Palpation and percussion of the kidneys diagnostic value. Palpation of the kidneys and bladder: a technique. Why is palpation of the kidneys needed, which reveals

On palpation of the right kidney: the left one is on the lower back, and the right one is on the stomach. With deep breathing of the patient's stomach, the upper arm on exhalation gradually sinks deeper, moving parallel to the spine and trying to reach the posterior abdominal wall. The lower arm simultaneously lifts the muscles of the lumbar region upward.

Palpation gives the impression of contact between the right and left hands. After the sensation of touching the hands has come (if the kidney is not palpated), it is necessary to ask the patient to take a deep breath - the kidney descends, and if it is accessible to palpation, its dense consistency is felt. In this case, the kidney is painless. In the case of an enlarged kidney or its sharp descent, the ballot method (Guyon method) should be used.

There is a method of palpation of the kidney while standing, proposed by S. P. Botkin. The patient stands facing the doctor, moderately leaning forward. The doctor performs the manipulation while sitting on a chair, while the patient's abdominal muscles should be relaxed. Pain on palpation of the kidneys or their location is characteristic of an inflammatory lesion, but can also be observed with an acute stretching of a capsule of a different nature - for example, due to edema of the kidney parenchyma during acute glomerulonephritis (AGN) or blockage of the ureter with a stone.

However, in most patients, the kidney cannot be palpated. Usually, it is palpable only in pronounced asthenics when it is lowered, in persons who have sharply and quickly lost weight, in multiparous women (asthenic physique). If the kidney is clearly palpable, one should consider the issue of prolapse or dystonia of the kidney (this is a condition when the kidney in the process of embryonic development did not rise completely from the small pelvis). In the case of a distinct palpation of the organ, its assessment follows. Usually the kidney is painless, its surface is even, smooth, bean-shaped, resilient. If the kidney is enlarged, it is easily palpable, and then it is necessary to find out the reasons for the increase (polycystic, tumor, etc.).

The ureteral points are determined by pressing in the back and abdomen, they are painful during inflammatory processes in the pelvis and ureters.

Palpation of the bladder (MP) is possible only when it is filled with urine or if there is a tumor process in it. In the filled state, the MP is palpated as an oval formation, the bottom of which is at one level or another above the pubic joint, which depends on the degree of its filling. The latter also determines the position of the researcher's right hand. Therefore, it is customary to precede palpation of the MP with percussion.

With an inflammatory lesion of the bladder, palpation of the organ or its location is painful. With a tumor of the urinary tract, a dense, painless, sometimes bumpy formation is determined by palpation.

Percussion in the study of the kidneys is not used due to the deep location of the organs.
Above the pubis, an overfilled bladder can be identified, as evidenced by the presence of dullness. MP percussion is performed along the white line of the abdomen in the direction from the navel to the pubic joint. When reaching the bottom of the bladder, instead of a tympanic sound, a dull sound is determined.

Laboratory and instrumental methods for the study of urinary organs. After an objective examination of the kidneys and ureters, as well as other systems in organs, they proceed to laboratory and instrumental diagnostics, which is carried out in the following sequence:

1. performing a urine test, in controversial cases, conducting several similar tests - to convince them of their reliability;
2. conducting basic functional tests;
3. x-ray examination;
4. ultrasound diagnostics;
5. conducting a radiological study using drugs excreted mainly by the kidneys, but labeled with isotopes (carried out if necessary);
6. performing a kidney biopsy, conducting light, electron and immunofluorescence microscopy - to clarify the diagnosis and select treatment tactics (carried out as needed).

In a laboratory study of the kidneys, it is necessary to remember the main elements of their functioning. In pathological extremes, they can manifest themselves in the form of certain symptoms.

Regardless of the disease, the doctor begins to receive the patient with a visual examination, anamnesis. The examination of the kidneys includes several types of primary examination, these are palpation of the kidneys, balloting or percussion. The techniques have been known for a very long time, but they are successfully used in modern medicine, meeting all the requirements of a specialist: understanding the general condition of the body, elucidating pathological changes of a different nature.

