Abdominal pain, characteristic of emergency conditions, or an acute abdomen. Superficial palpation of the abdomen. Tasks and algorithm for superficial palpation of the abdomen

Quite often, before referring the patient to a hardware examination, the doctor performs palpation - a diagnostic method, with the correct implementation of which, one can quite accurately determine the condition of the peritoneal organs.

This is not just a responsible method of studying the patient's condition, but also establishing a trusting contact with him, as this is a joint work. The doctor will not be able to obtain reliable data until the patient relaxes the abdominal cavity and allows himself to be examined. Since palpation of the abdomen allows a correct diagnosis to be made with great accuracy, which is especially important if the examination is carried out outside the walls of the hospital, for example, in an ambulance, such a diagnosis often saves a person's life.

Palpation as a research method

As a rule, the physical method of examination is carried out simultaneously with the collection of anamnesis. This allows the doctor to reveal a more complete picture of the disease of the digestive tract. In order for the process to go according to the rules, some factors that preceded it must be observed:

• The surface of the table or couch should be flat, and the head should be slightly raised.
• The light source should be opposite the place where the inspection will be carried out.
• The doctor's hands should be warm, because otherwise, the patient's abdominal muscles will involuntarily contract, which will prevent a full examination.

Fulfilling the main rule of palpation, which is to examine the painful area last, the doctor, by the nature of the patient's reaction, can draw preliminary conclusions and only then proceed to feeling the diseased organ.

If the patient has painful stomach, then the examination is carried out from all sides, which will allow not only to correctly assess the patient's condition, but also to determine the points where the concentration of pain is the strongest. Often the doctor has to use distraction tactics by asking the person questions, sometimes even unrelated to his state of health. In this way, the doctor breaks the mindset that touching the stomach = pain.

Palpation as a research method:

In addition to examining abdominal cavity, the doctor simultaneously examines the condition of the patient's skin, his appearance, for example, excessive thinness and other signs often indicate pathologies in the digestive tract.

There are several methods of physical examination of the human peritoneum, each of which is used in accordance with the tasks that must be identified.

In the human peritoneum are its main organs, such as the stomach, intestines, liver, spleen, gallbladder and pancreas. Superficial palpation, also called indicative, allows you to determine where the pain is localized, how tight the muscles of the abdominal cavity are and whether there is an increase in organs.

Such an examination is carried out by the doctor by lightly pressing the fingers of the hand lying on the patient's stomach. It begins on the left side of the inguinal region of the patient, who must report any pain at the site of the study.

The next area to study is located 4-5 cm higher, and then the palpating hand passes into epigastric region and to the region ilium on the right side.

When comparative palpation is performed, the doctor sequentially moves from the left side of the peritoneum to its right side:

• in the beginning, the iliac region;
• navel area;
• lateral areas of the abdomen (left and right);
• the hypochondrium is examined next;
• epigastric (left) part and to the right of the so-called "white line".

If the patient is healthy, then superficial palpation will not cause him pain. In the event that they are, then by their nature the doctor can identify the disease. For example, soreness over the entire surface of the abdomen, accompanied by muscle tension, speaks of acute peritonitis. With cholecystitis, the body will respond with pain when lightly pressed in the right hypochondrium, and with appendicitis - on the right side of the iliac region. Often the doctor determines the disease by the level of tension in the abdominal wall.

Thus, superficial palpation allows you to determine:

• where exactly the muscles are tense;
• places where the muscles diverge, and a hernia appears;
• localization of pain;
• the presence or vice versa the absence of tumors or seals;
• determine whether the internal organs are enlarged and, if so, how much.

After analyzing the data obtained, and correlating them with the anamnesis, the doctor will be able to make a preliminary diagnosis, which will subsequently be rechecked using a hardware examination.

This type of physical examination of the patient is performed only after a superficial examination. It is carried out in a slightly different way. The doctor bends the fingers of the palpating hand and presses on the stomach with its second phalanges. The examination is carried out parallel to the diseased organ with a preliminary grip of the skin, which will allow the hand to slide over the abdomen without causing its tension.

The fingers plunge deep into the peritoneum, but only when the patient exhales. All movements should be soft and unhurried. As a rule, 3-4 breaths and exhalations are enough to study the organ, while the doctor dips his fingers to the back wall, but so that they are located slightly away from the diseased organ, gradually approaching it.

During the examination, the doctor tries to perform the following tasks:

• identify the location of internal organs;
• determine their size and possible displacement;
• assessment of the state of hollow organs for the presence of sounds, for example, rumbling;
• determining whether there are seals, tumors or any other neoplasms, their size and location.

This is a rather complicated examination technique, since factors such as body fat or strongly developed abdominal muscles can affect its results. If during the procedure the patient experiences pain of any nature, he must report it to the doctor.

Palpation of the child's tummy is carried out in the same way and in the same sequence as in adults.

Palpation of the stomach

Before proceeding directly to the physical examination of the digestive organ, the doctor conducts ausculto-percussion and ausculto-affrication.

In the first case, he installs a phonendoscope between the sternum and navel of the patient lying on the couch. At the same time, he easily taps the area around the device with one finger. The purpose of the method is to establish the exact dimensions of the stomach.

In the second method, the doctor does not hit, but gently runs his finger along the abdominal wall around the phonendoscope. At the same time, rustling is heard in the apparatus at the border of the digestive organ, which stops as soon as the doctor's finger goes beyond the organ.

Having determined where it is located, the doctor can proceed directly to deep palpation. In this way, it is possible to detect the curvature of the digestive organ and the presence of tumors or seals in it.

What does pain on palpation mean?

As a rule, it is precisely by pain or their absence that the doctor is able to identify the presence of pathologies in the internal organs. Pain on palpation means:

• When they appear in the lower abdomen in women, it can be:
• diseases of the genitourinary system, for example, fibroids or cysts;
• neoplasms;
• inflammation in the gallbladder or appendicitis;
• if the pain manifested itself in a pregnant patient, then placental abruption or the threat of miscarriage may be a possible cause;
• bending of the uterus or bleeding in it.

Most often, pain in the lower abdomen in women is associated with inflammatory processes, for example, endometritis, uterine fibroids, cystitis or cholecystitis.

