Abdominal pain, characteristic of emergency conditions, or an acute abdomen. Varieties of pain syndromes. Examination of the caecum

Palpation of the abdomen is essential element diagnostics. Given superficial study carried out by a specialist can give enough wide range status information internal organs patient.

Properly performed palpation is painless and can indicate inflammatory processes, neoplasms and cysts. The amount of information received depends on which type of palpation the doctor performed: superficial or deep.

Inspection principles

Palpation of the abdomen is a very responsible study, which is necessary to detect inflammation of the internal organs and the presence of neoplasms.

The main principle of such an examination is the sequence of actions when probing each area of ​​\u200b\u200bthe abdomen and the full probing of all parts of the abdominal region.

An important element is professional approach a doctor who performs an examination of the abdominal cavity. The specialist should have short-cut nails, palms should be warm.

These conditions are mandatory for the comfort of the study. Also, the doctor's cold hands can lead to muscle tension. abdominals, which complicates the process of palpation.

During palpation, the doctor must also take care to distract the patient from the probing process. To do this, the doctor must take the patient with breathing exercises, adjust the frequency of inhalations and exhalations, as well as their depth.

Tasks and algorithm for superficial palpation of the abdomen

Palpation is necessary to examine the internal organs of the abdominal cavity. This research method can give an idea of ​​the properties of a particular organ, indicate the presence of neoplasms or inflammatory processes.

Also characteristic pain in any area of ​​the abdomen during palpation, allows you to narrow the circle of causes that could lead to illness and characteristic symptoms for which the patient went to the doctor.

There are two important rules which must be observed by the doctor conducting superficial palpation:

1. The most important rule of palpation is the following: you need to start probing the abdominal cavity only from a painless area of ​​\u200b\u200bthe abdomen. Usually this area is located symmetrically to the painful part.
2. It is impossible to immerse fingers deep into the abdominal cavity. You can't do it with your fingers either. circular motions plunging them deeper than necessary for superficial palpation.

Estimated

Superficial palpation of the abdomen always begins with an approximate palpation. With its help, you can determine the level of tone in the muscles of the anterior abdominal wall of the abdomen.

This type of palpation allows you to determine the degree of resistance of the abdominal muscles in painful places, as well as a possible divergence of the abdominal muscles (diastasis) in the region of the white line of the abdomen or the umbilical ring.

It is required to carry out palpation of the approximate type counterclockwise, with exceptionally soft non-circular movements. Probing starts from the left iliac region. This is explained by the fact that this area is more often painless.

After feeling this area, the fingers gently and gradually move 4-5 cm up. Approaching the costal arches, palpation is carried out taking into account light touches of the ribs with the fingertips. After that, the hands are moved to the opposite area, to the right flank. The circle of palpation ends with probing the suprapubic region.

Immediately after this, the doctor begins the second round of probing (small circle). In this case, the doctor mainly focuses on feeling the umbilical region. If the abdomen is very small, one round of palpation is usually enough. If the abdomen is large, both rounds of approximate palpation are mandatory.

The second, small circle of palpation also starts from the left iliac region. The movements are also soft and counter-clockwise.

Palpation of the indicative type is able to give enough a large number of information about the state of the internal organs and the abdominal wall of the patient.

Comparative

The main task of comparative palpation is to compare the symmetrical sections of the anterior abdominal wall. Also, comparative palpation is needed to feel the area of ​​the epigastrium, hypogastrium and mesogastrium.

Begin palpation from the lower abdomen. At the same time, the left and right iliac regions are compared. Later, the lateral and hypochondral regions are palpated. This palpation technique is also called herringbone palpation.

With this type of palpation, the doctor also examines:

• umbilical ring;
• inguinal rings;
• areas of the abdomen with postoperative scars.

This type of palpation is different in that it is better to carry it out not in the classic horizontal position, but vertically when the patient is sitting. This position increases intra-abdominal pressure and allows you to more effectively identify defects in the abdominal wall.

This type of palpation is completed by repeated probing. In this case, the patient needs to collect as much air as possible into the lungs and strain. This technique allows you to identify the divergence of the rectus muscles and hernial protrusions.

Goals of Deep Methodology

The doctor, after performing superficial palpation, usually conducts a deep palpation of the abdominal organs.