Types of examination by palpation

1. Superficial is a study by palpation: the specialist places his hands on the patient's body in the lumbar region and probes the location of the organs with symmetrical strokes. The goal is a preliminary clarification of deviations in the state of the kidneys, for example, noticeable tumors, shifts in position. In addition, superficial palpation of the kidney helps to identify:

• temperature condition of the skin;
• moisture, skin sensitivity;
• muscle tone, muscle tension level;
• the presence of subcutaneous seals, infiltrates.

Important! The technique is carried out only with straightened arms without pressure in the simultaneous mode of both hands

1. Deep kidney palpation technique- This is a more detailed examination and is carried out only by a professional specialist. The doctor must know exactly the location of the organs, the anatomical features of the patient's body, be able to carry out in-depth manipulations. The procedure is performed with one or more fingers with pressure on the patient's body. The type of examination is of the following types:

• sliding recessed carried out by probing the organ in a certain order, the doctor's fingers press the body to the desired depth in order to press the kidney against the back wall and feel it well;
• bimanual is carried out with both hands and is considered the most optimal technique, in which the doctor's left hand holds the organ in a fixed position, the right hand palpates, while moving towards the left - this option allows you to very carefully probe the organ along all the boundaries of the capsule;
• jerky palpation is used to diagnose the condition of the liver, spleen and is used extremely rarely for the kidneys, mainly if the right kidney is significantly reduced or enlarged - the technique helps to "see" the boundaries of the liver and kidney.

The balloting technique is also called “jerking” - the doctor easily pushes the patient's body on the left, gently feeling the left kidney with his right hand, which hits the left palm. The method is very well suited for determining the level of organ prolapse. In particular, if only the lower edge of the pelvis is palpated, this means the first degree of prolapse, but at the second stage, the specialist can probe the entire surface of the organ. The third degree is the most difficult, it allows you to “see with your fingers” the entire kidney, which not only fits freely in the palm of your hand, but also moves in different directions.

Palpation: technique

The technique allows any position of the patient: standing, lying on his side or on his back. The doctor's left hand, palm up, on the lower back, the right hand in the abdomen in the hypochondrium. The patient should relax and take deep, measured breaths. While inhaling, the doctor slightly presses with his right hand and "promotes" the kidney forward. The absence of pathologies will show the impossibility to probe the organ in any position of the patient - the kidney is not palpated. The lower edge of the right capsule may be accessible due to the anatomical location of the organ, but only if the patient is asthenic.

For normally obese and obese patients, the technique of palpation in a standing position is not effective. Suitable option with a forward tilt or lying on its side. Moreover, you will have to lie first on one side, then on the other, so that the doctor examines both organs as carefully as possible.

Important! The kidneys are well palpated only in the presence of anomalies, pathologies, and deviations. For example, the doctor will determine the omission, the presence of cysts, formations of sufficient size. Balloting reveals the presence of hydro-, pyonephrosis, so the patient needs to be manipulated so that the attending physician is not mistaken with the diagnosis

As for the examination of the ureter, which is necessary for suspected urolithiasis, the manual technique is rarely used - normally, the ureters are not amenable to palpation. In case of pain when tapping or pressing on one of the 4 projection points of the ureters, the doctor directs the patient for an additional examination - this indicates a possible course of severe pathology.

The examination of children differs little from the methods used for adult patients, however, the specialist must clearly know the renal points of children, depending on age. The fact is that the final formation of organs occurs only by the age of 8-11, and it is unacceptable to make a mistake in the process of palpation, so as not to make a diagnosis of prolapse or other pathology of the organ.

Percussion

Percussion of the kidneys is an examination technique related to palpation, performed exclusively in a standing position. The process is also called Pasternatsky's symptom. The characteristic differences are not stroking and pressing, but tapping. If the organs are normal, the patient will not respond to the doctor's manipulations, however, with the slightest pain, additional procedures should be prescribed to identify pathological renal processes.

Important! Palpation and percussion are visual diagnostic methods necessary for the initial examination and identification of possible pathologies in the kidneys. But if palpation is a simpler method, then percussion requires a lot of experience from the doctor: the doctor must determine the presence of neoplasms, fluid in the kidneys and other diseases by sound. Being one of the effective methods, the procedures cannot be final: the diagnosis will require additional laboratory and instrumental studies.

