One of the informative diagnostic methods is palpation. With its help, you can identify a number of serious pathologies in humans. A special technique is palpation of the points of the gallbladder. This body has certain features. It is impossible to palpate it in a healthy person, since its size is small and its walls are soft. Therefore, doctors use special techniques to diagnose various diseases. They will be discussed later.
Features of the procedure
Knowing the point of palpation of the gallbladder, the patient's reaction rate to such effects, the doctor can identify various pathologies in the body. This organ is located at the bottom of the right lobe of the liver. It has a relatively small size. It reaches a length of 14 cm and a width of only 5 cm. Its texture is soft. In healthy people, the gallbladder protrudes from under the liver by just one centimeter. Therefore, it is impossible to probe this organ if there are no serious pathologies in it.
There is a whole list of ailments, due to which the walls of the gallbladder can become denser. Most often, inflammatory diseases become the cause. Tumors and multiple adhesions also violate the structure of its tissues (appear after pericholecystitis, which the patient once suffered from).
Gallbladder disease
If the gallbladder is unnaturally large, palpated , this can indicate the development of such ailments:
- tumors (benign and malignant), metastases;
- pancreatic head cancer;
- dropsy;
- gallstone disease, which is accompanied by the formation of a large number of stones in the organ, obstruction of the ducts;
- empyema (accumulation of purulent contents in the gallbladder due to bactericidal infection).
In these cases, the specialist probes the organ under the lower border of the liver. The gallbladder in this case is located outward from the lateral edge of the (lateral) rectus muscle on the abdomen. It is located approximately at the intersection of the line (horizontal), which runs parallel to the ninth pair of ribs.
Since the organ is usually not felt, if there are no pronounced diseases, an effect is made on the points of the gallbladder and pancreas. This is an effective diagnostic method that allows you to identify deviations at an early stage.
Inspection Tasks
Each specialist who performs palpation knows the pain points of the gallbladder. This allows you to not only determine if the organ is enlarged. This technique reveals diseases, even when the gallbladder is not enlarged. By pressing on certain points, the doctor monitors the patient's reaction. If soreness has appeared in one place or another, this indicates the development of a certain ailment.
Palpation of the acupuncture points of the gallbladder allows you to identify a number of inflammatory pathologies in the organ, as well as in the ducts and channels that are suitable for it. There are a number of special symptoms that indicate the presence of pathology. So, for example, the doctor can determine if the patient has Ortner's symptom. It appears when tapping along the edge of the costal arch with the edge of the palm of the hand. The doctor performs this manipulation in the place where the gallbladder is located. If this symptom is present, the patient develops an inflammatory process in this organ.
To confirm this assumption, the doctor performs several more manipulations. As a result, in most cases, the symptom of Obraztsov-Murphy and Zakharyin is also manifested. Palm swaying in the gallbladder causes soreness. Moreover, it is acute with inflammation.
Palpation allows you to determine not only the type of disease, but also determine the place of its development. So, for example, there are points of the gallbladder channel, its ducts. In this way, chronic and acute forms of an organ disease are diagnosed. During the procedure, the doctor can evaluate the size of the lesion, determine the nature of the walls of the gallbladder, etc.
Pain points
To identify the disease in the early stages of development, the doctor conducts palpation according to a specific system. It presses on the points of the gallbladder on the stomach and back, determining the reaction to such effects. Palpation is carried out in different parts of the body.
The technique includes an examination in the following areas:
- Point at the site of the lateral edge of the rectus abdominis muscle tissue to the costal arch.
- Epigastric region.
- At 5 cm to the right of the navel, the choledochopancreatic zone is palpated.
- Between the nociceal muscles of the sternoclavicular-mastoid is the point of the phrenic nerve, which refers to the cervical adhesion. Pressing it may cause pain in the shoulder, under the collarbone. Sometimes it is concentrated in the hypochondrium on the right. This projection is called a "phrenicus symptom."
- An acromial point is located on the right shoulder. She most stands in the direction of the acromial scapular process.
- Scapular point. Located next to its lower right corner.
- Points of the 8th, 9th and 10th vertebrae. This is the region of Baos.