The purpose of such a study is to determine the position of organs, their shape and consistency, as well as size. Deep palpation is also aimed at identifying pathological neoplasms, tumors and cysts.

Special attention with deep palpation, the doctor gives painful areas of the patient's abdomen. This factor most often indicates a diseased or inflamed organ. With the help of deep palpation, radiating pains can also be determined.

The main condition for conducting a deep type of palpation is the doctor's knowledge of the projection of each organ on the anterior abdominal wall.

The sequence of palpation of each organ may vary, but classic version palpation is the following sequence:

1. Stomach.

The study of the organ that, when palpated, gives pain, is carried out at the very end. The study of the pancreas, stomach and colon is performed on exhalation. Carrying out deep palpation has a number of other rules according to which it is carried out by the doctor.

How to carry out?

The conditions under which deep palpation the same as in the surface type of research.

The doctor should relax the patient as much as possible. To relieve tension in the abdominal muscles, the patient should slightly bend the legs and place the soles on the bed. In more rare cases palpation is carried out in the vertical position of the body.

In order to accurately palpate individual bodies and understand their boundaries can be performed and research methods such as auscultation and percussion.

• Auscultation- a method in which the doctor listens to the patient's internal organs to identify specific sounds in them.
• Percussion- a method in which the doctor gently taps the patient's stomach and listens to the reaction of the patient's body.

During the study, the patient should breathe evenly, using the diaphragmatic muscles. The doctor's fingers plunge into the tissues gently and smoothly. In this case, the goal of penetration is to bypass the abdominal muscles and achieve rear wall abdominal cavity.

In most cases, it is not possible to carry out the procedure the first time; the doctor can achieve the goal only if the patient's abdominals are fully relaxed. For this purpose, it is used breathing exercises. Probing of deep tissues is performed by the doctor on the exhalation of the patient.

Examination in children

When palpation of the abdomen in children, very important aspects that the doctor notes are:

• moisture or dryness of the skin;
• turgor - elasticity of the skin, muscle and fat tissues;
• elasticity of the skin;
• temperature.

Palpation of the abdomen major research. It is carried out very carefully. The most important aspect successful palpation is the relaxation of the abdominal muscles. To achieve this goal, the doctor's hands must be warm.

If the child's skin is very sensitive and the baby reacts to touch as if tickled, then before starting palpation, the doctor holds his hand on his stomach for a while.

school children and preschool age palpated in the horizontal position of the body. The child is laid on his back, while the head is on the same level with the body. Palpation starts from the umbilical region or from the right iliac part of the body.

Even at the first stage of palpation, the doctor can notice bloating or retraction, and also understand what the tone of the abdominal muscles is.

Pain syndrome

Abdominal pain on palpation is also referred to as pinpoint pain. Such a pain syndrome manifests itself when pressing on a certain area of ​​\u200b\u200btissues.

Often such pain signals a disease of an organ. Which organ is sick can be understood by where exactly the pain appears during the palpation of the abdomen.

Thus, pain in one of the parts of the abdomen during palpation may indicate corresponding problems in nearby organs.

Norm

The norm is correct location organs in their places without going beyond the healthy area of ​​the location.

The stomach, liver, pancreas and spleen are not enlarged, are clearly palpable and are soft in texture, not loose. Normally, the gallbladder is not palpable and does not cause pain at the patient. The intestinal loops are located in their departments.

One of the main signs of health is the absence of pain when feeling the entire abdomen. The muscles of the press are normally relaxed, soft. white line the abdomen does not exceed a width of 1-3 cm. There are no hernial gates and internal organs.

Video about superficial palpation of the abdomen:

The general condition of patients with irritable bowel syndrome is usually good and does not correspond to numerous complaints. The nature of complaints is changeable, there is a connection between the deterioration of well-being and psycho-emotional factors.

The main complaints are abdominal pain, stool disorders and flatulence. Irritable bowel syndrome typically has no symptoms at night.

The symptoms of irritable bowel syndrome are extremely varied. Most characteristic symptoms are the following:

Abdominal pain - observed in 50-96% of patients, they are localized around the navel or in the lower abdomen, have different intensity(from slight aching to very pronounced intestinal colic). As a rule, pain decreases or disappears after defecation or gas discharge. Pain in irritable bowel syndrome is caused by nervous regulation motor function colon and hypersensitivity stretch receptors in the intestinal wall.

