Palpation of the abdomen: features and rules of the procedure. Typical changes in urinalysis and examples of pathologies. The mechanism of the procedure

Palpation is last step full-fledged objective examination belly. Before starting it, the patient should be asked to cough vigorously. As a rule, patients with developing peritonitis can cough only superficially, holding their hands on the stomach. It is possible, as it were, to accidentally kick (not very strongly) the bed or gurney on which the patient lies, which leads to a sharp increase in abdominal pain as a result of the transmission of a vibrational impulse. Thus, it is possible to easily diagnose peritonitis without even touching the patient's abdomen with a hand. In addition, malingerers often come across these tricks, who complain of pain in the abdomen upon direct palpation, but may cough vigorously and do not react in any way to a blow to the bed or gurney. In addition, to detect symptoms of peritoneal irritation, you can try to shake the patient by grasping the combs. ilium, or ask him (her) to jump on one leg.

Palpation of the abdomen begins with asking the patient to indicate the area where the pain first arose and where it is localized at the time of examination. It is necessary to carefully look at how the patient does this. If he accurately indicates the place of greatest pain with one or two fingers, then this testifies in favor of local irritation of the peritoneum. In the presence of diffuse pain in the abdomen, the patient usually either places the palm over the area that disturbs him, or makes circular movements with his palm around the entire abdomen. This allows the doctor to suspect irritation of the visceral peritoneum (so-called visceral pain).

Palpation of the abdomen must be performed with warm hands, with the whole palm, and not just with the fingertips. It is necessary to start palpation of the abdomen at the maximum distance from the area of ​​greatest pain, so as not to cause pain at the very beginning of the study. Many patients, especially children, are anxious and do not allow thorough palpation of the abdomen if this causes severe pain.

First of all, it is necessary to perform gentle (superficial) palpation, gradually moving the hands to the area of ​​greatest pain. The doctor's hands should move gently, consistently and methodically. Fingers should make as little movement as possible. You can not palpate the abdomen randomly, "jumping" from one area to another, because abdominal pain and tenderness on palpation can spread to more than one area of ​​the abdomen. The pressure of the hands on the patient's abdominal wall must be slowly increased until soreness appears or a protective tension of the anterior muscles occurs. abdominal wall. With adequate examination of patients with sharp pains in the abdomen, it is not necessary to cause severe pain during palpation. The pressure on the anterior abdominal wall should be increased only until the patient says that he is in pain, or the doctor feels an increase in the tone of the muscles of the anterior abdominal wall.

During palpation, it should be established whether there is tension in the muscles of the anterior abdominal wall, and if so, whether the entire anterior abdominal wall or some part of it is tense. In addition, the physician must determine whether this protective tension of the muscles of the anterior abdominal wall is arbitrary or involuntary. Voluntary muscle contraction decreases on inspiration, therefore, during palpation of the abdomen, the doctor should ask the patient to do deep breath and then exhale. If at the same time the tension of the muscles of the anterior abdominal wall is preserved, then it is regarded as involuntary, which is a sign of peritonitis. If the patient is ticklish or deliberately contracts the muscles of the anterior abdominal wall, then you can ask him to bend his legs at the hip and knee joints, which to some extent leads to relaxation of the rectus abdominis muscles and facilitates palpation. In case of tension of not the entire anterior abdominal wall, it is necessary to establish areas of muscle contraction. Palpation of the abdomen must be performed with both hands, which makes it possible to detect even slight differences. muscle tone in different departments abdominal wall (above, below, right and left). Patients consciously cannot contract the muscles of the anterior abdominal wall only on one side, therefore, one-sided protective tension of the abdominal wall is a sign of an inflammatory process in the abdomen.

More deep palpation in order to detect tumor-like formations in the abdomen and identify more deeply localized pain, it is necessary to conduct at the very end of the study and only in those patients who have superficial palpation there were no signs of peritonitis. During deep palpation of the abdomen, hepatosplenomegaly, aneurysm can be detected. abdominal region aorta or tumor-like formations in the abdomen. The doctor should always be aware of the formations that exist in the norm, which, upon palpation of the abdomen, can be mistaken for pathological neoplasms (Fig. 18).

