The gall bladder is an integral part of our body. This organ is part of the human excretory system, part of the digestive system. If there was no such bubble, then our entire intestines would be in fat globules. Is funny But it’s true. Palpation of the gallbladder (palpation), one of the ways to diagnose diseases of the investigated organ. How is this procedure carried out? What techniques are there? What can be detected by palpation of the organ?
What is the gall bladder?
This is a small organ (14 cm - length, 5 cm - width) involved in the digestion process. Its location is on the right, under the lower part of the liver. The bubble has soft walls, it stands out a little under the liver (1 cm), so palpation of the gallbladder in its normal state is impossible.
On the contrary, if the organ is palpated, then this indicates some kind of deviation from the norm. It is very difficult to feel this organ, but palpation of the gallbladder is a fairly effective method for identifying its diseases.
Palpation points
A healthy (without pathologies or with an onset of disease) gall bladder is not palpable. The same applies to the liver. But small sections of these organs can be felt, even if they are healthy and not enlarged. For example, the frontal surface of the left lobe of the liver or the bottom of the gallbladder. At the same time, palpation of the gallbladder is easier to detect than to feel the organ itself. Pain that appears at certain points indicates inflammation of the bile ducts, the bladder itself, or other deviations from the norm.
Palpation of individual areas is a special diagnostic method. By clicking on the known points of palpation of the gallbladder, the degree of human response shows what pathology the patient has. Such a diagnosis makes it possible to identify diseases at the initial stage, when the bladder is not yet enlarged and not felt.
These points may be:
- In the area under the pit.
- On the site next to the corticosteroids muscle.
- Under the shoulder blade on the right.
- On the right shoulder.
- In the area where the abdominal muscle and cartilage of the lower ribs connect.
Palpation process algorithm
For the prevention of diseases, gall bladder palpation is carried out, the algorithm of which is different for superficial, deep and comparative palpation. With a superficial doctor, he does not strongly press on the stomach of the patient lying on his back. First, in the groin on the left (the patient should report his feelings), then the fingers move 5 cm higher, then the epigastric region, and finally, the ilium on the right.
With deep palpation, palpation occurs with fingers immersed in the patient’s stomach. Bent fingers are pressed into the abdominal cavity to the second phalanges, they move parallel to the gall bladder with a grip of the skin, so that the hand freely moves along the stomach. Fingers sink deep enough, but only when exhaling. The organ is thus felt in about 4 inspirations. In this case, the fingers should reach the back wall on the side of the diseased organ, slowly moving towards it.
With comparative palpation, the left side is checked first, then the right. First, the iliac region, the area around the navel, the abdomen (left and right), the hypochondrium, the epigastric region (left) are felt, and then along the so-called white line to the right.
Liver and gall bladder
The liver, like the gall bladder, is an organ involved in the digestion process. They are located nearby, interconnected anatomically and in the process of functioning. Partially, these organs are located inside the ribs and are generally not palpable. Therefore, palpation of the liver and gall bladder is carried out jointly almost always and by a single technique. The gallbladder can be felt only if it is enlarged.
For what reasons does the gallbladder increase?
The increase in this organ is due to a malignant tumor, a decrease in the tone of the walls, water edema (the bubble is filled with edematous fluid), blockage of the biliary tract, overflow of accumulated pus due to bacterial infection, the formation of stones, bile accumulation, and tumors on the head of the pancreas. In this case, during palpation of the gallbladder, a large condensed organ is groped, resembling an egg or pear in outline.
Organ enlargement occurs when the disease is already in the middle or final stage.
Why is it necessary to examine the gall bladder?
Palpation of the gallbladder is regularly carried out in order to general examination of the body, despite the fact that there are no complaints, as well as in order to have an overall picture of the physical condition of the patient. In some cases, this is done to prevent the development of diseases of this organ and biliary tract. This, of course, is ideal, but most often people come for examination when pain occurs and most often acute.
The main thing when feeling the gallbladder is to identify its location, size, shape, sensitivity, condition of the walls. This diagnostic method allows you to identify not only the nature of the pathology, but also the place of its occurrence, for example, directly in the gallbladder or in its ducts.
Gallbladder disease
Pathologies from which the gall bladder suffers:
- benign and malignant tumors;
- bladder head cancer;
- metastases;
- empyema;
- dropsy;
- gallstone disease, which is accompanied by blockage of the biliary tract;
- cholecystitis (acute; chronic);
- gallbladder dysfunction (functional malfunctions);
- biliary dyskinesia (hyper- and hypotonic; hyper- and hypokinetic);
- cholecystocholangitis;
- cholangitis.
Pathologies arise due to parasites that appear in the gallbladder:
- giardiasis;
- dicroceliosis, etc.
Diseases can occur due to violations in the development of the organ itself. There are congenital structural abnormalities, but there are functional. They lead to the fact that the outflow of bile is difficult or stops altogether.
Techniques of palpation of the investigated organ
Palpation of the organ is carried out using the following methods:
- penetrating palpation,
- light palm strokes on the ribs,
- pressure on the points around the clavicle.
For palpation of the gallbladder, the doctor chooses the technique based on the patient's complaints. The procedure is as follows:
- Pressing or tapping the lower ribs on the right (the Ortner symptom is determined). In this case, pain confirms dyskinesia of the gallbladder (bile ducts) or cholecystitis.