• When the lower abdomen hurts in men, then this is a sign:
• prostatitis;
• inflammation of the appendages;
• appearance of neoplasms.

Pain in other areas signal problems in the liver, pancreas, spleen, or stomach. By their localization, the doctor can quite accurately determine in which particular organ the problem is located and what it is. Although palpation is only an initial examination, it often allows you to identify the disease and pay maximum attention to it during further checks.

For the first time, sliding deep palpation was used by V.P. Obraztsov, who proved that such a study can be carried out not only in patients with pronounced pathologies, but also healthy people. In this way, you can examine any area of ​​​​the abdominal cavity. Today this method is called sliding palpation according to Obraztsov-Strazhesko.

Video example of deep palpation:

Primary diagnosis and history taking should be carried out for each patient in order to identify the condition of the organs, their location, size and possible deviations from the norm. After that, you can assign the patient a further examination, paying maximum attention to the areas of localization of the disease.

Doctors refer to palpation (palpation) as a physical method of examining a patient. It is preceded by clarification of complaints, anamnesis, general examination. How is palpation of the stomach carried out, why is this or that method used, and what does the doctor determine in this way?

Quality primary examination stomach probing depends on the qualifications of the doctor.

General inspection

At this stage, the doctor detects the following signs of gastrointestinal ailments:

• Weight loss. It is due to the fact that the patient deliberately restricts food in order to avoid the appearance of pain after eating. Ulcers, especially men, are often asthenic, that is, unnecessarily thin.
• Pale skin (often sticky, cold sweating) indicates overt / hidden ulcer bleeding.
• Grey, earthy skin. This symptom may indicate stomach cancer.
• Scars on the abdomen from previous operations on the organs of the digestive tract.

The abdominal wall is also examined directly (the condition is the presence of good lighting). For example, if its movement during diaphragmatic breathing "lags behind", this is regarded as a sign of a local inflammatory process of the peritoneum.

Methods of palpation of the stomach

According to medical prescriptions, the method of palpation of the abdomen is carried out in strict sequence. Its purpose is to assess the condition of the anterior abdominal wall, cavity organs, and to identify pathologies. Such an examination is carried out on an empty stomach, the intestines must be emptied. The patient is placed on his back on the couch.

superficial

This procedure will determine:

• size, shape of the palpable part of the stomach, nearby organs;
• tension in the muscles of the abdominal cavity (at normal, it should be insignificant);
• localization of pain sensations, which makes it possible to make a preliminary diagnosis in case of acute processes(for example, a hard, painful abdomen, muscle tension on the right side - appendicitis).

Superficial palpation is carried out by gently pressing the flat lying fingers of one hand on the abdominal wall in certain areas. They start on the left, in the groin area, then move the hand 5 cm above the initial point, then move to the epigastric, right iliac region. The patient should lie relaxed, with his arms folded along, answer the doctor's questions about his feelings. This method is called approximate superficial palpation.

There is also a comparative superficial palpation. It is carried out according to the principle of symmetry, examining the right and left:

• iliac, umbilical region;
• lateral sections of the abdomen;
• hypochondrium;
• epigastric region.

The white line of the abdomen is also checked for hernias.

Deep (methodical) moving average

The technique is this:

During this examination, the doctor sequentially feels:

• intestines (sequence - sigmoid, straight, transverse colon),
• stomach;
• pylorus (sphincter separating the stomach and the ampulla of the 12 duodenal process).

Deep sliding palpation is also recommended when the subject is standing. Only in this way it is possible to grope for a small curvature, high-lying neoplasms of the pylorus. Deep sliding palpation in half of the cases (in patients with a normal position of the organ) allows you to check the greater curvature of the stomach, in a quarter of the cases - the pylorus.

Palpation of the gatekeeper

This sphincter - "separator" lies in a strictly designated location, a triangle outlined by certain lines of the body. Under the fingers, it is felt like an elastic cylinder (changing in accordance with the phases of contraction / relaxation of one's own muscles), sometimes becoming dense, sometimes not actually palpable. Palpating it, sometimes they hear a slight rumbling caused by the "flow" into the 12 duodenal process of liquid, gas bubbles.

Ausculto-percussion, ausculto-affrication

The essence of these two methods is similar. The goal is to determine the size of the stomach, to find lower bound. Normally, the latter is slightly above the navel (3-4 cm in men, a couple of cm in women). At the same time, the subject is laid on his back, the doctor sets the phonendoscope in the middle between bottom sternum and umbilicus. With ausculto-percussion, the doctor, using one finger, applies superficial blows in a circular direction with respect to the phonendoscope.

With ausculto-affriction, they do not “beat” with a finger, but pass it along the abdominal wall, “scrape” it. While the finger "goes" over the stomach, in the phonendosco

no rustling is heard. When you go beyond these limits, it stops. The place where the sound disappeared indicates the lower border of the organ. From here, the specialist conducts deep palpation: bending his fingers and placing his hand in this area, he feels the abdomen along the midline. solid education here is a tumor. In 50% of cases, a large curvature of the organ is felt under the fingers (a soft “roller” that runs transversely along the spine).

Soreness on palpation of the greater curvature is a signal of inflammation, ulcerative process.

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 dip his fingers very deep into the painful abdomen, while not 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.

Analyzing the data obtained after the examination, the doctor will be able to draw conclusions about the patient's state of health, about the pathological processes occurring 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 reach the pain point, the patient will report this. 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;
• an assessment of hollow organs is carried out - the presence of rumbling or other sounds in them is analyzed, which do not exist if the organ indicators 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 and small intestine are felt. 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, additional examinations are prescribed, after which the patient receives necessary recommendations and treatment.

The process of palpation of the stomach and intestines is important in terms of diagnostic studies of the 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, the presence of various neoplasms and abnormalities. 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 of 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).

In a normal state, 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 a normal functional state, the intestines do not rumble.