A characteristic feature is the occurrence of pain in the morning or afternoon hours (with the patient's activity) and subsidence during sleep, rest.

Violation of the stool - observed in 55% of patients and is expressed in the appearance of diarrhea or constipation. Diarrhea often comes on suddenly after eating, sometimes in the morning. The absence of polyfecal matter is characteristic (the amount of feces is less than 200 g per day, often it resembles “sheep”). The stool often contains mucus. Intestinal mucus is composed of glycoproteins, potassium and bicarbonates and is produced by goblet cells. Increased mucus secretion in irritable bowel syndrome is due to mechanical irritation of the large intestine due to a slowdown in the transit of intestinal contents. Many patients feel incomplete emptying intestines after defecation. Often the urge to defecate occurs immediately after eating, which is associated with the stimulating effect of gastrin and cholecystokinin on the motor-evacuation function of the intestine. This is especially pronounced after eating fatty and high-calorie foods. It is possible to alternate diarrhea and constipation: in the morning the feces are dense or in the form of lumps with mucus, several times a half-formed stool during the day.

Flatulence is one of characteristic features irritable bowel syndrome, usually worse in the evening. As a rule, bloating increases before a bowel movement and decreases after it. Quite often, flatulence has a local character. The combination of local flatulence with pain leads to the development characteristic syndromes. BUT. V. Frolkis (1991) identifies three main syndromes.

The splenic flexure syndrome is the most common. Due to anatomical features(high location under the diaphragm, sharp corner) in the splenic flexure in patients with irritable bowel syndrome and motor dysfunction are created favorable conditions for congestion stool and gas and development of a syndrome of a splenic bend. Its main manifestations are as follows:

• feeling of fullness, pressure, fullness in the left upper section abdomen
• pain in the left side chest, often in the region of the heart, less often in the region of the left shoulder;
• palpitations, a feeling of lack of air, sometimes these phenomena are accompanied by a feeling of fear;
• the appearance or intensification of these manifestations after eating, especially plentiful, stool retention, exciting situations and a decrease after passing gases and defecation;
• bloating and severe tympanitis in the region of the left hypochondrium;
• accumulation of gas in the area of ​​​​the splenic flexure of the colon (detected by x-ray examination).

Hepatic bend syndrome - manifested by a feeling of fullness, pressure, pain in the left hypochondrium, radiating to the epigastrium, in right shoulder, the right half of the chest. These symptoms mimic the pathology of the biliary tract.

Cecum syndrome - occurs frequently and simulates the clinic of appendicitis. Patients complain of pain in the right iliac region, radiating to the region of the right abdomen; the intensity of pain may gradually increase, however, as a rule, it does not reach such severity as in acute appendicitis. Patients are also concerned about the feeling of fullness, heaviness in the right iliac region. On palpation of the abdomen, pain in the region of the caecum is determined. A. V. Frolkis (1991) indicates that massage of the abdomen in the region of the caecum and palpation towards the colon ascendens contribute to the movement of chyme and gas from the caecum to ascending division large intestine and bring significant relief to patients. Palpation of the area of ​​the ascending colon towards the caecum can cause a significant increase in pain (usually with insufficiency of the ileocecal sphincter).

Non-ulcer dyspepsia syndrome - observed in 30-40% of patients with irritable bowel syndrome. Patients complain of a feeling of heaviness and overflow in the epigastrium, nausea, belching with air. These symptoms are due to impaired motor function. gastrointestinal tract.

Severe neurotic manifestations are quite common in patients with irritable bowel syndrome. Patients complain of headaches (reminiscent of migraine), a feeling of a lump when swallowing, dissatisfaction with inhalation (a feeling of lack of air), sometimes worried about frequent painful urination.

Spasmodically contracted sections of the large intestine (more often sigmoid colon) - are detected by palpation in many patients (the term "spastic colitis" was often used to refer to this condition).

Abdominal pain on palpation. AV Frolkis (1991) describes three situations that may occur during palpation of the abdomen in patients with irritable bowel syndrome.