Pain that occurs during palpation of the abdomen can be of two types: direct, local tenderness, when the patient feels pain at the site of palpation, and indirect, or reflected, tenderness, when pain occur elsewhere. For example, in patients with acute appendicitis, pain may appear at McBurney's point on palpation of the abdomen in the left iliac fossa. This symptom is called Rovsing's symptom and is a characteristic sign of peritoneal irritation. Comparative palpation of the abdomen with a relaxed and tense anterior abdominal wall can be performed by asking the patient to raise his head from the pillow: while the muscles of the anterior abdominal wall are reduced. If the source of pain is located in the thickness of the anterior abdominal wall or in the parietal peritoneum, then with tension of the muscles of the anterior abdominal wall, the pain usually increases. If the source of pain is located in the retroperitoneal space or in the abdominal cavity, but neither the parietal peritoneum of the anterior abdominal wall nor the abdominal wall itself is involved in the pathological process, then the intensity of pain usually does not change with tension of the muscles of the anterior abdominal wall.

A classic symptom of irritation of the parietal peritoneum is a significant increase in pain with deep palpation of the abdomen at the moment when the doctor abruptly removes his hand from the patient's abdominal wall. As already noted, this classic, time-tested symptom is still gross. Some authors consider it even barbaric, often leading to overdiagnosis of peritonitis, especially in children. Currently, to detect local irritation of the peritoneum and the inflammatory process in the abdominal cavity, more cautious techniques are more often used, which are described earlier.

For some pathological conditions, most often it occurs in patients with acute appendicitis, hyperesthesia of the skin of the abdominal wall is noted. If the skin is pinched or pricked with a pin, then a pronounced painful reaction occurs. Hyperesthesia of the skin of the anterior abdominal wall is an important clinical symptom, but it alone is not enough to make a diagnosis of acute appendicitis or any other disease of the abdominal organs. Pain in this case may resemble those of skin diseases.

Part of the objective examination of the abdomen is tapping on lumbar region or sides of the abdomen to identify soreness in these areas. Often pyelonephritis or urolithiasis disease present with abdominal pain. However, in such patients, upon detailed examination, the maximum pain is detected in the region of the costovertebral angles.

In unclear clinical situations, an examination by only one doctor is sometimes not enough. However, to assess the dynamics of the disease, it is very important that the repeated palpation of the abdomen is performed by the same doctor using the same techniques.

Other symptoms of abdominal pain

Psoas symptom (symptom of the lumbar muscle). The patient lying on his back, the doctor asks to raise the straightened leg, at the same time creating resistance with his hand (Fig. 20). In this case, with an inflammatory process that captures a large psoas or developing in its immediate vicinity (for example, in patients with acute appendicitis), as well as if the pathological process primarily affects the lumbosacral spine (for example, in patients with intervertebral hernia), pain occurs.

Obturator muscle symptom. For the patient lying on his back, the leg is bent at the hip and knee joints at an angle of 90° and then rotated inwards. With an inflammatory process in the region of the internal obturator muscle (m. obturatorius interims) (in particular, with pelvic abscesses, acute appendicitis, acute salpingitis) pain appears.

Murphy's sign. In the area below the right costal corner, the doctor exerts moderate pressure on the hypochondrium with the palm of his hand. The patient is asked to take a deep breath. Murphy's symptom is positive in the case when pain occurs when the liver and gallbladder are displaced downward. In this case, the patient even holds his breath in the middle of inhalation. This symptom is considered classic in patients with acute cholecystitis, but can also occur with hepatitis, volume lesions of the liver and pleurisy.