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 signs and symptoms: painful diarrhea (mushy, slimy stools, 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 gland, 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 the supine 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 detect symptoms of peritoneal irritation, it is allowed to gently shake the patient, after grasping the crests of the 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 using 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). An 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. Touching the 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 of various pathologies in the digestive organs (for example, acute appendicitis), hyperesthesia of the skin in the abdomen is observed. It is for this reason that if a patient is pinched or lightly pricked, then a painful reaction of the body will instantly occur. This is a fairly common clinical symptom, but its 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 the genitourinary system (cyst, endometritis, fibroids);
• use of the spiral as contraceptive;
• the 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;
• allocation of 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 is a pathological disorder that affects the uterus and appendages. Severe pain is observed on palpation of the middle of the abdomen;
3. Ovarian apoplexy correlates with ovulation. In this case, part of the blood enters the abdominal cavity due to strong physical exertion;
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 gives clearly to the 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. Inguinal hernia and its pinching are also dangerous. 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 on the right side, but also on the left. Quite often, the main reason lies in the spread of 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.

Pressing on the abdomen increases intra-abdominal pressure, which, in turn, can provoke increased pain in some pathologies. Also, when pressed, the sheet of peritoneum is pressed against the area of ​​\u200b\u200binflammation, which causes pain. In general, it is believed that increased pain during palpation of the abdomen in a certain place indicates that the pathological process is localized there. That is, with reflected pain ( for example, abdominal pain due to pneumonia or myocardial infarction) the pain will not increase in response to pressing.

If pain occurs when pressing lower part right abdomen, we can talk about appendicitis, as well as adnexitis or ovarian cyst in women. With the localization of pain in the upper abdomen on the right, the cause may be cholecystitis, duodenal ulcer, hepatitis. It should be noted that if the patient noticed local pain when pressing on the abdomen, you should not specifically press again, "exploring" the nature of the pain. It is better to consult a doctor who will conduct a qualified palpation of this area, determine the size of the organs and suggest possible diagnosis.

Stomach pain on the right in the middle of the menstrual cycle

Abdominal pain in the middle menstrual cycle are quite common and do not always speak of a pathological process. Often they are caused by rupture of the follicle in the ovary and the release of the egg into the fallopian tube. If the right ovary takes part in this process, then the pains, respectively, will be localized on the right below.

Of the pathological processes that can be exacerbated during menstruation, it should be noted a number sexually transmitted diseases (gonorrhea, chlamydia, trichomoniasis, etc.). However, these infections rarely rise high enough to give pain in the lower right abdomen. Pain may also be associated with benign or malignant neoplasms uterus, ovarian cyst.

Stomach pain on right side after sex

After sexual intercourse, pain in the lower abdomen occurs most often in women. This is usually associated with the presence of a chronic inflammatory process in the pelvis, which is activated through physical activity and raising intra-abdominal pressure. For example, if an ovarian cyst is present during intercourse, it may rupture ( apoplexy). Then in the first hours and sometimes minutes) after which the pain begins to increase. With apoplexy of the right ovary, respectively, there is pain in the right iliac fossa, radiating to the groin, buttock or leg.

Aching pain in right abdomen

Aching pain, as a rule, occurs with inflammatory processes of moderate intensity. For example, during an exacerbation of duodenal ulcer, it is localized in the right hypochondrium or in the epigastrium. Such pain begins after eating and lasts for several hours. Its origin is associated with irritation of the mucous membrane of the organ. Also, aching pains are possible with some variants of the course of cholecystitis, appendicitis and other inflammatory diseases.

Cutting pain in the lower abdomen on the right

Cutting pain in the abdomen on the right is more characteristic of intestinal pathologies. Most often it is localized in the lower abdomen. Such pains are caused by a spasm of smooth muscles in the walls of the organ, violations of food pushing. The cause is usually intestinal infections or food poisoning. In both cases, the pain can be quite severe, but there is no such serious threat of death as with an "acute abdomen".

Throbbing pain in the lower right abdomen

Pulsating pain in the lower abdomen on the right can be caused by some vascular diseases or an acute inflammatory process. In the first case we are talking about lower aneurysms abdominal aorta. The expansion of the vessel forms a bag, which pulsates in time with the heart. However, the pain will be moderate ( uncomplicated aneurysm does not cause acute pain). If the pain is severe, then most likely there is purulent inflammation. In the right lower abdomen, this may be due to advanced appendicitis. The appendix ruptures, causing local inflammation of the peritoneum ( peritonitis).

Constant abdominal pain on the right

Constant pain is usually not too sharp. Some patients do not attach importance to it for several weeks and only after this time has passed ( usually with amplification) see a doctor. Moderate in intensity, but prolonged pain characteristic of chronic appendicitis or cholecystitis, gastritis. In some cases, the inflammatory process gradually subsides, but it can also go into an acute phase. In any case, long-term pain should not be ignored. It is better to contact a specialist and immediately establish their cause. Then there is a high chance that the disease can be dealt with by conservative methods, without surgery.

Intermittent abdominal pain on the right

Periodic abdominal pain that appears over several months or years can be associated with a number of chronic diseases. In this case, pain will appear only in certain conditions during exacerbations. For example, gastric and duodenal ulcers can cause more severe pain spring and autumn, as well as in response to a violation of the diet.

In addition, inflammatory bowel diseases such as Crohn's disease or ulcerative colitis do not cause persistent pain. As a rule, an exacerbation with them lasts for several weeks, and then a period of remission begins. However, full recovery is difficult to achieve. Dieting and preventive treatment I only reduce the intensity of pain and the frequency of attacks.

Cramping pain in the lower abdomen on the right

Cramping pain in the right side of the abdomen is almost always caused by muscle tension, although it is rarely associated with an inflammatory process in the muscles. Painful spasms can occur, for example, with intestinal obstruction caused by a tumor or blockage of the lumen. In this case, peristaltic contractions of the intestine reach the obstruction, but do not spread further. Instead, there is an attack of severe pain in the form of contractions.

Sharp sharp pains in the abdomen on the right

Acute pain in the abdomen on the right side often occurs when internal organs rupture or blockage of blood vessels. It is in these cases ( in contrast to the gradually developing inflammatory process) there is a simultaneous irritation of a large area of ​​the peritoneum or the death of a large amount of tissue. Sudden acute pain, from which it can even take your breath away, is typical, for example, for perforation of a stomach ulcer, rupture of the gallbladder or appendix, thrombosis of the mesenteric arteries.