1. the situation is palpatory soreness of the abdomen of a neurotic type. It is characterized by diffuse palpation sensitivity of the entire abdomen, both during palpation along the intestine and outside it. During palpation, inappropriate behavior of the patient is possible, even slight palpation of the abdomen causes pain, sometimes patients scream, they have tears in their eyes (especially in women). In some patients, there is marked sensitivity to palpation of the abdominal aorta.
2. situation - pain on palpation of the entire colon.
3. situation - palpation determines the sensitivity of individual segments of the intestine, mainly descending sections.

The process of palpation of the stomach and intestines has importance in terms of diagnostic study human body. Monitoring of the digestive organs is carried out as follows: at the first stage qualified specialist gently probes the sigmoid colon - this is the most common landmark and the most accessible organ for palpation. Next, the doctor proceeds to study the state of the caecum and transverse colon. The ascending and descending sections of the suction organ are quite problematic to probe.

In practice, in the process of palpation, the fingers must be carefully immersed on the surface of the body area and gently pressed onto the organ under study (in the direction of the posterior abdominal wall). With the help of sliding movements, you can clearly determine the contours, density, presence various neoplasms and deviations. When touching (feeling) the sigmoid colon, one gets the impression that there is a smooth, dense and movable cylinder in the human body. The size is like this geometric figure» does not exceed the thickness thumb person. The formation parameters are directly related to the state of the walls, which are densely filled with gases and decay products (fecal / fecal masses).

During the course of the inflammatory process of the infiltrating walls, a significant thickening of the membrane occurs. Ulcerative manifestations form a bumpy and uneven surface of the suction organ. Acute inflammation sigmoid colon is accompanied by the formation of a dense consistency painful manifestation. Due to dense overflow with gases and liquid contents, motility retardation occurs. The spasm is palpable in the form of a cord and a cord. The patient experiences a systematic rumbling + false urges to defecation (false diarrhea).

AT normal condition the caecum is easily palpable. A specialist can detect a moderately active cylinder up to 3 cm in movement. Its mobility in pathological disorders is significantly increased. The internal consistency is significantly compacted with coprostasis and chronic inflammation. The volume and shape of the cecum directly correlates with the contents. In normal functional state the intestines do not growl.

The patient should remember that the presence of pain during palpation in the region of the caecum indicates the development of the pathological process. The digestive organ requires systematic and complex treatment.

In practice, after examining the caecum (+ appendix) it is possible to examine the less accessible parts of the large intestine. Palpation is carried out from the ascending to the transverse colon and descending intestines. The transverse part of the suction organ is qualitatively palpated only in the case of chronic inflammation. Tone, consistency, volume, shape depend on the tone and degree of muscle tension. For example, an inflammatory process of the ulcerative type forms serious prerequisites for the transformation of the transverse colon. At the same time, the musculature of the organ thickens significantly, its configuration changes.

To date chronic colitis and percolitis are quite common. With these ailments, the wall of the suction organ begins to contract painfully. Due to the bumpy surface, palpation is accompanied by sharp pain sensations. For example, with pericolitis, respiratory and active mobility are lost.

Palpation of the abdomen allows you to feel the tumor of the intestine, which is often confused with the pathology of various organs. Oncology of the caecum and transverse colon is distinguished by already known mobility. Pain is activated during the act of breathing (tumors below the navel are immobile). Feeling the abdomen with enterocolitis is accompanied by rumbling in the navel. The disease has specific features and symptoms: painful diarrhea (mushy slimy stool, abdominal pain, hardened colon). Palpation of the abdomen is carried out in combination with a digital examination of the rectum (sigmoidoscopy + radiography). These actions make it possible to predict the formation of rectal cancer and the formation of various syphilitic structures. It will also be possible to clearly determine the presence of inflammatory processes, cracks, fistulas, hemorrhoids and all kinds of tumors. The specialist can get a clear vision of the tone of the sphincter, the level of filling of the ampulla of the colon. In some cases, it is rational to palpate neighboring organs (bottom Bladder, prostate, uterus with appendages). This will reveal an ovarian cyst, a tumor of the genital organs, the degree of constipation, etc.

The mechanism of the procedure

Palpation favors last step full and objective research abdominal areas. The patient will need to cough vigorously before the procedure. In practice, a person with developed peritonitis manages to do this only superficially (holding the abdomen with his hands). It is allowed to make a small impact on the couch on which the patient is located in lying position. The vibration impulse will provoke the manifestation of pain in the digestive tract. Thus, it is quite easy to establish the diagnosis of peritonitis without touching the hand. To identify symptoms of peritoneal irritation, it is allowed to gently shake the patient, after grasping the combs ileum(or jumping on one leg).

