Pain in the stomach on palpation. Methods for diagnosing diseases of the stomach. With this type of palpation, the doctor also examines

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 the pain appears when you press on the lower abdomen on the right, 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 has 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 a 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. Also, pain can be associated with benign or malignant neoplasms of the 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 increased 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 is 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 will be able to cope conservative methods, without surgery.

Intermittent abdominal pain on the right

Recurrent abdominal pain that appears over several months or years may 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 in 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 often appears with ruptures internal organs 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 as a whole, it is possible to establish the cause of certain pain.

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 different reasons. At the same time, it is necessary to establish the cause in order to prescribe the correct treatment. A preliminary diagnosis is usually made by emergency doctors or 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. For pain in the abdomen most attention usually given to palpation of the abdomen. This is a probing of organs and formations 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 inspiration. 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. This image is formed by x-rays passed through the studied area of ​​the body and then caught on 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, do X-ray and analyze the result. 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) is a diagnostic method for studying 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 apparatus.

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 its high cost, as well as the fact that such a study cannot be performed 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, concomitant pathology, 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 carried out 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. Principle this study lies in the fact 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 introduced through natural openings ( 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 for 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 cardio-vascular 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 noted in diseases such as cirrhosis of the liver, renal amyloidosis, chronic poisoning with 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 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 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 assessing the internal structure of 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 to blood vessels and intestines that occurred during diagnostic procedures.

General blood analysis

Complete blood count is the most common laboratory method research. He gives 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 of a biochemical blood test, you can find various changes 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, in the analysis of urine it is often possible to detect changes in its normal indicators, 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 amount of blood is filtered in the kidneys, and the concentration 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 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. In 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 causes of abdominal pain:

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

Microbiological research methods

Microbiological methods are used to detect pathogens infectious diseases, which could cause pain in the right side of the abdomen. Any research can be biological material, in which, according to the attending physician, there are microbes that caused the disease. 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 easiest, fastest and safest way to rule out 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. At the same time, an experienced doctor, based on its results, 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 upper divisions GIT ( 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 resulting bile can also be examined with microbiological methods.

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

One of the most serious conditions in medicine is considered 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 acute abdomen are urgent indication to hospitalization in profile ( most often surgical) department of the nearest hospital. The prognosis is best when surgical intervention carried out in the first few hours from the onset of symptoms. With a later visit to the doctor, serious complications develop that worsen the evolution of the pathological process and lengthen the recovery period after the provision of a 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. Also inappropriate for prehospital stage waste time trying to determine the exact cause of the symptoms. There are too many of these reasons, 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 to lying position on a stretcher;
• special measures for transportation are usually not required, but with the development of acute arterial hypotension ( a sharp decline 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. These drugs reduce pain, but do not eliminate the cause of the disease. The symptoms of the disease become blurred, 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 depress the action of the 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 medications depressing 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) accept special measures to fight pain. In the case of each pathology, they are different, and therefore there are no uniform treatment standards for all abdominal pain.

For each 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

In 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 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 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

In 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, surgical treatment in this case is not the only way out. With stenosis, there is no such high risk of complications as with inflammatory diseases of the abdominal cavity. Patients may be given antispasmodic drugs and 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 possible changes in the patient's condition if something happens. If the patient loses weight, this indicates a lack of effectiveness 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 increase the contractions of the intestines, while its walls are already weakened due to infection. Nutrients will not be absorbed, and the pain will increase.

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 fruits, a child may 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 more prolonged exposure 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 will help to establish the true cause of the disease.

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 by physiological causes and do not indicate the development of any serious disease. Moderate periodic pain and discomfort can be caused by overeating, fetal growth, baby movements ( on the later dates ), 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. It 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, rises from the right iliac fossa to the level of the navel, and sometimes even higher, in late pregnancy. 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 organs of the 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.