As noted above, no qualified doctor considers the nature of abdominal pain as a leading symptom. He will be guided mainly by the accompanying symptoms and complaints. Only by considering them in a complex can one establish the cause of certain pain sensations.

Diagnosis of the causes of pain in the right side of the abdomen

Diagnosis of pain in the right side of the abdomen is a very difficult process, since this symptom can be caused by many various reasons. At the same time, it is necessary to establish the reason for the appointment proper treatment. Preliminary diagnosis usually put by emergency doctors or a family doctor at the first contact with the patient. After that, depending on the results of this examination, the patient may be hospitalized in the department of surgery, gastroenterology, gynecology, therapy for further examination and diagnosis.

The most informative diagnostic methods for pain in the right side of the abdomen are:

• physical examination;
• radiography;
• ultrasound procedure ( ultrasound);
• diagnostic laparoscopy;
• diagnostic laparotomy;
• serological tests;
• microbiological research methods;
• electrocardiography ( ECG);
• diagnostic probing.

Physical examination

Physical examination involves a series of simple manipulations and a general examination of the patient in order to collect primary information about the disease. With pain in the abdomen, the most attention is usually paid to palpation of the abdomen. This is a probing of the organs and formations of the abdominal cavity through the anterior abdominal wall. The patient takes a supine position, slightly bends his knees, breathes deeply and relaxes the abdominal muscles. Palpation should start from the area that is the least painful, and end with the most painful area. Some diseases can be suspected with a high degree of probability already at this stage ( with the condition that the study was performed correctly).

On palpation of the abdomen, the following changes are possible:

• increased pain ( often talks about the inflammatory process);
• skin hypersensitivity - pain with a simple touch in certain places;
• board-like tension of the abdominal muscles - often indicates perforation of an ulcer, peritonitis and other serious surgical pathologies;
• pain when slowly pressing and abruptly tearing off the hand ( positive Shchetkin-Blumberg symptom) indicates local involvement of the peritoneum in the inflammatory process;
• liver enlargement - may indicate hepatitis of various origins;
• pain in the right iliac fossa - often occurs with appendicitis, adnexitis in women;
• local bloating - may indicate intestinal obstruction in this place;
• abnormally located seals - as a rule, they turn out to be tumors of various organs;
• a uniform increase in the abdomen with fluid accumulation - most often indicates pathological processes in the liver.

There are other pathological changes for which the doctor may suspect the diagnosis. In addition to palpation, it is important to listen to breathing and feel the pulse. Both respiration and pulse become more frequent during an acute inflammatory process. In addition, with severe pain, the patient's breathing is modified, he tries to increase the amplitude of inhalation with the chest, but the stomach is not involved in this process.

Other important indicators of general condition are temperature, blood pressure, listening ( auscultation) heart sounds. All this gives information about how various body systems work and often allows you to suspect the cause of pain.

Radiography

Radiography is the acquisition and subsequent examination of an x-ray image. Such an image is formed by X-rays that have passed through the area of ​​the body being studied and then hit the film. The radiation source of these rays is an X-ray tube located in front of the object under study. radiograph ( x-ray image) is formed due to the different density of tissues, since the structures of the human body have varying degrees absorption of rays. Those tissues that have more high density, will absorb radiation more strongly ( picture shows dark areas), and those with lower density are weaker ( light areas).

This study is desirable to carry out in two mutually perpendicular projections ( positions) - straight and lateral. This is done to prevent shadows from overlapping each other and thus to more effectively diagnose various pathologies.

Radiography is of the following types:

• Plain radiography. The first type is conventional radiography, which is based on the natural contrast of the tissues and structures of the human body, due to their different density.
• Contrast radiography. The second type is artificial contrast radiography. The essence of this method is the introduction of contrast agents into the cavities, organs or vessels of the body, which absorb radiation weaker ( oxygen, nitrous oxide, carbon dioxide) or, conversely, stronger ( compounds of iodine, barium) than the organ under study. After the introduction of a contrast agent into the body, an x-ray is taken and the result is analyzed. This allows you to better assess the contours of cavities, formations, the boundaries of organs, etc.
• Plain radiography. Plain radiography is a study of an entire organ or group of organs ( e.g. plain abdominal x-ray). The mutual position of organs, their relative sizes are estimated.
• Spot radiography. Targeted radiography is a study of a specific area or formation in any organ ( e.g., targeted x-ray of a liver cyst).

This method is completely safe for the patient, is inexpensive and does not take much time. As a rule, on modern computer devices, an image can be obtained within 10-15 minutes after the procedure. Contrast radiography is somewhat more difficult to perform ( it is required to introduce contrast, check if the patient is allergic to it). After this procedure, the patient is observed for some time, as adverse reactions may occur.

Magnetic resonance imaging ( MRI) represents diagnostic method study of tissues and organs, based on the phenomenon of nuclear magnetic resonance. The bottom line is that each tissue of the body contains a different concentration of hydrogen ions. Their movement in the electromagnetic field is captured by the device.

At the time of the study, a magnetic field is created in the MRI cabin, and electromagnetic radiation of a certain frequency acts on the tissues of the body, which causes the excitation of hydrogen atoms. Simultaneously with this MRI scanner of the cabin, the electromagnetic response of these excited atoms is recorded. The information received from the scanners to the computer is processed and then displayed in the form of images on the monitor screen. You can print them out and get an MRI scan.
MRI is one of the most accurate and safe methods modern diagnostics with pain in the abdomen on the right. However, its limited use in medicine is primarily due to high cost, as well as the fact that such a study cannot be carried out by those who have ferromagnetic implants ( pacemakers, knitting needles, etc.).

There are several types of magnetic resonance imaging:

• Conventional MRI. Conventional MRI is used in the diagnosis of numerous diseases. It is used both to detect volumetric formations ( cysts, tumors, abscesses, obstructions, hernias, stones), and to detect inflammatory, infectious, autoimmune and other pathologies.
• MR perfusion. MR perfusion is a type of MRI that allows you to assess the level of blood supply to organs. With pain in the abdomen on the right, it is most often used in the diagnosis of diseases of the vessels, liver and kidneys.
• MR spectroscopy. MR spectroscopy helps determine the biochemical concentrations of individual metabolites ( metabolic products) in the organ or tissue under study. A significant advantage of this type of research is the ability to detect pathology on its early stages.
• MR angiography. MR angiography is a method for diagnosing vascular pathology. Distinguish between MR angiography without contrast and with contrast. With abdominal pain in the right region, this type of study is mainly used in the diagnosis of abdominal aortic aneurysms, thrombosis and embolism of mesenteric vessels.