And the bladder uses a variety of methods of examination, which include palpation of the kidneys, percussion and examination. Each type of diagnostics has its own characteristics and provides a certain set of information.

So, in more detail. Palpation of the kidneys in a healthy person does not give results, since they are not palpable. This procedure can be carried out only if there is an organ pathology. Or very thin people.

Palpation of the kidneys is carried out in two positions: lying and standing. In the supine position, the abdominal muscles are lowered, they are relaxed, as a result of which the procedure is facilitated. While standing during the examination, you can feel the movable kidney, which has a downward displacement under its mass.

Palpation of the kidneys is carried out with two hands. The patient lies on the couch on his back, legs should be straight, hands should be freely placed on the chest. In this position, the abdominal muscles relax as much as possible, breathing becomes even, calm. The doctor is to the right of the patient. He puts his left hand under the lower back, just below the last rib in such a way that it is located not far from the spine. When examining the left kidney, the hand is placed under the back further, behind the spine.

The doctor's right hand is located on the abdomen slightly below the costal arch outward from the rectus muscles. On exhalation, the specialist plunges the hand into the abdominal cavity towards the fingers of the left hand.

Further. On palpation of the kidneys, during the approach of the hands, the patient is invited to take a breath. Very deep. As soon as he exhales, the specialist can feel the edge of which will approach the right hand and pass under her fingers. If the organ has a strong increase, the doctor will be able to completely palpate its anterior wall, find both poles. This method of examination allows you to determine the shape and size of the body.

There is also a technique for palpation of the kidneys in the position of the patient, lying on his side. In this case, the procedure is carried out according to the same rules as in the supine position. But when the patient is located on his side, the doctor sits, and the patient should be turned to face him. His torso leans forward slightly, muscles relax. When examining in this case, it is possible to detect nephrosis. In the first stage of the disease, only the lower pole of the organ is probed. On the second, the entire organ is easily detected. In the third stage of nephrosis, the organ is freely displaced in any direction. Sometimes there is pain during palpation.

Sometimes, during the procedure, you can confuse the organ with a filled area of ​​the colon, an enlarged right lobe of the liver, or with a tumor. To prevent this from happening, you should know the shape of the organ: it resembles a bean with a smooth surface. The kidneys are characterized by lifting up and returning to their original position. After palpation, protein and an admixture of erythrocytes appear in the urine.

You can examine the patient in a standing position. In this case, the doctor sits opposite the patient, and the patient stands in front of the specialist, leaning forward slightly and crossing his arms over his chest. The doctor places his hands in the same way as when examining the kidneys from behind.

results

During palpation of the kidneys in children and adults with an enlarged organ, the following pathologies can be assumed:

• nephritis;
• hydronephrosis;
• hypernephroma;
• developmental anomaly in the form of a lowered kidney.

Everything is very serious. In addition to palpation, percussion of the organ is evaluated. More.

Percussion

In order. In order for the doctor to more accurately establish the diagnosis, it is necessary to palpate and percussion the kidneys. The last examination method allows you to identify changes in sound over the organ.

Normally, a tympanic sound is heard. This is due to the fact that the kidneys are covered by the intestines. If a dull sound is heard, then this indicates a sharp increase in the organ. In this case, the intestinal loops move apart.

Symptom of Pasternatsky

Of great importance in the examination is the definition of Pasternatsky's symptom. This is a tingling method in which the soreness of the organ is assessed. During the procedure, the doctor is behind the patient. The left hand is placed on the area of ​​the twelfth rib and slightly to the left of the spine. With the edge of the palm of the other hand, short, light blows are applied to the left hand. Depending on the severity of pain, the type of symptom is determined: positive, mild, negative.

A positive symptom of Pasternatsky is determined with ICD, pyelonephritis, paranephritis and some other ailments. It should be understood that the patient can feel soreness with osteochondrosis, disease of the ribs, lumbar muscles. Less commonly, pain occurs due to pathologies of the gallbladder, pancreatitis and other ailments.

Palpation of the bladder

Next moment. Palpation of the kidneys and bladder is performed to identify a variety of pathologies. That is. To examine the bladder, the patient is in the supine position. In this case, the doctor places a hand longitudinally on the stomach. When immersed in the abdominal cavity, a fold is formed, directed to the navel. This action is performed several times, gradually moving the hand to the pubic joint.