Considering the points of the gallbladder and the symptoms of certain organ pathologies, it should be noted that sometimes pain appears when pressure is applied on the right side of the tenth to twelfth vertebrae. You can also detect gallbladder disease by tapping the edge of the palm slightly to the right of the area from the ninth to eleventh vertebra of the thoracic region. The doctor can also apply not only tapping, but also pressure.
Features of palpation
On palpation of the gallbladder, identical methods are used, as with a similar liver procedure. There are different methods that allow you to carry out a similar procedure. Some of them are not even written in special textbooks, but are much more effective. One of the original methods of palpation is pressure on the points of the body when a person is in a sitting position. In the classical technique, the patient should be in the supine position at the time of the procedure.
Tapping the gallbladder channel or other parts of it can be carried out according to the original method. The patient should sit on a couch or hard chair. Then he should lean forward a little. Hands need to lean on a couch or chair. In this position, the abdominal muscles will be relaxed.
During palpation, the doctor tilts the patient's body more or less forward. He is also asked to perform certain breathing exercises. At this time, the doctor presses on certain points on the body. During breathing exercises, the patient performs a movement with the abdomen. The doctor is in front and to the right of him. A medical specialist holds the patient’s shoulder with his left hand. So he can periodically change the angle of the torso. This allows you to achieve relaxation of the abdominal muscles.
The doctor’s right palm at the time of such an examination is located first at the right external edge of the rectus muscle on the abdomen. It should be perpendicular to the anterior abdominal wall. At the time of exhalation of the patient, the doctor plunges into the hypochondrium. So he can get almost to the very back of his wall.
After this, the patient takes a slow, deep breath. The liver at this moment falls to the doctor’s palm with its lower edge. This organ can be felt well at this moment. The doctor can assess at this moment the elasticity of her tissues, the sensitivity and general characteristics of the lower edge of the organ. At this moment, it is possible to feel the gall bladder. This allows you to identify certain pathologies. With the classical method of palpation, the gallbladder can be found much less often.
The choice of methodology
Gallbladder points are palpated in many ways. Palpation classic has several disadvantages. Only the fingertips of the doctor touch the organ under investigation. Therefore, in this way only the most prominent areas of the liver can be examined.
If the procedure is carried out when the patient is in a sitting position, the liver and gall bladder are felt by the entire surface of the phalanges. Here the fingers are the most sensitive. This method allows you to feel a large area of organs at the time of the study.
Palpating the points of the gallbladder on the body, the doctor using the presented technique can identify the causes of pain in the organ. The method of palpation in a sitting position is the most informative.
Other diagnostic techniques may be used. So, the patient is in a supine position. The doctor puts his left palm on the costal arch. In this case, his thumb should be on the meridian of the gallbladder. Points on the surface of the chest are pressed with the rest of the fingers.
At the time of inhalation, the doctor feels the area in which the gallbladder should be. At the same time, he performs multidirectional sliding movements. The researcher must sequentially plunge into the area under the ribs. This is the feeling of the lower border of the organ. During the examination, the doctor uses several different techniques.
Diagnostic techniques
Projection points of the gallbladder can be palpated using various techniques. There are a number of officially approved techniques that the researcher applies during this procedure. They provoke the occurrence of pain symptoms. According to what sensations the patient experiences during such manipulations, the doctor can determine the characteristics of the organ pathology. There are a number of specific symptoms that occur during palpation.
So, for example, to determine the symptoms of Kerr and Obraztsova-Murphy, penetrating palpations are used. To establish the presence of symptoms such as Grekov-Ortner, the researcher thumps the side of the palm adjacent to the little finger (ulnar) along the costal arch on the right.
Using special techniques, it is possible to identify the "phrenicus symptom." To do this, the doctor presses the index finger between the legs of the sternocleidomastoid muscle. When pain occurs, we can say that pathological processes develop in the body. However, they can be localized near the body. The muscles in the area are tense.
Numerous studies have confirmed that during palpation of special points, inflammatory processes that occur in the gallbladder and its ducts, leading paths can be detected. If the muscles are tense in the area of the projection of the organ, this may indicate an inflammatory process, which also develops in the peritoneum.