CT scan

CT scan ( CT) is a method of transverse, layered x-ray examination. As with radiography, the source of radiation is a ray tube ( x-ray). The radiation receiver in this study is a special ionization chamber. After entering the X-ray receiver, they are transformed into electrical impulses, which are then transmitted to a computer for processing. During CT, the radiation source and receiver move synchronously in the same direction, around the longitudinal axis of the patient's body, which makes it possible to take the required number of images in any area of ​​interest to the doctor.

Although computed tomography compared to x-ray examination relatively expensive, it is a valuable diagnostic method for examining pain in the abdomen on the right. Being highly informative, CT helps to detect and assess the severity of the disease, the presence of complications, comorbidities, the presence or absence of any changes in tissues and organs.

Colonoscopy

Colonoscopy is a diagnostic method that allows you to assess the condition of the mucous membrane of the large intestine. This procedure is performed by an endoscopist using a medical endoscopic probe. It is a tube with a built-in video camera, which transmits information about the state of the mucosa to the monitor screen. Colonoscopy is a quick and indispensable diagnostic procedure for diseases such as cancer, polyps, ulcers, inflammation of the large intestine, ulcerative colitis, etc. With colonoscopy, you can not only visualize the condition of the intestinal mucosa, but also select material for research ( take a biopsy).

This procedure is harmless, but during its implementation the patient may experience discomfort. To reduce it, before a colonoscopy, the patient is prescribed antispasmodics, which relax the intestinal wall. Then an anesthetic injection is given to make the procedure less painful. And only after that they begin a colonoscopy. On average, the procedure itself lasts from 10 to 15 minutes, depending on the purpose of the study. The results of the study are provided to the patient immediately after the end of the colonoscopy ( if tissues were not taken for microscopic analysis).

On the eve of the procedure, the patient is forbidden to eat ( 12 hours before the procedure). If the procedure is performed in the morning, then a perfusion enema is done in the evening to completely cleanse the intestines. This is necessary for better visualization of the intestinal walls on the screen during the procedure.

Ultrasound procedure

Ultrasound is a diagnostic method based on the receipt and analysis of ultrasonic waves reflected from body tissues. The principle of this study is that different tissues and environments in the human body have different acoustic impedance ( prevent the passage of ultrasound). Tissues with greater resistance reflect ultrasound more strongly ( light and bright images) than those with lower values. The stronger the reflection, the more waves hit the recorder ( sensor) and the lighter and brighter the fabrics and structures look ( on the monitor screen) reflecting the irradiated area.

There are the following types of ultrasound:

• Extracorporeal Scan. Extracorporeal scanning is the most common type of ultrasound, which consists in scanning internal organs and tissues from the surface of the human body. The advantages of the method are its high availability, low cost, lack of contraindications, easy and informative.
• Intracorporeal Scan. The essence of the method of intracorporeal ultrasound is the introduction of special ultrasound sensors into the body cavity. They are entered through natural holes (through the urethra, vagina, anus or oral opening), and through artificial ( through traumatic and surgical openings). A significant advantage of this method is the possibility of maximum approximation of the sensor itself to the organ ( which improves image clarity) to be investigated. The downside is invasiveness injury) and special indications by which it can be carried out.
• dopplerography. One of the varieties of extracorporeal ultrasound is dopplerography. It is based on the Doppler effect. The principle of this effect is based on the change in the reflection of ultrasonic waves depending on the speed of objects in the medium under study. In medicine, dopplerography has found its application in the diagnosis of lesions of the cardiovascular system.
• echo contrast. This method is based on the introduction of gas microbubbles into the vascular bed ( contrast agent) and assessment of vascular patency and tissue perfusion.

The ultrasound method allows to evaluate the size, shape, position of internal organs, their contours, as well as the structure of parenchymal and hollow organs ( characteristics of walls and shells). In addition to determining physiological characteristics, this study can determine the presence and localization various diseases, which are the cause of pain in the abdomen on the right.

With the help of ultrasound, the following types of pathological changes can be detected:

• Enlargement of the organ in size. An increase in the organ can be observed with cholecystitis, pancreatitis, hepatitis, appendicitis, chronic prostatitis, intestinal obstruction, hydronephrosis, etc.
• Reducing the body in size. A decrease in the organ is ascertained in diseases such as cirrhosis of the liver, renal amyloidosis, chronic poisoning various heavy metals, etc.
• Volumetric formations. Of the main volumetric formations, cysts filled with serous fluid and tumors can be distinguished. On ultrasound, cysts look like a circle or an oval. Their edges are smooth, with clear contours. Inside the edges is black ( anechoic) a zone that is a reflection of the serous fluid inside the cyst. Ultrasound structure of neoplasms is diverse. Allocate anechoic ( bleeding) black, low echogenic ( necrosis) dark gray, echo-positive ( tumor tissue ) light gray and hyperechoic ( calcification) light zones.
• cavity formations . Cavernous formations, such as abscesses or tuberculous cavities, unlike cysts, have uneven edges and a heterogeneous ( heterogeneous) internal structure.
• Inflammatory formations. For inflammatory formations characterized by irregular edges, varied shape and moderate hypoechogenicity of the affected area. This, for example, can be observed in various inflammatory and infectious diseases of the abdominal cavity.
• Obstruction of the blood vessels. Doppler ultrasonography or echo contrast is often used to diagnose clogged blood vessels. These methods allow you to quickly determine the presence and localization of blood flow disorders.
• stones. With the help of ultrasound, diseases such as cholelithiasis and nephrolithiasis can be easily diagnosed. In the pictures, the stones look like rounded, hyperechoic formations with clear edges.
• Pathological accumulation of fluid. Ultrasound can detect abnormal accumulation of fluid ( exudate) in the abdominal cavity. Exudate ( anechoic zone) is one of the signs of inflammation and is observed in peritonitis, trauma, infectious lesions of the intestine, etc.