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 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 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 from ascending to transverse caudal and descending colon. 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, inflammatory process 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 is the last stage of a full and objective examination of the abdomen. 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 motions palms. 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 takes a 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 the 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, in the course of acute appendicitis, pain accumulates at the McBurney point in 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 on the 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 is accompanied by aching pain 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. Severe pain is 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. Pain syndrome localized in the lower abdomen (squeezing neighboring 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, a peptic ulcer is formed. 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.

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 daytime hours(when the patient is active) and subsides 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, acute angle) 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. The patient complains of pain in the right iliac region radiating to the area 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 abdominal massage 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 a violation of the motor function of the 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.

Spastically reduced areas of the large intestine (usually the 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.

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Questions and answers on: pain in the lower abdomen on palpation

2012-05-23 09:48:00

Alina asks:

Hello! During pregnancy, they found follicular cyst right ovary. After giving birth, 9 months passed, I went for an ultrasound scan, they wrote: "Endometriosis of the body of the uterus 1 stage adhesive process on the left, "an enlarged follicle of 16 mm is still in the left ovary. On palpation, the lower abdomen hurts on the right. The cysts said no. Periodic attacks of pain in the lower abdomen. Could this be due to endometriosis?

Responsible Serpeninova Irina Viktorovna:

Yes, endometriosis can give pain in the lower abdomen, but it is necessary to exclude the inflammatory process of the pelvic organs. Pass smears, be examined for STDs, do a colposcopy.

2010-06-08 14:30:56

Anastasia asks:

Good afternoon, I have a question. Cycle 28-31, The last menstruation was on 05/10/2010. On 05/24/2010 there was sexual contact with her husband, and on 05/29/2010 there were sharp pains in the lower abdomen and small bloody pains, the pain looks like a stake was inserted into the vagina all the way to the stomach , could not even sit down normally, the next day everything went away. 06/04/2010 did a test, without waiting for a delay, positive with clear bright stripes, 06/06/2010 did a second test, also positive with bright stripes. 06/07/2010 in the morning I couldn’t even eat nausea, at work it became bad, a sharp stabbing pain, as if inside and on palpation, an indistinct pain in the left side from below, while dizziness thought I would faint right at the workplace, Urgently left home and went to her to the gynecologist, upon examination, she said that the uterus is slightly enlarged, she cannot say for sure that I am pregnant or not, but she is worried about my left appendage and said to come in 10 days if it becomes bad to call an ambulance. The question is, am I really pregnant and how old am I and what do these pains in my left side mean?

Responsible Medical consultant of the portal "site":

Hello Anastasia! Combination positive result pregnancy test, changes found in the appendages, and pain in the lower abdomen indicates the presence of a situation that does not allow waiting 10 days. Possible options- ectopic pregnancy (for more details, see the article Ectopic pregnancy on our medical portal), a combination uterine pregnancy and ovarian cysts. Currently, you are shown an ultrasound of the pelvic organs with a transvaginal sensor - the study will not show pregnancy (since the period is very short), but it will allow you to detect changes in the appendages, if any, and determine their nature. Take care of your health!

2008-10-03 14:06:31

Natalia asks:

Good afternoon. I am 20 years old, never gave birth, had no abortions or miscarriages. For the past 3 months I have periodically appeared cutting, stabbing pains in the lower abdomen on the right, localized in the area of ​​\u200b\u200bthe connection of the leg in the inguinal region (where The lymph nodes) and give it to the navel, sometimes the liver hurts, every day it makes me sick. At first they thought that it was an appendix or a violation of the intestinal flora. There is no pain on palpation. I went to the surgeon, they did an ultrasound and performed probing. Found only a small gastritis. On the same day (as recommended by the surgeon), an ultrasound of the small pelvis was performed (11 days of the cycle). Ultrasound doctors found a cyst of the right ovary ("thin-walled formation along the right uterine rib" measuring 32*20*22 mm) and endometrial hyperplasia (11 mm). I showed the results of the ultrasound to the local gynecologist, and he, having examined me again for an ultrasound (day 19 of the cycle), did not find any pathologies, and was generally surprised by the results of the previous ultrasound. I gave swabs. According to their results, the doctor suspects thrush (no symptoms). Now I take fluconazole and homeopathy. The pain doesn't go away. Menstruation is always very profuse and the first days are very painful. I don’t know which doctor I should turn to, what can hurt so incomprehensibly? What should I treat, I do not understand at all. Advise what to do....