The palpation procedure begins with the patient being asked to clearly indicate the area where the first pains formed (the primary localization of the disease). The specialist needs to carefully monitor the actions of the patient himself. This is how you can identify the causes of irritation of the peritoneum. Diffuse pain visceral type in the abdomen are easily determined with the help of circular movements of the palm. Hands should be warm.

The procedure begins as far as possible from the main focus of pain. This helps to avoid unplanned pain at the very beginning of the study. Children, and sometimes adult patients, sometimes do not allow a quality examination due to pain.

First of all, the doctor must perform a gentle and accurate palpation (superficial). Experienced specialist moves gently, methodically and consistently. The fingers make minimal amount movements. It is strictly forbidden to palpate the abdomen randomly! The pressure on the surface of the body should not be high. Otherwise, there will be a protective tension of the muscles of the abdominal cavity. Touches on sore spot should be carried out until the patient says that he really hurts.

A qualified specialist can always determine the degree of tension in the muscles of the anterior wall of the abdomen. The physician must distinguish between voluntary and involuntary muscle tension. For a clear definition this factor during palpation, a person produces deep breath and exhale. If muscle activity persists, then this indicates the development of peritonitis.

It is rational to make a deeper palpation if peritonitis was not detected during a superficial examination. This allows you to detect various tumor formations, hepatosplenomegaly, aortic aneurysm. It is very important for the physician to remember optimal dimensions for normal structures so as not to confuse them with malignant ones. Pain during palpation of the abdomen and intestines has two types:

1. immediate local pain - the patient experiences a sharp pain at the site of the study;
2. indirect (reflected soreness) - pain sensations are formed in a different place when palpated. For example, when flowing acute appendicitis pain accumulates at McBurney's point on the left side of the iliac fossa. This symptom is called "Rovsing" and is a reliable sign of peritoneal irritation.

It is easy to carry out comparative palpation of the patient with tense abdominal muscles. For this, the patient, who is in a supine position, is asked to gently lift their head off a pillow.

The classic symptom of irritation of the parietal peritoneum is not difficult to identify. To do this, at the time of the study, the doctor must sharply remove his hand from the surface of the body and observe the patient's reaction. In most cases, patients experience a significant increase in pain. This classic survey technique is rather crude, some scholars refer to it as a barbaric method of study.

With the development various pathologies in the digestive organs (for example, acute appendicitis) there is hyperesthesia skin in the belly area. It is for this reason that if a patient is pinched or lightly pricked, then a painful reaction of the body will instantly occur. It's pretty common clinical symptom, but its fact of establishment is not enough for a firm diagnosis of acute appendicitis and other diseases of the abdominal organs.

An integral part of the palpation study is gentle tapping along lumbar region(+ sides of the abdomen) to determine the degree of pain in these areas. Quite often, pyelonephritis and urolithiasis correlate with sharp pains in the abdomen (rib-vertebral region).

In doubtful clinical situations, examination alone is not enough. An accurate assessment of the dynamics of the disease is established by repeated palpation of the abdomen by the same doctor.

Varieties of pain syndromes

Causes of pain in women

To date, medicine identifies two types of fundamental causes that affect pain during palpation. Organic factors include:

• inflammatory processes in genitourinary system(cyst, endometritis, fibroids);
• use of the spiral as contraceptive;
• formation of various pathological formations;
• the presence of inflammation in the gallbladder (including appendicitis, pyelonephritis);
• sharp pains during pregnancy (placental abruption, miscarriage).

The functional reasons are as follows:

• systematic failures in cycles during menstruation;
• selection uterine bleeding;
• ovulation + uterus bending.