Diagnostic laparoscopy and laparotomy

Laparoscopy and laparotomy as diagnostic methods are used very rarely. They are used only in cases where other methods are not sufficiently informative, and the doctor wants to get more information. reliable information about the disease.

Laparotomy is a surgical incision in the tissues of the abdominal wall to access various organs of the abdominal cavity. During laparoscopy, a laparoscope is inserted into the abdominal cavity through a small hole. It allows visual via monitor screen) examine the external structure of the abdominal organs.

The advantages of laparoscopy, in contrast to laparotomy, are speed, low tissue trauma, and the absence of postoperative rough and painful scars. After laparoscopy, patients usually recover very quickly, which reduces their length of stay in the hospital. Significant disadvantages of both methods are their invasiveness ( injury) and the impossibility of estimating internal structure organ tissues.

The main possible complications during laparoscopy and laparotomy can be internal bleeding or peritonitis ( upon infection). The causes of complications are often accidental mechanical damage blood vessels and intestines that have arisen during diagnostic procedures.

General blood analysis

General analysis blood is the most common laboratory method of research. It provides important information about the state, first of all, of the cellular composition of the blood, as well as the level of other specific indicators. The appearance of changes in the blood is often associated with pain in the right area, so the appointment of this study is an important diagnostic step.

Blood for this analysis can be taken both from a finger and from a vein ( more often taken from the finger). It is not necessary to take blood on an empty stomach, but fatty foods or a generally heavy meal can skew the result somewhat.

Blood chemistry

A biochemical blood test is a type of laboratory test that helps analyze the concentration of certain metabolic products and enzymes in the blood serum. Based on the results of this study, the doctor can draw a conclusion about the condition and work of many organs. A biochemical blood test is a very fast, economical and informative method study of the function of internal organs, which is widely used in the diagnosis of various diseases.

When studying the results biochemical analysis blood can detect various changes in biochemical parameters. Basically, these changes are associated with their increase.

Changes in the main biochemical parameters and possible causes

Analysis of urine

Urinalysis is a standard diagnostic element complex diagnostics diseases of the genitourinary, cardiovascular, digestive and other systems. In diseases that cause pain in the abdomen on the right, changes in its normal parameters can often be detected in the analysis of urine, some of which are presented in the table below.

Typical changes in the analysis of urine and examples of pathologies

Usually, the first portion of morning urine is needed for analysis, since a person does not drink water during the night. During this time, a significant volume of blood is filtered in the kidneys, and the concentration of various substances will most objectively reflect the processes in the body.

Fecal analysis

Color also plays a significant role. stool. Lighter colors ( and sometimes even a chair almost white color ) talk about problems with the release of bile into the intestinal lumen. If there is pain in the right hypochondrium, this speaks in favor of cholecystitis, cholelithiasis, cholangitis, or other problems with the gallbladder. Almost black liquid stool (melena) is a consequence of bleeding in the upper sections gastrointestinal tract (stomach, duodenum). As it passes through the intestines, the blood is partially digested and becomes almost black.

Serological tests

Serological tests are called special reactions that allow you to detect various antigens or antibodies in the patient's blood. This research method is widely used for suspected various intestinal infections or autoimmune diseases. In the first case, they look for antigens ( alien fragments) bacteria or antibodies produced by the immune system. At autoimmune pathologies specific autoantibodies to the body's own cells can be detected.

This analysis is used only in the presence of relevant symptoms. It requires a routine blood donation, and the result can be ready in a few hours or days ( depending on the method used). Serological tests can confirm the presence of an infectious disease and make a definitive diagnosis.

This method can detect the following reasons abdominal pain:

• dysentery ( shigellosis);
• escherichiosis;
• other infections.

Microbiological research methods

Microbiological methods are used to detect pathogens of infectious diseases that could cause pain in the right side of the abdomen. Any biological material in which, in the opinion of the attending physician, there are microbes that caused the disease, can be subjected to research. In the case of abdominal pain, these are most often stool samples, but for some diseases, urine, blood, vomit, etc. are also taken.

One of the possible causes of pain in the right side of the abdomen may be myocardial infarction. Electrocardiography allows you to evaluate the bioelectrical activity of the heart muscle. This is the simplest, fastest and safe way to exclude a heart attack as a possible cause of pain. As a rule, this study is recommended for most patients in whom abdominal pain is not associated with other symptoms ( no bloating, palpation of the abdomen does not increase pain, no problems with digestion).

Removing an ECG takes no more than 15 - 20 minutes. In the same time, experienced doctor according to its results, it can make a conclusion about the work of the heart with high accuracy. Thus, this method allows us to exclude cardiology as the cause of abdominal pain and gives Additional information which may be needed for further treatment.

Fibroesophagogastroduodenoscopy

This diagnostic method belongs to the instrumental. The essence of the method is the introduction through the mouth opening of a special apparatus - an endoscope. At the end of the flexible wire is a small camera that transmits the image to the monitor. The patient should not eat before the procedure at least 12 hours before). To weaken vomiting reflex antiemetics and sedatives are also prescribed.

FEGDS allows the doctor to examine the upper gastrointestinal tract ( gastrointestinal tract). With it, you can confirm the presence of stomach ulcers, gastritis, cancerous tumors. If necessary, a biopsy of suspicious formations is taken right during the procedure ( a piece of tissue is taken for analysis). It is also possible to stop small bleeding. With the help of this procedure, it is possible to exclude or confirm a number of pathologies of the stomach and duodenum, which can cause pain in the right upper abdomen.

Diagnostic probing

The purpose of diagnostic probing is to obtain bile directly from the gallbladder. To do this, a special probe on a flexible tube is inserted through the esophagus and stomach into the duodenum. When it reaches the exit of the common bile duct, the probe is fixed. After that, the patient lies on his right side and puts a warm heating pad under the ribs. Under the influence of heat, the muscles of the gallbladder relax, and bile begins to flow through the tube. Sometimes, to accelerate the outflow of bile, you have to resort to a stimulating massage.