Responsible Bystrov Leonid Alexandrovich:

Hello Natalia! Nevertheless, according to your description of the symptoms, this is very similar to chronic appendicitis. It may be necessary to exclude the pathology of the kidneys. The description of the ultrasound data you provided is more like a hydrosalpinx (increase fallopian tube, which can be filled with contents and emptied) and is therefore not always visualized on ultrasound. In the most difficult cases, if other non-gynecological pathology is excluded, they resort as last resort, to diagnostic laparoscopy for diagnosis. Well, if you are sexually active and do not always use a condom, for the purpose of contraception, you need to be examined for STIs.

2013-02-07 18:10:54

Svetlana asks:

Hello. For about a year, I periodically suffer from constipation and pain in the left lower abdomen. Completely examined by a gynecologist (even diagnostic laparoscopy did) - they found external endometriosis on the peritoneum and rectovaginal septum, burned all the foci, everything else was normal. The gynecologist advised me to visit a gastroenterologist. But the pains in the left lower abdomen remained, before they intensified with prolonged non-emptying, I used laxatives (Bisacodyl in suppositories, Gutalax), but over the past 2 months, the pains have become almost constant aching and pulling, sometimes it even starts to hurt left leg. AT given time I have been taking Dufalac and de-nol on the advice of a gastroenterologist for about 2 weeks now, but the stool is still not getting better, and the pains are getting worse. The gastroenterologist suspects inflammation of the sigmoid colon. Palpation of the sigmoid colon through the abdomen severe pain I do not feel, the intestine is mobile. Please tell me if this inflammation is treated without surgical intervention And is it necessary to undergo such a procedure as sigmoidoscopy? And tell me, please, is it possible to use metiraucil suppositories for the period of 1 month, because. I still can’t tune in to this procedure (((I still hope that proper nutrition and diet will help. Thank you for your attention.

2010-05-17 22:25:17

Light asks:

Which specialist should I contact? Aching pains on the right lower abdomen with food intake, stools are not associated once a day or once every two days, did a colonoscopy, they barely went to the hepatic angle, which they looked at - catarrhal colitis, chronic hemorrhoids. On palpation of the caecum, there is a sloshing sound when pressed. Seven years ago, she went to the emergency room with suspected appendicitis, the surgeon said that the intestines or gynecology. Analysis blood is the norm, blood biochemistry - norm, urinalysis - for culture - str. faecolis 3 * 10 in the 3 degree, citrobacter freundii less than 10 in the 3 degree, leukocytes are normal. Ultrasound of gynecology-cyst on the right (7 years already), ovl. nabt. in sowing gynaecs. smear-str.ovalae 5 * 10 in the 4th degree, lactobacillus acidophilus less than 10 in the 3rd degree. The norms in the forms are not indicated. The cytology is normal. cholecystitis, hron. pyelonephritis, nephroptosis on the right, cyst on the right. FGDS - erosive gastritis, catarrhal duodenitis. Blood on helicobacter is normal. please please give me good advice or a consultation.

Responsible Tkachenko Fedot Gennadievich:

Hello Svetlana. In this situation, you need to consult a proctologist with an adequate proctological examination.
I would recommend doing the following:
1) fibrocolonoscopy - it is necessary to examine the entire large intestine,
it is even possible to perform an examination under general anesthesia for this purpose.
2) irrigography;
3) study of the passage of barium sulfate through the alimentary canal;
4) CT scan of the abdominal cavity and small pelvis.
5) consultation of a gynecologist and a gastroenterologist.
6) If necessary, it is possible to perform a diagnostic laparoscopy.