Normally, an empty bladder is not available for palpation, as it is located behind the womb. The filled organ is felt. With inflammation, the bladder is palpated outside the womb. The patient may feel pain when pressed.

Percussion of the bladder

To determine the upper border of the bladder, the percussion method is used. During this type of diagnosis, the doctor places a finger-plessimeter (which knocks) horizontally to the organ. Tapping is carried out along the midline, in the direction from top to bottom, starting from the level of the navel and ending with the pubis.

When the bladder is empty, a tympanic sound is heard, which persists until. In case of overflow of the organ in the region of the upper border, the sound becomes dull. This place is marked as the upper limit.

Conclusion

Physiological diagnostic methods allow to identify a variety of pathologies of the kidneys and bladder. With their help, determine the size, location of organs, as well as the presence of fluids in them. After the examination, palpation and percussion, they are necessarily assigned. OAM is mandatory.

When examining the genitourinary system, the lumbar region is first examined, then the kidneys are palpated, penetrating palpation of the renal and ureteral pain points is performed, tapping over the kidney area and auscultation of the renal arteries. After that, the bladder (with its increase) and the external genital organs (in men) are examined.

Local hair growth on the lower back usually indicates the presence of congenital cleft lumbar or sacral vertebral arch (spina bifida), which may be combined with an anomaly in the development of the genitourinary system. In kidney diseases, patients sometimes bend the body in the direction of the lesion to relieve pain, while in acute sciatica - in the opposite direction.

The kidneys are located in the retroperitoneal space and are adjacent to the posterior abdominal wall on both sides of the spine at the level of XI-CP of the thoracic and I-II lumbar vertebrae. In this case, the XII rib runs approximately in the middle of the kidney. Both kidneys have moderate respiratory mobility.

It is usually performed with the patient in the supine position. It is advisable to conduct a study after a bowel movement. Use the method of deep bimanual palpation. First, the right kidney is felt. The palm of the palpating right hand is placed longitudinally on the right flank of the abdomen outward from the edge of the rectus muscle so that the tips of closed and slightly bent fingers are at the costal arch. The palm of the left hand with closed and straightened fingers is placed in the transverse direction under the right half of the lower back lateral to the free end of the XII rib. The patient during the study should breathe evenly and deeply, using the abdominal type of breathing.

On exhalation, the right hand is smoothly immersed in the abdominal cavity and gradually, over several respiratory cycles, they try to reach the back wall of the abdominal cavity with their fingers. At the same time, active lifting movements of the fingers of the left hand put pressure on the lumbar region, trying to bring the posterior abdominal wall closer in the direction of the palpating right hand (Fig. 67).

With a significant omission of the kidney (nephroptosis), its lower pole or the entire kidney is palpated already at this stage of palpation. If contact between the fingers of both hands through the thickness of the lumbar region is established, but the kidney is not found, the patient is asked to take a deep breath in the “belly”, without straining the abdominal muscles. At the same time, if the kidney is accessible for palpation, it, moving down, reaches the fingers of the right hand and passes under them.

The doctor, having felt contact with the kidney, slightly presses it with his fingers against the posterior abdominal wall, on which he simultaneously exerts pressure from below with his left hand, then, sliding down the surface of the kidney, he feels it. Palpation must be carried out very carefully so as not to increase or provoke pain and not cause the patient to feel faint.

Having felt the kidney, determine its shape, size, consistency, the nature of the surface and the presence of pain. Sometimes the kidney can be held between the fingers of both hands, which allows you to more carefully determine its properties and the degree of displacement in different directions. At the same time, a symptom of "balloting" can also be detected: a slight push of the right hand on the kidney in front is transmitted to the palm of the left hand lying on the lower back, and, conversely, a push of the fingers of the left hand on the kidney from behind is felt by the palm of the right hand in front.

During palpation of the left kidney, the right palm is placed on the left flank of the abdomen, and the left palm is advanced further behind the spine and fingers are placed transversely under the left half of the lower back lateral to the free end of the XII rib (Fig. 68). Palpation is carried out in the same way as already described.

