Method for examining abdominal palpation

Palpation is a method of examining a patient, in which the sense of touch of the fingers is used. The method complements the examination data and allows to reveal soreness, local temperature, skin moisture, mobility and size of lymph nodes. All external structures, bones, muscles, joints, surface vessels are examined palpatically. This method determines the presence of edema and bruises. Of particular importance in the diagnosis of diseases is palpation of the chest and abdomen. Let's consider features of carrying out of the given inspection.

Palpation of the abdomen is one of the main methods of examining the internal organs of the abdominal cavity. Using this method, you can identify some pathological changes in organs, as well as their location. In clinical practice, surface and deep palpation of the abdomen is used.

Before palpation, you must sit on the right side of the patient, preferably at the level of his bed. The patient should lie without tension, on a low pillow, put his hands along the trunk, legs bend at the knees. The hands of those who palpate must be warm, dry, with short nails. Surface palpation of the abdomen is determined by:

- muscle tension, which is part of the anterior abdominal wall;

- localization of the place of pain;

- swelling of the abdominal wall, obesity, ascites and flatulence;

- swelling of the abdominal wall and abdominal cavity ;

- any seals in the abdominal wall;

- divergence of the rectus abdominal muscles , a hernia, a symptom of irritation of the peritoneum.

Using this method, you receive preliminary information about the condition of internal organs.

Before the beginning of palpation, the patient is asked to indicate a sore spot. During the examination it is necessary that the patient inform the doctor when he has pain and when they disappear. In a healthy patient, there are no painful sensations when performing superficial palpation, the possible muscle tension in the abdominal wall is very small and symmetrical on both sides.

With peritonitis, surface abdominal palpation causes severe soreness and muscle tension over the entire surface of the abdominal cavity. In the case of acute appendicitis or cholecystitis, local palpation causes severe pain, which increases significantly with sudden removal of the hand. Thus, the well-known symptom of Shchetkin-Blumberg is determined. With the help of superficial palpation of the abdomen, many diagnostic data can be obtained to determine the increase in internal organs, the tension of the stomach or intestinal loops, and the presence of tumors.

Deep palpation of the abdomen is carried out according to the method of Obraztsov-Strazhesko. This method was proposed at the end of the XIX century by the Kiev physician-therapist VP Obraztsov and was later supplemented by Obraztsov's student-therapist ND Strashesko.

Deep abdominal palpation is performed by a sliding method. The doctor suggests that the patient relax the muscles of the abdominal wall. During exhalation, the doctor immerses his hand in the abdominal cavity until the sensation of the surface of the organ under examination. Then the hand slides over the surface with the tips of the fingers, located perpendicular to its axis. Hand movements are regulated by respiratory movements. Using the method of deep palpation, you can obtain the necessary data on the shape, size, consistency, mobility, sensitivity of internal organs located in the abdominal cavity.

Deep methodical palpation of the abdominal cavity is performed in a generally accepted sequence. First, the sigmoid colon is palpated , then the blind, vermiform appendix, the right and left parts of the colon, the stomach, the transverse part of the colon, the liver, the pancreas, the spleen and the kidneys. Thus, each patient's palpation is examined, no matter what disease he is supposed to have.