The exact mechanism for it remains unknown.

Дата добавления: 2015-10-30