The most painful sensations can be determined in the area of the gallbladder itself, as well as the Shoffar triangle. This is the area that is limited by an imaginary horizontal line drawn 6 cm above the navel. The second side of the triangle is the midline of the body. The hypotenuse of this area is a straight line drawn from the navel to the right and upward at an angle of 45º.
Symptoms
During the palpation procedure, various pain syndromes occur in the presence of pathology. They may be different. For each symptom, there is a name and a special description. The following symptoms exist:
- Kerra and Lepene. It is detected during classical palpation. The doctor presses on the exhale on the point of the gallbladder. Kera and Lepene symptom is confirmed in this case if the pain is localized in the area located directly above the organ.
- Murphy. Appears when breathing is interrupted with a deep breath. This is an acute pain in the abdomen. It appears when pressing with the thumb on the area below the costal arch approximately in the area of the gallbladder. Other fingers of the doctor at this moment should be located on the edge of the arc. Murphy's symptom can also appear when palpating the patient in a sitting position. The doctor at this time is behind the back of a person. He puts his fingers on the gallbladder. If the patient's breathing with a deep breath at the time of palpation is interrupted, this is also called a symptom of Murphy. Acute soreness also appears. In some patients, such sensations develop spontaneously against the background of a deep breath. The doctor may not even put pressure on the gallbladder.
- Lepene. Soreness intensifies when the rib touches the right hypochondrium, when the patient takes a deep breath. At the same time, when you exhale, discomfort decreases.
- Lida. It occurs with chronic cholecystitis. In this case, the muscles become flabby and atrophy in the right hypochondrium.
- Baos. Detects the development of acute cholecystitis. Soreness appears with pressure on the right (4-5 cm retreat) from the twelfth vertebra with a slight displacement of tissues.
- Skvirsky. Detects cholecystitis. The pain appears when pressing the edge of the palm on the area that is between the ninth and eleventh vertebrae on the right.
- Mussey-Georgievsky ("phrenicus symptom"). Appears in the presence of pathologies of the liver and gall bladder. The pain appears at the moment of pressure on the point that is located between the legs of the muscle on the right at the upper edge of the clavicle. Here is the nerve of the diaphragm. With the development of the disease, this acupuncture point is irritated. The channel of the gallbladder, liver tissue and gallbladder is checked by identifying this symptom.
- Ortner-Grekov. Allows you to identify the inflammatory process in the gallbladder. The pain syndrome occurs when the edge of the palm is striking along the lower edge of the costal arch on the right.
These are the main symptoms by which one or another pathology can be diagnosed. The doctor can detect one or several of these manifestations at once. After that, a decision is made on further actions.
Gallbladder enlargement
By pressing on the points of pain in the gallbladder, the doctor identifies many inflammatory processes. However, when diseases appear in the middle and advanced stage, the organ will be enlarged. It can be felt. Against this background, painful symptoms may appear when pressing acupuncture points.
The gallbladder may increase due to the development of such diseases:
- the appearance of stones inside the body;
- accumulation of bile, an increase in its amount;
- accumulation of pus in the body cavity.
These processes cause more or less pain. After palpation, the doctor prescribes additional diagnostic procedures. Only then do they make the appropriate diagnosis. In addition to the listed reasons, the gallbladder may increase due to the appearance of dropsy. In this case, the organ is filled with edematous fluid instead of bile.
Wall seal
There are various diseases of the gall bladder. The points that the doctor presses on react differently in the presence of different pathologies. Additional data can be obtained by palpation of the organ itself. If, with the appearance of some pain symptoms when pressing the points, it will be established that the tissues of the gallbladder have become denser, become elastic, this indicates a number of pathologies.
Similar changes may appear when the duct is blocked by a stone. In this case, the organ itself does not increase. The walls do not stretch, but are densely compressed. Also, their structure becomes heterogeneous. When pressing on the gall bladder, soreness appears.
If the cause of the painful symptoms lies in the obstruction of the duct with a tumor, the organ will increase in size. It accumulates bile. It can take an egg or pear shape. The walls will be resilient.
If a tumor develops in the head of the gallbladder, the walls become tense. Pressure does not cause pain. When breathing, the organ may shift slightly to the side.
Having considered the features of the diagnosis of diseases of the gallbladder, palpation points and methods of influencing them, we can understand the methods for identifying various ailments of this organ.