To determine the type of pathology of the kidneys and bladder, a variety of examination methods are used, which include palpation of the kidneys, percussion and examination. Each type of diagnosis has its own characteristics and gives a certain set of information.
Palpation of the kidneys
So, more details. Palpation of the kidneys in a healthy person does not give results, since they are not palpable. This procedure can only be carried out if there is an organ pathology. Or very thin people.
Palpation of the kidneys is carried out in two positions: lying and standing. In the supine position, the abdominal muscles are lowered, their muscles are relaxed, as a result of which the procedure is facilitated. Standing during the examination, you can feel the moving kidney, which has a displacement down under its mass.
Palpation of the kidneys is carried out with two hands. The patient rests on the couch on his back, legs should be straight, arms should fit freely on the chest. In this position, the abdominal muscles relax as much as possible, breathing becomes smooth, calm. The doctor is to the right of the patient. He puts his left hand under the lower back, just below the last rib so that it is located near the spine. When examining the left kidney, the hand is placed under the back further, behind the spine.
The doctor’s right hand is located on the abdomen slightly below the costal arch outside the rectus muscles. On exhalation, the specialist immerses the hand in the abdominal cavity towards the fingers of the left hand.
Further. With palpation of the kidneys, during the rapprochement of the hands, the patient is invited to take a breath. Very deep. As soon as he exhales, the specialist can feel the drooping kidney, the edge of which will approach the right hand and pass under her fingers. If the organ has a large increase, the doctor will be able to completely palpate his front wall, find both poles. This method of examination allows you to determine the shape and size of the organ.
There is also a technique for palpation of the kidneys in the position of the patient, lying on his side. In this case, the procedure is carried out according to the same rules as in the supine position. But when the patient is placed on his side, the doctor sits, and the patient should be turned to face him. His body leans forward slightly, the muscles relax. During the examination in this case, it is possible to detect nephrosis. In the first stage of the disease, only the lower pole of the organ is felt. On the second, the entire organ is easily detected. At the third stage of nephrosis, the organ freely moves in any direction. Sometimes during palpation pain is observed.
Sometimes, during the procedure, you can confuse the organ with a filled section of the colon, an enlarged right lobe of the liver, or with a tumor. To avoid this, you should know the shape of the organ: it resembles a bean with a smooth surface. For the kidneys, a rise up and a return to its original position is characteristic. After palpation in the urine appears protein and an admixture of red blood cells.
You can examine the patient in a standing position. In this case, the doctor sits opposite the patient, and the patient stands in front of the specialist, leaning forward slightly and crossing his arms over his chest. The doctor puts his hands in the same way as when examining the kidneys from behind.
results
During palpation of the kidneys in children and adults with an enlarged organ, the following pathologies can be assumed:
- nephritis;
- hydronephrosis;
- hypernephroma;
- developmental anomaly in the form of a lowered kidney.
Everything is very serious. In addition to palpation, percussion of the organ is evaluated. More details.
Percussion
In order. So that the doctor can more accurately establish the diagnosis, it is necessary to palpate and percussion of the kidneys. The last examination method allows you to identify changes in sound above the organ.
Normally, a tympanic sound is heard. This is due to the fact that the kidneys are covered by the intestines. If a dull sound is heard, then this indicates a sharp increase in the organ. In this case, the intestinal loops move apart.
Symptom of Pasternatsky
Of great importance during the examination is the definition of Pasternatsky's symptom. This is a tingling method in which organ soreness is assessed. During the procedure, the doctor is behind the patient. The left hand is placed on the area of the twelfth rib and slightly to the left of the spine. The edge of the palm of the other hand inflicts short mild blows to the left hand. Depending on the severity of pain, the type of symptom is determined: positive, mild, negative.
A positive symptom of Pasternatsky is determined with ICD, pyelonephritis, paranephritis and some other ailments. It should be understood that the patient can feel soreness with osteochondrosis, diseases of the ribs, muscles of the lower back. Less commonly, pain occurs due to pathologies of the gallbladder, pancreatitis and other ailments.
Bladder palpation
The next moment. Palpation of the kidneys and bladder is carried out to identify a variety of pathologies. I.e. For examination of the bladder, the patient is in a supine position. In this case, the doctor has a longitudinal arm on the abdomen. When immersed in the abdominal cavity, a fold is formed, directed towards the navel. This action is performed several times, gradually moving the hand to the pubic joint.
Normally, an empty bladder for palpation is not available, since it is located behind the bosom. A full organ is felt. With inflammation, the bladder is felt outside the womb. The patient may feel pain when pressed.
Bladder percussion
To determine the upper border of the bladder, the method of percussion is used. During this type of diagnosis, the doctor places a finger-pessimeter (which knocks) horizontally to the body. Tapping is carried out along the midline, from top to bottom, starting from the level of the navel and ending with the pubis.
With an empty bladder, a tympanic sound is heard that persists until the pubic joint. In the case of overfilling of the organ in the upper border, the sound goes dull. This place is marked as the upper limit.
Conclusion
Physiological diagnostic methods allow you to identify a variety of pathologies of the kidneys and bladder. With their help determine the size, location of organs, as well as the presence of fluids in them. After examination, palpation and percussion, urinalysis is mandatory . OAM is mandatory.