Normally, the kidneys are usually not palpable. They become accessible for palpation, mainly in case of nephroptosis, pathological mobility ("wandering kidney"), or with an increase in the size of the organ by at least one and a half to two times. However, in asthenics, it is sometimes possible to feel the lower pole of the right kidney, which is normally located below the left kidney. Nephroptosis, like the "wandering kidney", can be one- or two-sided. In this case, the kidneys are best palpated in the position of the patient standing with the body slightly tilted forward.

The doctor performs palpation, sitting on a chair in front of the patient (Fig. 69). The technique of palpation is the same as in the study in the supine position. If the kidneys are not changed, they are round, bean-shaped, with a smooth surface, dense elastic consistency, painless.

An increase in the size of one of the kidneys is most often caused by its tumor lesion or dropsy (hydronephrosis). With kidney cancer (hypernephroma), its surface is bumpy, the consistency of increased density, while with hydronephrosis, the kidney with a smooth surface, soft consistency, sometimes fluctuates during palpation.

The reason for the increase in both kidneys at the same time is usually their cystic degeneration (polycystic kidney disease). In this case, palpation of the kidneys determines the roughness of their surface and soft elastic consistency. In some cases, it becomes necessary to distinguish a marked increase in the left kidney from splenomegaly. At the same time, it should be taken into account that the kidney is characterized by a deeper and medial location, it has a specific bean-shaped shape with a notch in the middle of the inner edge, easily shifts upward and is able to ballot on palpation. In addition, tympanitis is determined percussion over the kidney, since it lies retroperitoneally and is covered by the intestine. Unlike the spleen, an enlarged kidney is easier to palpate when the patient is in an upright position.

With ascites, severe obesity and flatulence, it is often difficult to penetrate the palpating hand into the depths of the abdominal cavity to feel the kidneys. In these cases, you can apply balloting palpation method.

The study is carried out in the position of the patient lying on his back. The initial position of the doctor's hands is the same as with deep palpation of the kidneys. With the fingers of his right hand, he makes quick jerky movements along the anterior abdominal wall in the direction from top to bottom. You can also use jerky movements of the fingers of the left hand along the lumbar region in the direction of the palpating right hand. A significantly enlarged or lowered and mobile kidney in this way can sometimes be brought closer to the anterior abdominal wall and probed.

It is used to detect pain in the projection of both kidneys and ureters. Pain points in front are probed in the position of the patient lying on his back.

Alternately deeply and vertically immerse the index or middle finger at symmetrical points. First, the renal points are palpated directly by the hypochondral arches at the anterior end of the X rib, and then the upper and lower ureteral points, which are located at the intersection of the outer edges of the rectus abdominis muscles, respectively, with the umbilical and scallop lines (Fig. 70a).

The posterior renal points are palpated with the patient in a sitting position. At the same time, they alternately strongly press with a finger at symmetrical points lying at the intersection of the lower edge of the XII rib and the outer edge of the long muscles of the back (Fig. 70b).

Soreness on palpation of the renal and ureteral points usually indicates the presence of a pathological process, most often of inflammatory origin.

It is carried out alternately on both sides also in order to detect pain in the projection of the kidneys.

The study is carried out in the position of the patient standing or sitting. The doctor stands behind the patient, puts the palm of the left hand in the longitudinal direction on the lower back in the region of the XII rib and inflicts short jerky, but not very strong blows on its back surface with the ulnar edge of the right hand (Fig. 71).

The occurrence of pain in this case is observed in patients with urolithiasis, pyelonephritis, paranephritis. However, this symptom is nonspecific, since it is also often observed in lumbar myositis and sciatica.

It is important for the diagnosis of renovascular arterial hypertension. The renal arteries depart from the aorta at the level of the I-II lumbar vertebrae. The arteries are auscultated from the front and back alternately on both sides. Auscultation of the renal arteries in front of the patient lies on his back. The stethoscope is pressed tightly against the abdominal wall 2-3 cm above the navel and 2-3 cm away from it, after which the patient is asked to inhale, then exhale completely and hold his breath. Gently pressing on the abdominal wall with a stethoscope, immerse it deep into the abdomen and listen.