Inflammatory processes are the main reason for the occurrence of pain during palpation of the stomach and intestines. The disease begins with classic acute manifestations and is supplemented by various signs of intoxication of the body, namely:

1. Endometritis accompanied aching pains in the abdomen. You can establish their manifestation with a slight palpation. The patient experiences heaviness in the area of ​​​​the appendages + compaction of the uterus;
2. Endometriosis - pathological disorder, which covers the uterus and appendages. Strong pain observed on palpation of the middle of the abdomen;
3. Ovarian apoplexy correlates with ovulation. At the same time, part of the blood enters the abdominal cavity because of the strong physical activity;
4. Uterine myoma. The pain syndrome is localized in the lower abdomen (squeezing of adjacent organs);
5. Appendicitis requires surgery medical intervention. Pain on palpation in the region of the appendix;
6. Cholecystitis is an inflammatory process of the gallbladder. Pain radiates clearly lumbar and back;
7. Cystitis is a lesion of the bladder. Pain is observed both during palpation and during urination.

Causes of pain in men

Pain on palpation in men is preceded by a number of factors. It can be both inflammation of the appendages, and prostatitis, cystitis, various formations. Doctors identify some signs of pain in which it is necessary to hospitalize a person. If the pain is concentrated in the area of ​​​​the appendix formation, then this indicates the course of appendicitis. Also dangerous inguinal hernia and her crush. In this case, the organ simply protrudes outward and has a hard cover. The patient experiences severe pain. Abdominal pain is also a consequence poor quality food. Thus, it is formed peptic ulcer. The main causes of pain in men are: diverticulitis, urinary disease, cystitis, pyelonephritis and excessive hypothermia.

In some cases, sharp pains are localized not only with right side but also on the left. Quite often, the main reason lies in the spread intestinal infection. In this case, the main symptoms of appendicitis are observed, which have a paroxysmal manifestation. The pain syndrome often intensifies during the meal.

When diagnosing diseases of the gastrointestinal tract, palpation of the intestine is performed. This method allows you to put provisional diagnosis and determine the presence of pathology. When palpating, the localization of symptoms and the degree of pain are detected, the doctor determines the temperature and the presence or absence of seals, checks general state internal organs, appearance belly.

When are they assigned?

It is prescribed in the presence of complaints in the patient in the abdomen. Acute or persistent attacks of pain, delayed or upset stool, gas formation, suspicion of a cyst or tumor, and other pathologies are indications for a primary external examination of the peritoneum. Palpation - main method in discovery pathological changes abdominal cavity and abdominal organs. After an external examination, the doctor prescribes additional tests based on preliminary findings.

Types of palpation

It is divided into 2 types: approximate and deep. First, the doctor conducts an approximate examination, and then proceeds to deep palpation. This pattern of inspection is concretely defined and unchangeable. The doctor moves from one examined organ to another in the required sequence. If the patient has severe abdominal pain, the doctor is very careful when applying pressure. It is carried out on an empty stomach, after emptying the intestines.

Approximate palpation

With its help, the doctor determines the body temperature, the state of the peritoneum - asleep or inflated. Soreness and the location of tense organs, muscle tone, and the level of sensitivity are felt. The procedure is performed with the patient lying down, limbs extended along the body. The patient's breathing is deep and even. The doctor on the right puts his hands on the patient's abdomen and lets him get used to his hand. Superficial palpation is performed with both hands.

In a normal state, the surface of the abdominal cavity does not hurt, it is soft, healthy mobility of organs is felt. With pathologies in the place where the disease is localized, the muscles are tense, involuntary resistance to pressure is felt. With a bulging or protruding anterior wall of the abdomen, the doctor determines the cause of this condition using approximate palpation.

Upon completion of the initial palpation, the doctor proceeds to a deep examination. Using this method, pathologies of internal organs, muscle tissues and anterior inner wall belly. In the presence of pathologies, neoplasms, tumors, hematomas and swellings are probed. Such a detailed examination allows you to assess the state of the location of the organs, their displacement. Feeling the hollow organs, the doctor pays special attention to the nature of the sounds - their absence means that the organ is healthy.

When discovered painful swelling or a cyst, its size, location, shape, density, level of pain and other characteristics are determined by palpation. Particular attention is paid to sounds - rumbling, noise, splashing. The technique of the method is complex, probing is carried out, starting from left to right, from bottom to top. The wall of the abdominal cavity with a thick fat layer, swelling or with developed muscle tissue represents an obstacle to a full inspection.