- Indentation of the doctor’s hand under the right lower rib with simultaneous exhalation of air by the patient ( Murphy-Obraztsov symptom is determined ). The resulting unpleasant sensations are signs of acute cholecystitis.
- The application of light blows to the body over the gallbladder of a patient lying on his back (Zakharyin symptoms). Signs of acute cholecystitis in this case are pronounced. The patient may experience pain. If it is acute, then this indicates the development of the inflammatory process.
- The same light strokes over the gallbladder on the right side (Vasilenko symptom). If pain occurs on inspiration, then this is a symptom of cholecystitis, cholelithiasis, urolithiasis.
- Pressure on the point between 10 and 12 vertebrae (right). Pain sensations indicate the presence of pathology.
- Palpation of the gallbladder (signs of cholecystitis). If the patient feels pain, then pathology develops.
- Blows on the lower part of the ribs during inspiration (Lepene symptom). Painful sensations arise - symptoms of cholecystitis are present.
- Not strong blows on the right lower costal arch with the edge of the palm of the hand (Ortner-Grekov symptom). If pain is felt, then this is a symptom of the inflammatory process in the bladder.
- Pressure on the point to the right of the 12th vertebra (Boas symptom) - pain indicates the presence of symptoms of acute cholecystitis.
- Squeezing the point near the apex of the right clavicle (symptom of Mussi-Georgievsky). Here the nerve of the diaphragm passes, while pain confirms inflammation of the tissues of the gallbladder or bile ducts. Painful sensations can sometimes be given to the right hand, shoulder, and right side.
- Palpation at the time of inspiration of the gallbladder point (Kera and Lepene symptom). Pain concentrated over the organ is a symptom of cholecystitis.
- Feeling of an organ in a person (leaning on a couch) who sits and leaned forward a little. The doctor, bending over the patient’s shoulder, finds a position in which the organ is best palpated, applies the palm edge to the body and presses the fingers under the ribs, after a perfect inhalation of the patient, the organ is palpated very well (to determine the cause of pain), since when inhaling the liver and bladder slightly lower down.
- The diagnosis puts a hand on the chest of a lying patient (four fingers), with a thumb presses on the examined organ. After inhaling the patient, the bubble is felt with the thumb.
- The thumb is pressed under the lower rib approximately to where the organ is located, the other fingers are at this time on the lower edge of the costal arch. If breathing is interrupted during the patient’s inhalation and he feels a sharp abdominal pain, this indicates the development of cholecystitis (Murphy symptom). The same symptom during palpation of the gallbladder can be found in a patient who sits. The doctor, being behind him, puts his fingers in the location of the organ. The patient takes a breath simultaneously with pressure on the bubble with his fingers. If at the same time breathing is interrupted, then this indicates the development of pathology. Sometimes breathing is interrupted without pressure on the bubble. It also confirms the presence of the disease.
- A palm edge presses on the area between 9 and 11 vertebrae on the right (Squirsky symptom). If pain occurs, then the patient has cholecystitis
- When feeling the bottom of the gallbladder, its elongation is felt. At the same time, the organ protrudes noticeably from under the edge of the liver with an increase (Courvoisier symptom). This is a sign of acute cholecystitis or a blockage of the bile duct by a tumor.
- Pressing the xiphoid process with your finger (Pekarsky symptom). The presence of pain is a symptom of chronic cholecystitis.
Palpation of points and the organ itself will show the most complete picture of the disease. These research methods are complementary.
How to detect cholecystitis?
Pain or discomfort in the right side below the ribs is an alarm bell for the patient. These are signs of a developing disease. Palpation of the gallbladder in chronic cholecystitis will help determine the size of the bladder, how it is located, what shape it has, in what condition the walls of the bladder are.
The condition of the walls of the bubble
How much the walls of this organ are dense and elastic depends on the diseases that cause its increase. When the bile duct is blocked by stones, the bladder does not enlarge. But the walls become not homogeneous and compact. In this case, pain is felt in the gallbladder during palpation. When a tumor occurs that blocks the bile ducts, the organ grows very much, since bile accumulates in it. The walls of the bubble do not lose their elasticity, and by the shape of the touch, it becomes like a pear or an egg.
A tumor on the head of the bladder makes the walls tense, but there is no pain when feeling, and when you inhale, the bladder moves to the side.
Children examination
In children, the gallbladder performs the same function as in adults, namely, it is involved in the digestion process. Practical diseases are the same, but with some features.
With lesions of the gallbladder, children complain of pain (under the ribs) in the right side, bitterness in the mouth, nausea, flatulence. Often there is vomiting of bile. In this case, the skin and whites of the eyes turn yellow.
As for the size and location of the gallbladder, it is not large and is located inside the chest. That is why palpation of the gallbladder in children is impossible.
Conditions preventing palpation
If the patient’s abdominal muscles are strongly inflated, the patient is obese or at least overweight, strains the abdominal muscles and does not relax them, bloating appears, then palpation is impossible.
Also, the organ is not felt if the liver is rotated around the front axis. At the same time, its bottom is shifted up, and its upper part is down and back. With tense abdominal muscles, it will not be possible to feel the liver and gall bladder.