Auscultation of the renal arteries from behind is carried out in the patient's sitting position. The stethoscope is installed in the lumbar region directly under the XII rib near its free edge. The detection of systolic murmur at the indicated points indicates the presence of stenosis of the corresponding renal artery.

It is located in the cavity of the small pelvis, therefore, it becomes available for research only with its pronounced overflow due to urinary retention. In this case, when the patient is lying on his back in the suprapubic region, the bulging of the anterior abdominal wall is visually determined, and on palpation - a round, elastic, fluctuating formation, over which a dull sound is noted during percussion.

The method of palpation of the bladder is similar to the method of palpation of the colon: the palm is placed longitudinally in the suprapubic region at the site of the protrusion of the anterior abdominal wall. In this case, the fingers should be directed towards the navel. The skin fold is displaced in front of the fingers and, on exhalation, a palpation is performed (Fig. 72).

During percussion, the plessimeter finger is set in the transverse direction at the level of the navel so that the middle phalanx of the finger lies on the anterior midline and is perpendicular to it. Using quiet percussion strokes, percussion is carried out along this line in the direction of the pubis (Fig. 73). At the border of the overflowing bladder, the tympanic sound turns into a dull one. When the position of the patient changes, the upper limit of dullness over the bladder does not change.

In women, in order to distinguish the bladder from an enlarged uterus (pregnancy, tumor), it is necessary to release urine and re-perform palpation and percussion.

In men, they are first examined visually, determining the shape and size of the penis and scrotum, the condition of their skin. The scrotum is examined in the horizontal and vertical position of the patient. They check the possibility of opening the preputial sac, examine the glans penis, the external opening of the urethra and the mucous membrane of the foreskin.

After that, the cavernous bodies of the penis and the urethra are palpated, determining their consistency and the presence of pain. The study is completed by palpation of the contents of the scrotum. In particular, the size, shape, surface nature and consistency of the testicles are determined, after which the epididymis and spermatic cords are felt. It is also important to compare the degree of development of the external genital organs and the age of the patient.

Significant compaction of the cavernous bodies of the penis, and sometimes the curvature of its shape (Peyronie's disease) may be a manifestation of a systemic sclerosing process. Persistent painful erection of the penis, not associated with sexual desire (priapism), is sometimes observed with lesions of the brain and spinal cord, leukemia, some poisonings and infections.

In some cases, it is not possible to open the preputial sac and expose the glans penis due to congenital or cicatricial narrowing of the foreskin (phimosis). However, it must be remembered that it is in this section of the penis that various pathological changes are most often localized, including syphilitic, tuberculous and tumor origin.

Mucous or mucopurulent discharge from the urethra indicates urethritis, and serous-bloody discharge in combination with a palpable indurated seal along the urethra is most often observed in cancer of the urethra. If a patient has a kidney tumor, a significant expansion of the scrotal veins on the corresponding side is sometimes detected.

An increase in the size of the penis and scrotum in volume due to skin edema often occurs with the development of anasarca in patients with nephritis and congestive heart failure. In this case, edematous skin becomes transparent, gelatinous to the touch. Dropsy of the testicles (hydrocele), as a rule, is also accompanied by an increase in the volume of the scrotum. Her skin, however, is not changed, the scrotum, when palpated, has a soft elastic consistency, fluctuates, the testicles and their appendages are not palpable. Hydrocele is most often caused by inflammation or swelling of the testicles and their appendages.

With injuries and hemorrhagic diathesis, hemorrhage may occur in the cavity of the testicular membranes (hematocele), which is accompanied by an increase in the volume of the scrotum and the appearance of a reddish-bluish color. With inguinal-scrotal hernia, varicose veins of the spermatic cord or dropsy of its membranes (funicular) there is a limited soft elastic swelling in the upper part of the corresponding half of the scrotum. To determine the cause of the appearance of such swelling, the scrotum is examined and the inguinal canal is palpated in various positions of the patient.

With inflammatory lesions of the testicles (orchitis), an increase in their size and severe palpation pain are observed, but the surface of the testicles remains smooth. Orchitis can be unilateral or bilateral.