The most common causes of 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 immunity, can also be exacerbated 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 the fallopian tube. Then, in the process of fetal growth, the tube stretches and may break.
• Endocrine diseases. Hormonal changes can be cascading, as many glands internal secretion 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 diabetes (up to diabetic coma). In these cases, periodic abdominal pain of various localization may appear.
• Genetic diseases. Some genetic diseases may not show up for a long time. Their development is often triggered by various types of 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.

Quite often, before referring the patient to a hardware examination, the doctor performs palpation - a diagnostic method, with correct execution which can accurately determine the state of the organs of the peritoneum.

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 a 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 the abdominal cavity itself, the doctor simultaneously examines the condition of the patient's skin, its 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.

The human peritoneum contains 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 site for study is located 4-5 cm higher, and then the palpating hand passes into the epigastric region and into the region of the ilium with 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 in 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.

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 asked to take a 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.

During palpation, the doctor should not plunge his fingers very deep into the painful abdomen, while not making circular movements. Feeling should be soft.

Circular movements are only allowed 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 are reached pain point, the patient will report it. Pain can be identified by the facial expression of the patient and by tense abdominal muscles.

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

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

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

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

What is the purpose of deep palpation?

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

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

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

• determination of the exact location of internal organs;
• examination of internal organs, determination of their exact dimensions, 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 a study sigmoid colon and a 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.

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« Acute abdomen"- a threatening condition in which significant damage to the abdominal organs occurs and requires immediate surgical care. This condition can be in many diseases, but the signs characteristic of an "acute abdomen" will be common. These are the following symptoms:
Intolerable sudden onset pain in the abdomen, causing groaning
Increased pain with the slightest movement and coughing
Can't find a position to relieve suffering
Signs of intestinal obstruction: no stool, bloating
Protective tension of the abdominal muscles
Severe general condition with tachycardia, cold sweat, weakness, pallor, drop in blood pressure.

"Acute abdomen" may occur as a single symptom for the first time without a previous disease. This, for example, is a rupture of the spleen with an abdominal injury or acute appendicitis, which will immediately require surgical care.
But very often "acute abdomen" occurs as a complication already an existing disease. For example, perforation of a long-term gastric ulcer or rupture of an ovarian cyst, renal colic with urolithiasis, which is not eliminated by taking antispasmodics.
Therefore, timely adequate treatment chronic diseases is the prevention of their exacerbation and severe consequences.

Diseases that can give a picture of "acute abdomen"
Acute intestinal obstruction
Acute appendicitis
Acute pancreatitis
Hepatic and renal colic
Perforated ulcer of the stomach or duodenum
Peritonitis
Ruptured abdominal aortic aneurysm
Thrombosis, embolism and spasm of mesenteric (mesenteric) vessels
ovarian cyst torsion, ovarian rupture
Aborted ectopic pregnancy with ruptured fallopian tube
Tumors
Heart attack or rupture of the spleen
Liver rupture
Strangulated hernia, etc.
In any of these conditions, you can not hesitate to call an ambulance for a minute.
We present short description the main symptoms of these diseases.

Acute intestinal obstruction
Causes leading to intestinal obstruction: spasm of the intestine or its paresis (disappearance of peristalsis), tumor, strangulated hernia, adhesions, fecal stones, thrombosis and embolism of the mesenteric vessels, foreign bodies, peritonitis, helminthic and hair balls, overeating after hunger. Moreover, adhesive disease accounts for up to 70% of all cases of obstruction.
Cramping unbearable pain all over the abdomen occurs suddenly, and its intensity increases, the patient groans from pain.
It is during this first period that it is urgent to call an ambulance. Before her arrival, you can give the sick antispasmodic (no-shpu, baralgin, papaverine), laxatives are categorically contraindicated.
Then (without the provision of medical assistance), against the background of some decrease in pain, repeated vomiting occurs, first with the remains of food with bile, and subsequently acquires a fecal character, severe dryness in the mouth, thirsty.
There is no stool and gases do not go away, the abdomen is swollen and asymmetrical, intestinal peristalsis can sometimes be seen by eye.
With some types of obstruction from the rectum, mucus with blood may be released.
The patient is very restless, tossing about in bed.
Pallor of the skin, tachycardia, decreased pressure, shock are characteristic.
Before the development of peritonitis, the abdomen is soft, painful in the area where the obstruction to feces is located.