Before the procedure in 10 - 12 hours) the patient should not eat anything, as this may increase the gag reflex when swallowing the probe. In advance, they also drink a certain amount of sorbitol solution or special mineral waters that stimulate the relaxation of the gallbladder. To obtain a good sample of bile, the patient lies on a heating pad for 1 to 2 hours, after which the probe is removed.

Using this method, you can collect information about pathological processes in the liver and gallbladder. If an infection is suspected, the obtained bile can also be examined using microbiological methods.

What to do with pain in the right side of the abdomen?

One of the most serious conditions in medicine is considered an acute abdomen. It is characterized by severe pain in any part of the abdominal cavity and is most often caused by an active inflammatory process. Diseases with symptoms of an acute abdomen are an urgent indication for hospitalization in the profile ( most often surgical) department of the nearest hospital. The prognosis is most favorable when surgery is performed within the first few hours of symptom onset. With a later visit to the doctor, develop serious complications, which worsen the evolution of the pathological process and lengthen recovery period after providing qualified medical care.

With severe pain in the abdomen, it is unacceptable to self-medicate and self-diagnose, refuse hospitalization or use various manipulations at home to reduce symptoms. It is also inappropriate at the prehospital stage to waste time trying to establish the exact cause that caused the symptoms. There are too many of these causes, and some of them require immediate treatment. The final diagnosis will be made in the hospital. Sometimes it is found out only during the operation, which is performed if the pain does not go away, and their cause is not clear.

For severe abdominal pain, there are the following recommendations:

• call an ambulance;
• take maximum comfortable position in bed, in which the pain is relieved;
• apply cold to the stomach - this slows down blood circulation and inhibits inflammation in the abdominal cavity;
• regular monitoring of blood pressure;
• upon arrival of doctors, it is desirable to transport the patient in a supine position on a stretcher;
• special measures for transportation are usually not required, but with the development of acute arterial hypotension (a sharp drop in blood pressure) may require transfusion of colloidal solutions ( reopoliglyukin, plasma).
• before hospitalization, it is advisable to limit drinking and not consume any food until a doctor's examination and an accurate diagnosis.

There are also several important prohibitions that must be remembered when providing first aid. In an acute abdomen, drugs from the NSAID group should not be used to reduce pain ( non-steroidal anti-inflammatory drugs) and painkillers ( Nimesulide, Ibuprofen, Ketoprofen, Tramadol, etc.) before examination by a specialist. Data medicines reduce pain, but do not eliminate the cause of the disease. The symptoms of the disease become erased, and in such conditions it is more difficult for the doctor to make a timely correct diagnosis. This, in turn, may worsen the prognosis during pathology due to delays in providing qualified medical care. It is also undesirable to use various warming procedures, take hot baths, apply a heating pad to the affected area of ​​\u200b\u200bthe abdomen. This can lead to a more rapid deterioration in the general condition, accelerate the progression of inflammatory processes ( vessels dilate, swelling increases, and the infection is activated).

Also, do not drink alcohol. Alcoholic drinks are depressing nervous system, have an analgesic effect, which, as with the use of analgesics ( painkillers), reduces symptoms and makes it difficult for the surgeon to make a quick diagnosis. For the same reasons, it is necessary to refrain from the use of sleeping pills, antipsychotics and other drugs that depress the nervous system.

It is extremely dangerous to stimulate intestinal motility with various laxatives. medicines and apply cleansing enemas. Stretching of the intestines and tension of its walls often cause increased pain. For example, with perforation of the intestine, its contents will begin to fall into large quantities into the abdominal cavity and generalized peritonitis will develop. The patient's condition will seriously deteriorate in a matter of minutes. For the same reason, one should not force vomiting or gastric lavage.

If the pain in the abdomen is moderate or appears periodically, then this condition is not regarded as an acute abdomen. However, it is still advisable to consult a doctor and try to follow the rules prescribed above. After the diagnosis is made, or if the patient already knows the diagnosis ( exacerbation of a known pathology) take special measures to combat pain. In the case of each pathology, they are different, therefore there are no uniform treatment standards for all abdominal pain.

For everybody individual disease specific measures are needed to eliminate abdominal pain and complete treatment:

• acute cholecystitis;
• acute appendicitis;
• stenosis of the pylorus of the stomach;
• intestinal infections;
• irritable bowel syndrome.

Acute cholecystitis

At acute cholecystitis treatment is strictly surgical. Once diagnosed, pain is usually relieved with antispasmodics that relax smooth muscle gallbladder. Then the patient is operated on, most often removing the gallbladder. This operation called a cholecystectomy.

Cholecystectomy can be performed in two ways:

• Laparotomy. This method is considered traditional, but outdated. The abdominal wall is dissected, followed by removal of the gallbladder. At the same time, the patient has long healing sutures, there is a risk of postoperative complications.
• Laparoscopy. With laparoscopy, only a few small holes are made in the anterior abdominal wall. Through them, with the help of special equipment, the gallbladder is removed. Bleeding is avoided by cauterization of tissues. Rehabilitation after such an operation is much faster, and the risk of complications is lower.

Acute appendicitis

At acute appendicitis urgent removal of the inflamed appendix is ​​also recommended - appendectomy. It is almost always done with a dissection of the anterior abdominal wall. This is necessary because during the operation it may turn out that the appendix is ​​in an atypical position. Then the incision will have to be enlarged. Appendectomy is considered a routine operation and the mortality rate is very low. Pain disappears within 1-2 weeks after surgery.

If the operation is refused, there is a risk of developing peritonitis. Then the prognosis is much worse. It is also possible to form an appendicular plastron, in which the appendix "sticks together" with neighboring organs, forming a large inflammatory focus. Then the risk of complications during the operation increases.

Stenosis of the pylorus of the stomach

The cardinal method of treatment for stenosis of the pylorus of the stomach is surgical intervention. It consists in expanding this hole so that food can freely pass into the duodenum. Sometimes this can be achieved using a special probe, which is passed into the stomach through the mouth. Air is pumped into the pear at the end of the probe, it increases in diameter and expands the narrowed area.