Technique

Palpation is carried out when the patient lies on his back, arms and legs are extended along the body, breathing is deep and even. The doctor sits to the right of the patient, his hands are dry and warm, the room is warm and quiet. Right wrist puts on left side iliac abdominal region of the patient, making light pressure with straight 4 fingers. This method assesses the tone and degree of muscle tension. The brush moves to the right, and then up to the epistragia, also first to the left, and then to the right side of the abdomen along the intestines.

The technique of deep palpation is carried out according to the Strazhesko-Obraztsov method. With its help, the condition of the internal organs and the peritoneum is examined. This palpation is also called sliding and methodical, because the state of the organ is felt at the moment when the researcher's hand slips off it. There are strictly prescribed rules in which order they are examined abdominal organs.

Sigmoid colon

During probing, the surface condition, mobility, intestinal diameter and other characteristics are determined. If the organ is healthy, the intestine is felt as a dense smooth cylinder; when pressed, there are no pain symptoms It slips easily under your fingers. If a rumbling is heard, this is a sign of gas formation and fluid accumulation, which usually occurs when inflammatory processes. Probing causes pain. At malignant formations or constipation, the bowel feels hard, immobile, and enlarged.

Examination of the caecum

In the groin area, where the navel and ilium connect, the hands form skin fold and sliding motion from the navel to the top ilium the caecum is felt. In 80% of cases, the procedure is successful. A healthy gut feels like a smooth, pear-shaped cylinder. Pain and a strong rumbling when pressed indicate inflammation. The mobility of this intestine should normally not exceed 3 cm. If the range is greater, there is a risk of volvulus and obstruction.

Deep and superficial palpation of the abdomen are one of the methods for examining organs located in the peritoneum.

With their help, the doctor will be able to identify the painful area, determine the temperature of the skin, the nature of the lymph nodes.

During the procedure, the doctor will be able to examine with his fingers the external structure of tissues, muscles, bones and joints, and determine the compliance of organs with the norm.

Inspection principles

Palpation of the abdominal cavity is a fairly responsible method of examination. That is why the doctor must conduct it in a certain sequence, regardless of the conditions in which the examination is performed.

This examination technique is carried out with a specific purpose - to study the condition of the organs located in the abdominal cavity, their tissues, to determine the ratio of organs.

Non-compliance with the norm allows the specialist to identify pathologies and disorders of the internal organs.

A painful abdomen is examined with hands only on an empty stomach. The patient needs to empty the bowels. If it is not possible to completely empty the intestines, then the patient is given an enema.

Examination of the patient can be carried out in several positions: when the patient is standing, sitting on a chair or lying on the couch, but most often the patient is offered to take horizontal position.

The couch should have a flat surface, a slight rise at the head. Its best location is opposite the light source, so the examined surface of the patient will be well lit.

If the doctor is right-handed, then his chair should be installed on the right side of the couch. Accordingly, if the doctor works with his left hand, then the chair is installed on the left. The height of the chair is the same as the height of the couch.

On examination, the patient should breathe through the mouth. The doctor's hands should not be cold, as the abdominal muscles will contract reflexively - the palms should be warmed.

Suitable for this hot water or battery. In addition, with cold hands, the doctor will not be able to carefully examine the patient, because the sensitivity of such palms will be reduced and it will be difficult to identify the compliance or non-compliance of the parameters with the norm.

The basic rule of the procedure is not to inspect the painful area first. It is worth starting the examination on the left, on the right, in the lower abdomen, gradually moving towards the points where pain is felt.

On palpation, the doctor should not immerse his fingers very deeply into painful stomach without making circular motions. Feeling should be soft.

Circular movements are permissible only to determine pathological formations. It is necessary to examine the painful abdomen from different sides - left, right, bottom, top.

This will make it possible to correctly assess the nature of the surface, detect the presence of pathologies, determine points of pain and identify other characteristics.

Tasks and conduct of superficial palpation

Superficial palpation of the abdomen is carried out in order to achieve certain tasks:

• find out how actively the abdominal wall takes part in breathing;
• determine muscle tension on the left, right, bottom, top, in the center of the abdomen;
• identify points where the abdominal muscles diverge or a hernia protrudes;
• determine in which place of the abdominal cavity a sharp pain appears;
• detect a tumor and seals located in the peritoneum, or exclude their presence;
• check and evaluate the size of internal organs, find out their compliance or non-compliance with the norm.