Acute appendicitis
This disease is more common than all other acute conditions of the abdomen, but its danger cannot be underestimated.
Characterized by a sudden onset with pain in the epigastric or umbilical region. Gradually, the pain intensifies and goes to the right lower abdomen. Often gives to the rectum, lying on the left side and increases during walking (especially when right leg appears at the back).
There is an increase in temperature up to 37.2-38 ° C, nausea or vomiting, tachycardia, dry mouth.
When probing the right lower abdomen, the pain intensifies, especially during the withdrawal of hands (positive symptom of Shchetkin-Blumberg), the muscles in this area are tense.
In old age, signs of appendicitis can be smoothed out, because. sensitivity decreases with age nerve endings, and the process is slow.

Acute pancreatitis
In acute pancreatitis, massive destruction of pancreatic tissue occurs. This is an extremely dangerous disease that requires immediate medical attention. If this help is not provided to the sick person, he may die after a few hours or days from the onset of the disease.
The pain first occurs in the right or left upper abdomen or under the "spoon", then becomes girdle. May spread throughout the abdomen.
The pain is severe, unbearable, as in myocardial infarction or perforated ulcer.
Often the onset of pain is preceded by the use of a large amount of strong alcoholic beverages or fatty foods.
Repeated vomiting is typical, which does not bring relief and bloating.
The general condition is severe, inhibited, the skin is cold and wet, the pressure is reduced, tachycardia, shock is possible in severe pancreatitis.
The stool becomes light or gray, its amount increases significantly.
The tongue is dry and inflamed, the inflammation may cover the whole mouth.
The skin is pale, icteric or cyanotic. May appear small hemorrhages around the navel and on the buttocks.

biliary or hepatic colic (Acute cholecystitis)
It usually occurs in the evening or at night in patients with cholelithiasis or a tumor, when a stone or tumor blocks the outflow of bile from the gallbladder, i.e. there is an infringement of the stone in the bile ducts.
Characterized by a sharp, sharp, cramping pain in the right hypochondrium or right side, radiates to the back, under right shoulder blade, in the shoulder or neck.
The temperature can rise to 37.5-38.5 ° C and be accompanied by chills, nausea, vomiting, a feeling of bitterness in the mouth, tachycardia. Occasionally - jaundice and itching of the skin.
Patients often groan and rush about to find a position in which the pain would decrease, but they cannot find it.
The occurrence of an attack is preceded by the use of fatty or fried foods, alcohol, cold drinks, as well as overeating, physical activity, shaking driving, stress.
When probing, there is tension in the muscles of that part of the abdominal wall where the projection of the gallbladder is located. Shchetkin-Blumberg's symptom is positive (maximum pain during taking hands off the stomach).
An attack of biliary colic can be a single one, when the removal of the gallbladder is immediately required, or it can last up to 5-6 hours and pass after the use of antispasmodics.

nephrolithiasis (renal colic)
This condition develops when stones (and sometimes a tumor) block the outflow of urine from the kidneys.
The pain is unilateral in the side or lower back, unbearable, cutting, cramping with irradiation to the lower abdomen, thigh and inguinal region.
Often joins bloating, nausea and vomiting, constipation, urination becomes more frequent. There may be an increase in temperature.
The skin is pale, cold, moist.
Behavior during such an attack of colic is restless, it is impossible to find a comfortable position, so the patient rushes about in bed.