However surgery in this case is not the only way out. This is not the case with stenosis. high risk complications, as in inflammatory diseases of the abdominal cavity. Patients may be given antispasmodic drugs and a special diet. The principle of the diet is liquid and semi-liquid food ( soups, cereals, etc.). It passes through the stomach easier and faster, without lingering in the area of ​​the narrowed pylorus. In this case, you should regularly see a doctor in order to detect if something happens. possible changes in the patient's condition. If the patient loses weight, this indicates a lack of effectiveness of conservative treatment and surgery is recommended.

Intestinal infections

With intestinal infections, it is recommended to follow a diet. You can not eat meat, fatty or salty foods, alcohol, raw vegetables and fruits. All this will strengthen the contractions of the intestine, while its walls are already weakened due to infection. Nutrients will not be absorbed, and the pain will intensify.

Most intestinal infections go away on their own after 2 to 3 weeks, when the body produces antibodies to pathogens. To speed up treatment and prevent severe forms of disease, antibiotic therapy is most often prescribed. The choice of antibiotic depends entirely on the type of infection. Properly selected drug will reduce pain and other symptoms after 5 to 7 days.

Products that can provoke these diseases are:

• alcohol;
• smoked meats;
• pickles;
• excessively fatty or spicy foods;
• mushrooms;
• pickled foods.

Also a possible cause of abdominal pain in children are allergic reactions. They, contrary to popular belief, are not limited to skin manifestations. For example, in response to feeding honey, nuts, citrus baby can give diarrhea, abdominal pain.

At the same time, such inflammatory diseases of the abdominal cavity as gastritis, appendicitis, cholecystitis are less typical for children. These pathologies develop as a result wrong image life and nutrition, and therefore require a longer exposure to provoking factors. Also rare in children is, for example, thrombosis of the mesenteric arteries. At the same time, an aneurysm of the abdominal aorta ( if it is congenital) may well give periodic pain.

Thus, the range of possible causes of pain in the right side of the abdomen in children is quite wide. Examination of such patients presents certain difficulties. Young children cannot indicate the nature of the pain, and sometimes they simply cannot say what hurts them. Then you have to navigate by the behavior of the baby, the accompanying symptoms. With unusual behavior, constant crying in combination with diarrhea, vomiting or flatulence, abdominal pain should also be suspected. Only timely appeal to a specialist to help you install true reason diseases.

Why does it hurt in the right lower abdomen during pregnancy?

Abdominal pain during pregnancy is a fairly common occurrence faced by the vast majority of women. Most often they are caused physiological reasons and do not indicate the development of any serious disease. Moderate periodic pain and discomfort can be caused by overeating, fetal growth, baby movements ( at a later date), squeezing some organs or their displacement. However, any regular pain, and especially acute, should be taken seriously. Many dangerous diseases debut or worsen during pregnancy. In this case, they can endanger the health of both the mother and the fetus.


The frequent exacerbation of certain pathologies in pregnant women is explained by the following changes in the body:

• Hormonal changes. From the moment of conception endocrine glands expectant mothers begin to work differently. The process of attachment of the fetus in the uterus is accompanied by an increase in the production of a number of hormones that prepare the body for the period of pregnancy. This can trigger some autoimmune and genetic diseases that have not been shown before.
• Displacement of the abdominal organs. The growing fetus displaces some of the moving organs. For example, the cecum, along with the appendix, in late pregnancy rises from the right iliac fossa to the level of the navel, and sometimes even higher. Compression of intestinal loops, vessels or nerves can provoke an inflammatory process.
• Presence of a growing fetus. Often, pain is directly related to the growing fetus and is the result of pregnancy complications.
• Changing food preferences. Pregnant women often change their diet. Some try to switch to healthier foods, while others simply begin to like new, sometimes exotic dishes. However, the authorities digestive system, accustomed to a certain diet, do not always accept such changes. Intestinal dysbacteriosis, exacerbation of some of its diseases may develop.
• Weakened immunity. During pregnancy the immune system normally works worse than usual. This increases the risk of infectious diseases. Often there are intestinal infections caused by opportunistic microbes that are normally present in the intestines, but do not cause disease.

Together, all these changes create fertile ground for the development of various diseases. Basically, all the reasons causing pain in the abdomen in ordinary people, can also occur in pregnant women. However, some of them, due to the mechanism of development, occur more often during pregnancy.

Most common causes pain in the right side of the abdomen during pregnancy are the following pathologies:

• Inflammatory diseases of the abdominal cavity. Diseases such as appendicitis, cholecystitis, colitis are more common during pregnancy due to mechanical compression of the organs by the enlarging uterus. In the appendix, for example, its lumen can be squeezed, in the intestine, the patency of its contents can worsen. However, without chronic problems with these organs or infection, inflammation will not develop.
• Circulatory disorders. There are cases when the growing fetus displaced the abdominal organs in such a way that some vessels were pinched. In these cases, acute oxygen starvation of certain tissues occurs. For example, torsion of intestinal loops leads to compression of the mesenteric arteries. It is also possible to twist the ovary or other organs with relatively high mobility.
• Autoimmune processes. Some diseases associated with increased activity of the immune system can also worsen during pregnancy. Abdominal pain can cause Crohn's disease, ulcerative colitis.
• Complications of pregnancy. Such dangerous complications as fetal hypoxia, placental abruption or intrauterine death can cause acute pain. Also, acute pain in the right lower abdomen may be associated with an ectopic pregnancy, when a fertilized egg is attached not in the body of the uterus, but in > fallopian tube. Then, in the process of fetal growth, the tube stretches and may break.
• Endocrine diseases. Hormonal changes can be cascading, as many endocrine glands affect each other's work. Therefore, increased secretion of hormones necessary for the normal course of pregnancy sometimes causes thyrotoxicosis ( high levels of thyroid hormones in the blood), exacerbation of diabetes mellitus ( up to diabetic coma). In these cases, intermittent abdominal pain may occur. different localization.
• Genetic diseases. Some genetic diseases may not show up for a long time. Their development is often triggered various types stress ( one of which is pregnancy.). A typical example of such a disease is porphyria, in which increased secretion of the porphyrin protein causes periodic severe abdominal pain. Proved that this pathology largely predetermined congenital factors, but it often manifests itself during pregnancy.

In general, there can be many reasons for abdominal pain during pregnancy. The appearance of this symptom should be notified to the doctor leading the pregnancy.