Enlargement, significant compaction and tuberosity of the surface of one of the testicles are characteristic of its tumor lesion. Tumors of the testis, as a rule, are malignant (seminoma) and are characterized by early metastasis. An increase in the size of the epididymis can also be caused by an inflammatory process (epididymitis) or, less commonly, by a tumor lesion. Epididymitis is usually accompanied by severe pain, swelling of the testicular membranes and hyperemia of the skin of the scrotum. If the enlargement of the epididymis is due to the development of a cyst, a rounded formation of a soft elastic consistency is palpated, while the testis and the epididymis itself are well differentiated.

The appearance in the scrotum of massive dense tuberous infiltrates with the formation of purulent fistulas is usually caused by tuberculous or fungal (actinomycosis) lesions. In some patients, the absence of one or both testicles in the scrotum (cryptorchidism) can be noted. In this case, you should look for the testicle in the inguinal canal with the patient in the vertical and horizontal position.

General underdevelopment of the external genital organs (hypogenitalism) indicates a violation of puberty and can be observed in diseases of the hypothalamic-pituitary system, impaired endocrine function of the testicles, and some genetic developmental defects (Klinefelter's syndrome). Hypogenitalism is often combined with a female body type and body hair, the presence of gynecomastia and a thin voice.

Age-inappropriate precocious puberty in children and adolescents is usually caused by tumors in the pineal gland (pineal gland), testicles, or adrenal glands.

A special study of the genital organs is carried out by a urologist and a dermatovenereologist, and if a hernia is detected, an examination by a surgeon is indicated. In women, the genitals are examined by a gynecologist.

When symptoms of kidney disease occur, when examining a patient, palpation of the kidneys is mandatory first. The organ is palpated if the kidney is lowered or swollen. Conducting this research method is primary and has been used since ancient times. If there are no changes in the size and location of the kidney, then it is not felt on palpation.

Palpation of the kidneys should be carried out by a specialist, which allows you to obtain primary data on the state of the organ, but not harm it.

Application and effectiveness

The primary method of diagnosing the disease with symptoms such as pain in the lumbar region is palpation. Percussion is often used along with palpation. This makes it possible to establish a preliminary diagnosis in a short time and subsequently assign additional diagnostics using modern technologies. Palpation is applied as follows:

• the doctor places his left hand on the lumbar region near the patient's spine;
• puts the right one on the abdominal cavity below the ribs opposite the left;
• during a deep exhalation with the right hand, the doctor gently presses, trying to reach the fingers of the left hand.

Thus, when the patient exhales, the lower part of the kidney shifts slightly, and when it changes, it is easy to detect by touch with the right hand. In advanced cases, if the kidney is greatly enlarged, the doctor can feel the entire organ, examine its surface, mobility and degree of pain. When feeling, it is easy to identify such pathological changes as the omission of an organ. The resulting neoplasm, a change in the size of the kidney in the presence of a cyst, and similar abnormalities are also found on palpation. This method will be effective in the manifestation of the so-called "wandering kidney", when it changes location due to any concomitant emerging or congenital pathology.

In childhood, the same methods of primary examination are carried out. If the kidney is healthy, it will not be felt when probing. In the event that the doctor palpates the child, the kidneys are examined in most cases when the child lies on his side or back.

Types of palpation for the kidneys

There are 2 types of palpation that are used during the examination of patients:

1. Superficial palpation - the doctor feels the organ, initially focusing on the presence or absence of pathology. When conducting primary palpation, it is already possible to draw a preliminary conclusion about the patient's condition. The hands of the examiner in a straightened state with stroking movements feel the area where the organs are located, without making any pressure. Thus, the doctor determines the characteristics of the patient's skin, muscle tone and the presence of tension.
2. Deep palpation - used for a detailed examination of the internal organs of the patient. The doctor performs it with several fingers of the right hand, applying strong pressure on the abdomen. Usually a sliding deep is used - a methodical examination of internal organs, which has a certain sequence. With strong pressure, the doctor presses the kidney against the back wall and feels the organ in detail.

Bimanual method

For the doctor to perform this method, the patient can be both in a horizontal and vertical position. If the subject is lying, he should stretch his legs, and put his hands on his chest. If the organ is being examined on the right, the doctor sits on the right side of the patient and palpates the lumbar part under the rib with the left hand. The location of the other kidney remains unchanged. If the study is carried out when the patient is standing, the palpation is carried out in a similar way.