Perforation of a stomach or duodenal ulcer
Occurs against the background of an existing peptic ulcer or may be its first sign. The duodenum is more often affected (85%).
The maximum perforation occurs in autumn or spring.
Before the perforation of the ulcer, there are often precursors - increased pain, chills, subfebrile temperature, nausea.
Sudden severe dagger pain in the region of the stomach or in the right hypochondrium, which then spreads to the right lower abdomen, and later throughout the abdomen.
The pain radiates to the right shoulder, collarbone or right shoulder blade.
There may be vomiting with an admixture of blood.
Skin pale or ash gray, moist, cold sweat.
The abdomen does not participate in breathing, it is very tense.
The patient occupies a forced immobile position lying on the right side with legs bent and brought to the stomach.
After the first attack, the dagger pain may subside for 3-6 hours, the condition improves, but then everything returns again, because. peritonitis occurs; vomiting appears, sometimes with blood, the temperature rises, the pulse quickens, the pressure drops. Waiting for a period of improvement after the first symptoms of perforation is a direct threat to life.

Peritonitis (inflammation of the peritoneum)
Peritonitis, as a rule, is the result of a complication of other diseases of the abdominal organs (appendicitis, acute cholecystitis, ruptured abdominal aortic aneurysm, perforated stomach ulcer, acute pancreatitis). The main signs of peritonitis underlie the concept of "acute abdomen".
The strongest unbearable pain in the abdomen, which increases with movement, coughing and even breathing with tension in the muscles of the anterior abdominal wall.
The pain first occurs at the location of the organ where the disaster occurred, and then spreads to the entire abdomen.
At various diseases pain can radiate to different places:
- In diseases of the liver and gallbladder - in the right shoulder.
- In case of damage to the spleen - in left shoulder.
- In diseases of the pancreas - in the back.
- In diseases of the kidneys and urinary tract - in the lower abdomen.
Heat.
Severe bloating, signs of intestinal obstruction.
Vomiting, blood in stool,
Severe general condition: pallor, cold sweat, tachycardia, there may be shock.

Dissecting aneurysm of the abdominal aorta with its rupture
tear of the inner layer of the aorta with blood flowing between the layers of the walls of the aorta and subsequent dissection.
Sudden, tearing, stretching or burning pain in the navel.
The pain is very intense from the very beginning and continues continuously, spreading along the course of the dissection, often radiating to the lower back.
Slight tension in the muscles of the anterior abdominal wall, but there are no symptoms of peritoneal irritation.
More often develops in the morning.
Mostly men after 55 years of age with a hereditary predisposition are ill.
Develops against the background of severe atherosclerosis, hypertension, rheumatism or syphilis. The risk also increases during pregnancy.
If, during dissection, all 3 layers of the aortic wall break through, then internal bleeding occurs with rapid blood loss, which is later joined by symptoms of peritoneal irritation, i.e. "acute abdomen"
Great tension in the muscles of the abdominal wall, with inability to move or touch the abdomen.
Dizziness, pallor, cold sweat, pressure drop with collapse, tachycardia, loss of consciousness.
There may be vomiting.

Thrombosis, embolism, spasm of mesenteric (mesenteric) vessels
The mesenteric vessels supply the intestines with blood.
These three conditions have a similar clinical picture, as they and spasm, and thrombosis, and embolism of the mesenteric vessels lead to circulatory disorders in the intestinal wall, oxygen starvation and development of gastrointestinal infarction.
With spasm of the mesenteric vessels, the pain is periodic, acute, intermittent, spreads throughout the abdomen and lasts about 3-4 minutes.
Taking antispasmodics (papaverine, no-shpa, nitroglycerin) with spasm of the mesenteric vessels eliminates pain.
Blockage (thrombosis) blood clot mesenteric vessels or their embolism, there are signs of peritonitis and intestinal obstruction:
Pain with thrombosis of the mesenteric vessels is constant, strong, cutting, begins suddenly and is accompanied by severe bloating.
The localization of pain depends on the location of the vascular lesion: in the navel, in the right or left iliac region, or spreads throughout the abdomen.
The pain is aggravated by the slightest movement, so the patients lie motionless on their backs, bending their knees.
Nausea and indomitable vomiting are observed from the very beginning of the disease.
Retention of stool and bloating.
Sometimes at the beginning there may be frequent loose stools mixed with blood.
The condition is severe, characterized by pallor, cold sweat, dry tongue, tachycardia, sometimes shock.
There is tension in the muscles of the abdominal wall.
Thrombosis of the mesenteric vessels is most common in patients with atrial fibrillation, atherosclerosis and suffered a heart attack myocardium.