2008-05-11 11:55:49

Julia asks:

Hello! Tell me what could be the cause of pain in the lower abdomen). At the doctor's appointment with palpation, there is no pain at all, but during intercourse, the slightest excitement, after going to the toilet, the pain is simply impossible. No one can clearly tell me what exactly hurts. Antibiotics immediately begin to drip, but they, of course, do not help, because. I don't have inflammation. Maybe you can answer me, can myoma hurt like that directly.

Responsible Tarasyuk Tatiana Yurievna:

Good afternoon!
Causes of pain during intercourse, after it and after going to the toilet there is a mass. If pain, burning, itching occurs in the vagina during intercourse or immediately after it, inflammation is most likely the cause. In such a situation, it is necessary to undergo an examination for infections. Sometimes pain during intimacy is caused by the tension of adhesions in the small pelvis - such pain is located deep in the abdomen, intensifies and weakens depending on the position and “aggressiveness” of the partner’s actions. In this situation, the selection of a position saves. If the pain in the lower abdomen associated with adhesions, persists constantly, including - outside of sexual activity - it is necessary to treat a chronic inflammatory process - including with the help of physiotherapy.Another cause of pain can be injuries, including stitches after childbirth and operations.Pain also causes endometriosis - it is characterized by pain before menstruation, which disappear with it.Pain during intimacy is also characteristic of endometriosis - and can be impossible or excruciating at the end menstrual cycle. Irregular sex life, insufficient satisfaction, sexual abstinence, dissatisfaction with relationships leads to a violation of the venous outflow - as a result, again, pain. Pain localized along the walls of the pelvis, aggravated by touch (sexual intercourse, examination on a chair, ultrasound with a vaginal probe), often sharp, shooting, radiating to the leg, is characteristic of pelvic neuralgia.
And finally - insufficient release of lubrication due to unwillingness of intimacy, subconscious rejection of the partner, after removal of the Bartholin gland that secretes lubrication or as a result hormonal disorders (postpartum period, reception hormonal contraceptives, menopause).
Pain is clearly a signal of disorder (disease or psychological state).
In a word, you need to understand! And on the Internet it is impossible to determine the cause of the pain in you!
Go see a doctor!

Palpation examination of the abdomen begins with a superficial (approximate) palpation, which determines the tone of the muscles of the anterior abdominal wall, the degree of their resistance to palpation, painful areas, as well as the divergence (diastasis) of the rectus muscles and the umbilical ring.

The study is carried out in the position of the patient lying on his back with pubescent along the body or arms folded on his chest and straightened legs. The bed should be flat, not too soft, and the headboard should be low. The doctor sits with his right side at the patient's bed, facing him (the "left-handed" doctor sits to the left of the patient). In this case, it is necessary that the doctor's chair should be at the level of the patient's pelvis, and the seat of the chair should be located at the height of his bed. Special meaning on palpation of the abdomen, it has the condition of the doctor's hands: the hands must be necessarily warm, and the nails cut short. In order to warm their cold hands, the doctor should intensively rub the brushes against each other or wash them with hot water.

It is advisable to palpate the abdomen on an empty stomach and after a bowel movement. The patient during the study should breathe through the mouth, deeply and evenly, using the diaphragmatic type of breathing, but without straining the abdominal wall. Before starting palpation, to reduce the tension of the abdominal press, it is advisable to a short time put one or both palms on the patient's stomach, giving him the opportunity to get used to the doctor's hand. At the same time, attention should be paid to the uniformity of the participation of various parts of the abdomen in the act of breathing and to check the patient's ability to breathe with the active participation of the diaphragm: while inhaling, the doctor's hand lying on the anterior abdominal wall should rise, and on exhalation, it should fall.

Normally, all parts of the abdomen evenly participate in the act of breathing. With diffuse inflammatory lesions of the peritoneum (diffuse peritonitis) or paralysis of the diaphragm, the movement of the abdominal wall during breathing is completely absent, and with local peritonitis or paralysis of one of the domes of the diaphragm, various parts of the abdomen participate in the act of breathing unevenly.