By analyzing the data obtained after the examination, the doctor will be able to draw conclusions about the patient's health status, about pathological processes flowing in his abdominal cavity, about the state of the organ that causes pain to a person. The results of palpation are confirmed by other types of examination.

With superficial palpation, the patient should be in a horizontal position. Hands should be stretched along the body, relax all the muscles.

The doctor is obliged to warn the patient before palpation that during the examination he may experience pain.

The patient should inform the doctor about which points, when pressed, cause the most pain.

There are cases when the patient is not warned about the pain. When palpation of the abdomen on the left, right, below or in its lower part, the doctor should carefully observe the facial expression.

The examination is carried out with a warm palm, which should be placed on the abdomen at the bottom left. Gently pressing on the abdominal wall, the hand must be moved to the center of the abdomen.

When the fingers are reached pain point, the patient will report it. Pain can be identified by the facial expression of the patient and by tense abdominal muscles.

If all human organs are normal, then the patient will not feel pain on palpation. This is how the entire abdomen is examined.

Indicative information about the patient's state of health will help the doctor make a diagnosis, which is confirmed or refuted by additional examinations and tests.

Indicative information after superficial palpation of the abdomen will help the doctor to conduct a deeper examination.

Details of the pathologies of the internal organs can be obtained by the doctor with sliding palpation of the abdominal cavity.

What is the purpose of deep palpation?

Only when superficial palpation of the abdomen is complete can the doctor proceed with deep palpation.

The procedure is carried out in order to determine the signs of pathologies, the inconsistency of the characteristics of the internal organs with the norm, or to identify neoplasms.

The inspection is carried out in order to perform the following tasks:

• definition exact location internal organs;
• examination of internal organs, determination of their exact dimensions, the study of their tissues, the nature of displacement, compliance with the norm;
• being assessed hollow organs- the presence of rumbling or other sounds in them is analyzed, which does not happen if the indicators of the organ are normal;
• determination of compaction, tumors, cysts and other neoplasms that cause pain to a person, the study of their nature, density, size, shape and other parameters.

This technique of examining a patient has certain difficulties, because the doctor probes the organs from left to right, below and above through the wall of the abdomen.

It can have a large fat layer, developed muscles or swelling, so it is quite difficult for a doctor to examine the organs located inside.

If the organ is large, then it is easier to study it than a smaller one, lying deep or mobile.

During the procedure, the doctor's hands must move in sequence. Most often, deep palpation of the abdomen begins at the bottom of the abdominal region with an examination of the sigmoid colon and the caecum with a process.

Moving up, the stomach is felt and small intestine. Then the hands slide to the liver, spleen, pancreas and kidneys.

The pain that the patient will feel will tell the doctor about the pathological processes in any organ.

Sometimes this order is not followed. The reason is that the patient feels pain in a certain place during superficial palpation of the peritoneum or if the patient complains of discomfort in a certain area of ​​the abdomen.

In this case, the points where pain was felt are studied last.

How to carry out deep palpation?

Most often, for such an examination, the patient takes a horizontal position. To examine some organs, the patient's standing position is sometimes required.

So, the liver, kidneys, spleen descend in a vertical position, so it is easier to examine them below.

The doctor's hand is placed on the surface of the subject's abdomen at the bottom left. In this case, the fingers should be slightly bent.

The thumb is not palpated, so it can simply be taken aside. It should be noted that the completeness of the examination is ensured when not only the ends of the fingers, but the entire palm touches the surface of the abdomen.

After immersing the fingers in the abdominal cavity, the doctor should move with sliding movements up to 5 cm. In this case, the immersion depth should not change.

If it is necessary to examine an organ that does not have a solid wall behind, then the doctor should place his hand under the patient's lower back on the right or left.

The doctor's fingers should plunge deep enough into the abdominal cavity. For this, the dive should be carried out at the moment when the patient exhales.

At this time, the abdominal muscles relax as much as possible. If, after the first dive, the fingers have not reached the desired depth, a short break should be taken. During the next exhalation, continue the dive.

During the procedure, you can distract the patient with a conversation, bend his legs so that tense abdominal muscles relax.

After palpation, the doctor carefully records all the readings, then analyzes them.

To clarify the diagnosis are assigned additional examinations, after which the patient receives necessary recommendations and treatment.