Rupture of an ovarian cyst
The provoking factor is physical activity, trauma, sexual intercourse.
It manifests itself as a sudden pain in the lower abdomen, first the pain is local on the right or left, then it becomes diffuse.

Torsion of an ovarian cyst
The pain is associated with ovarian ischemia and is manifested suddenly by acute pain in the lower abdomen on the right or left. There is an increase in pain during probing and there are symptoms of irritation of the peritoneum.
Often a woman knows that she has a cyst.

Spontaneous (spontaneous) abortion
Pain in the abdomen is acute, severe, cramping, sudden. Occurs in the suprapubic region.
Accompanied by uterine bleeding.
It often occurs after physical effort, heavy lifting, trauma, sexual intercourse.

Rupture of the fallopian (uterine) tubes in ectopic pregnancy
An ectopic pregnancy is accompanied by moderate pain and a delay in menstruation, there may be minor bloody issues from the vagina. If a complication occurs in the form of a rupture of the tube, the pain suddenly intensifies, becomes diffuse, the bleeding becomes severe, leading to fainting. The lower abdomen is very painful when palpated, symptoms of peritoneal irritation appear.
This condition is often associated with physical activity, heavy lifting, sexual intercourse.

Tumor diseases of the abdominal organs
Pain in malignant tumors is very rarely the first sign of the disease, and its appearance indicates a far advanced process.
Almost always, pain is preceded by a “precancerous disease”, for example, long-term and improperly treated chronic atrophic gastritis or peptic ulcer, intestinal polyps. Therefore, pain in tumors at first has the character of the disease against which they develop, but later the nature of the pain changes, its dependence on food and other symptoms familiar to the patient.
It is necessary to be attentive to the appearance of new symptoms or the change in the nature of old and familiar signs. It is at this stage that the treatment nice results. But "acute abdomen" with tumors is a sign that speaks of a far-reaching process. Don't wait for threatening symptoms.
Always to be considered heredity through parents, brothers and sisters.
Signs of neoplasms at the onset of the disease are nonspecific and may resemble other diseases. This is bloating, nausea, heartburn, discomfort in the stomach, loss of appetite, constipation, diarrhea, etc.
However, regardless of which organ is affected, there are a number of signs that
allow to suspect the presence of a tumor in the abdominal cavity:
Anemia of unknown nature
Unexplained weight loss and loss of appetite,
Abdominal pain that occurs at night
If the disease began after 50 years;
Fever of unknown origin
Causeless general failure weakness, depression, apathy
Persistent constipation that does not respond to medical treatment,
The appearance of blood and mucus in the stool,
Pale earthy skin tone
Sudden onset of jaundice
The tumor may be palpable.

Spleen infarction
The reason for the development of this pathology is thrombosis or embolism of the spleen vessels, which occur with certain heart defects, increased pressure in the vena cava, bacterial endocarditis, rheumatism, coronary artery disease, leukemia.
If the infarction is small-focal, it may be asymptomatic or with minor pain in the left hypochondrium.
If the heart attack affects a large area, there is a strong, sudden pain in the left hypochondrium (sometimes spreads to the entire abdomen), which is aggravated by breathing, movement and coughing. The pain radiates under the left shoulder blade and in the lower back.
At extensive heart attack collapse may develop.
There is an increase in temperature, tachycardia, a drop in pressure, vomiting, and intestinal paresis are possible.
Muscle tension in the left hypochondrium is insignificant, palpation of the abdomen is painful.
More often, self-healing occurs.