Superficial palpation is carried out with the right hand or simultaneously with both hands on symmetrical parts of the abdominal wall. The palpating palm with closed and straightened fingers is placed on the area under study. In this case, the brush should be flexible, soft, its muscles are relaxed. Smoothly, without penetrating deep into the abdominal cavity, careful sliding and stroking movements are carried out with the fingers along with the skin of the abdomen along the muscles of the abdominal wall, slightly pressing on them and feeling the pulp of the terminal phalanges. Only the hand is involved in palpation. The forearm of the palpating hand should be in horizontal position at the level of the patient's body. The elbow and shoulder joints remain relatively immobile. Moving the brush from one part of the abdomen to another, gradually feel the entire abdominal wall. At the same time, they try to distract the patient's attention, for example, by engaging him in regulating the frequency and depth of breathing.

The patient should not talk during palpation, only monosyllabic answers to questions about the presence of pain are allowed. When conducting superficial palpation, the doctor should look not at the stomach, but at the patient's face in order to notice his reaction to the appearance of pain in response to palpation in time.

Sequentially, paired areas of the abdomen are first felt - iliac, lateral and hypochondrium, and then unpaired - epigastric, umbilical and suprapubic. Painful areas of the abdomen are felt last. Pay attention to the tone of the abdominal muscles, the presence of pain and the degree of resistance of the abdominal wall to palpation. In order to detect local pain, you can also use lung reception tapping with a bent finger on various parts of the abdominal wall (Mendel's symptom).

The anterior abdominal wall on superficial palpation is normally soft, pliable, painless, abdominal Press well developed. In the presence of pain, its prevalence and the accompanying reaction of the muscles of the abdominal wall are determined. Then, asking the patient to raise his head, inhale and strain, the doctor places the tips of closed and slightly bent fingers along the anterior midline. right hand and gropes white line belly from xiphoid process to the pubis (Fig. 43).

Normally, the tensed rollers of the rectus abdominis muscles and the umbilical ring do not let the fingertips through. With the divergence (diastasis) of the rectus abdominis muscles, the fingers freely push the muscle rollers to the sides and penetrate between them. With the expansion of the umbilical ring, it freely passes the tip of one or even two fingers.

In order to identify hernial protrusions, palpation of the white line of the abdomen, the umbilical ring and inguinal regions is also carried out in the patient's standing position, asking him to strain.

If pain is found in any part of the abdomen and in response to it, a moderate transient local resistance of the muscles of the abdominal wall appears in the corresponding area directly during palpation, then they speak of the presence of local resistance. Such a reaction of the muscles of the abdominal wall decreases or completely disappears when the patient's attention is distracted or after prolonged stroking of the abdomen.

Local resistance of the abdominal muscles is most often caused by pathology internal organs located in the projection of the painful area, less often, the pathology of the abdominal wall itself. Pain with local resistance is usually dull, tolerable, and can sometimes be characterized as hypersensitivity or discomfort. However, with severe spasm smooth muscle, for example, the gallbladder or intestines, the pain is acute (colic).

In the case of involvement in the inflammatory process of the sheets of the peritoneum (peritonitis), the pain on palpation is pronounced, unbearable. At the same time, a significant and persistent tension of the muscles of the abdominal wall is detected, which persists regardless of palpation. This reaction of the abdominal wall is called muscle tension, or muscle protection. With diffuse peritonitis, muscle protection, as a rule, is diffuse ("board-shaped" abdomen), and with local peritonitis - local.

Palpation reveals another important symptom irritation of the peritoneum: the pain felt by the patient when the hand is carefully immersed in the abdominal cavity is much weaker and more limited than the acute and diffuse pain that occurs if the pressure is suddenly stopped and the palpating hand is quickly removed from the abdomen (Shchetkin-Blumberg symptom). In acute appendicitis, this symptom is positive at McBurney's point, located on the border of the outer and middle thirds of the right umbilical-spinal line.