Spleen rupture
Spleen rupture can occur in two situations: 1. Spontaneously, if the spleen is pathologically changed as a result of leukemia, mononucleosis, liver cirrhosis, etc., it is enlarged and its capsule is thinned. In this case, a rupture can occur even for no apparent reason or with the slightest injury to the abdomen. Therefore, with an enlarged spleen, great physical exertion and contact sports are contraindicated. 2. Rupture of a healthy spleen occurs during strong blows or injury. The presence of an injury to the trunk or a blow to the left side immediately before the disease is very important in the diagnosis.
The moment of rupture is most often manifested by fainting, and lasts several hours. Later, pain appears in the left hypochondrium, sometimes it covers the entire abdomen, sometimes it radiates to the left shoulder. The pain is sharp, but not as severe as with peritonitis.
Then there may be signs of irritation of the peritoneum with slight tension in the abdominal muscles. Shchetkin-Blumberg's symptom is not always positive.
During rupture of the spleen, large amounts of blood enter the abdominal cavity, causing all signs internal bleeding: sensation of flashes of light before the eyes, cold, moist and pale skin, dizziness, cold sweat, weakness, rapid thready pulse, decreased pressure, lethargy, confusion. Shock does not always develop.
Patients take a position on the left side with legs bent to the stomach.
On palpation, pain is present, but muscle tension is weak.
A ruptured spleen always requires surgery.

Liver rupture
The reason is abdominal trauma.
Often occurs simultaneously with rupture of the spleen.
Signs of internal bleeding are mild, because. the liver does not bleed as much as the spleen, but the general condition is always worse when the liver ruptures, because. almost always accompanied by shock.
The pain is expressed more in the right hypochondrium.
When the liver ruptures, jaundice sometimes develops, because blood clots can clog the bile duct.
The prognosis for a ruptured liver is always worse than for a ruptured spleen.

Strangulated hernia
A hernia is a protrusion of organs located in the abdominal cavity with a parietal sheet of the peritoneum into the spaces between the muscles or under the skin through natural anatomical openings or acquired after trauma and surgery.
Most often there are inguinal, umbilical, postoperative hernias.
The cause of hernia is an increase in intra-abdominal pressure, which increases during severe physical activity, with constipation, difficult childbirth, prolonged strong cough.
A hernia can develop even after a single increase in intra-abdominal pressure, for example, when lifting heavy objects.
A hernia can be in a person for a long time and not disturb. But sometimes the hernial contents come out through the hernial opening and are not reduced. The result is abuse.
Infringement of the intestine is especially dangerous, because. plus, to the violation of blood circulation in it, intestinal obstruction with severe intoxication is added.
When a hernia is infringed, regardless of its location, the symptoms will be the same:
Acute pain with physical exertion and not decreasing after its cessation.
Severe pallor of the skin, tachycardia, drop in blood pressure, anxiety.
If you cough with your hand on the hernia, you can feel that the cough impulse is not transmitted to it.
There may be vomiting, sometimes with a fecal odor, bloating.
With infringement of the intestine, signs of intestinal obstruction develop.
In case of prolonged infringement, suppuration of the hernia occurs with high temperature, intoxication, severe swelling and redness in the area of ​​the hernial protrusion.
Subsequently, peritonitis may develop.
At the location of the hernia, a dense rounded formation is determined.
Don't try to fix the hernia yourself! You can do it wrong and cause further complications. Urgent call ambulance, and before her arrival, you need to lie on your back, put a container of ice on the area of ​​\u200b\u200bthe hernial protrusion and drink an antispasmodic (baralgin or no-shpu).

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?

The quality of the initial examination of the stomach by 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) indicate 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 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.

Also check white line abdomen 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 the lower limit. 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 the lower part of the sternum and the navel. 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. The solid formation 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.