Palpation of the stomach is carried out in the initial phase of the examination of the gastrointestinal tract. The procedure relates to physical methods for examining a patient. Palpation is carried out in the presence of problems with the digestive tract, the method allows to determine the presence of hernias, neoplasms or cysts. There are four types of palpation, which differ in the sequence of examination of the abdominal cavity and the intensity of pressure on the hands.
Particular attention should be paid to the palpation procedure performed by children, because the skin of young patients is very delicate and sensitive.
Stomach anatomy
The stomach is a bag-shaped extension intended for temporary storage and partial digestion of food taken. It performs important functions. The length of the organ reaches 20-25 cm, the volume is 1.5-3 liters. The size and shape of the stomach are due to its fullness, the age of the patient and the state of the muscle layer.
The stomach is located above the epigastrium, most of it to the left of the middle plane, and 1/3 to the right of it. The organ in its normal physiological position supports the ligamentous apparatus.
The wall of the stomach consists of three layers, each of which has a specific structure. The gastric walls are protected by the inner epithelial layer - the mucous membrane. Underneath is submucosal adipose and epithelial tissue, including capillaries and nerve endings. It contains glands that produce secretions, mucus and peptides of the stomach.
Food passes through the esophagus into the stomach and is digested under the influence of gastric juice and hydrochloric acid for a period of 2-6 hours. Then, due to periodic muscle contraction, the food lump moves to the exit and is pushed into the duodenum in portions.
Norm and deviations
Normally, the stomach is located on the left side of the body, however, systematic overeating can cause it to move to the abdominal area of the organ. Near the esophageal opening and the transition to the duodenum are located muscle thickening in a circular shape. They prevent food from entering the esophagus. In case of violations of the functions of the food valve, the gastric contents are thrown into the esophagus, causing heartburn. Damage to the sphincter causes bile, pancreatic juice, or vice versa, the flow of acidic contents into the intestines, which leads to irritation of the walls of the stomach and ulceration.
Normally, the position of the cardia is determined on the front wall of the abdomen in the region of 6-7 ribs. The arch or the bottom of the stomach reaches the fifth rib, the pylorus reaches the eighth rib. Small curvature is located below, to the left of the xiphoid process, and the large projection passes in an arcuate manner from the fifth to eighth intercostal space.
Depending on the specifics of the physique, specific forms and types of the human stomach are distinguished:
- The shape of a horn or cone. They occur when a person has a brachymorphic physique. The stomach is almost transverse.
- The shape of a fishing hook. It is characteristic of patients with a mesomorphic physique. The stomach’s body is located vertically, then sharply bends to the right side, forming an acute angle between the evacuation path and the digestive sac.
- Stocking shape. It is fixed when the patient has a dolichomorphic physique. The descending zone of the stomach is lowered low, and the pyloric part is raised steeply up, placed in the midline or slightly to the side of it.
These forms are inherent in a body in an upright position. When a person lies on his side or on his back, the shape of the stomach changes. That is why the palpation procedure is carried out in the supine position in order to get the correct clinical picture characterizing a certain pathology.
Deviations from these norms and changes in the size of the stomach, as well as organ displacement indicate the presence of pathological processes and may be symptoms of a particular disease.
When is palpation performed?
Indications for the procedure are cysts, tumors of various geneses, hernias, organ displacement, obesity, inflammatory processes. In this case, the patient may complain of increased flatulence, pain in the stomach, it is possible to observe the clinical picture of appendicitis.
At the initial examination, the doctor also fixes in patients weight loss associated with food restriction to clarify the presence of pain after eating, pallor of the skin, indicating hidden ulcerative bleeding, or gray skin, which is a symptom of stomach cancer.
Indicative inspection
An indicative examination helps to determine the tone of the muscle fibers of the stomach and the possibility of organ resistance in painful areas. This type of examination allows you to get a picture of the state of organs in the abdominal cavity. Ausculto-affection is used - light percussion with dashed finger movements. Palpation is carried out counterclockwise, by pressing and circular motions. Inspection begins on the left side, then palpates the upper zone near the ribs and ends the procedure by pinching the lower right side.
Examination of the small circle of the gastrointestinal tract (around the navel) allows you to clarify the diagnosis. By palpation, the gastroenterologist determines the foci of pain and inflammation. With gastritis, palpation of the stomach causes severe pain, since its walls are inflamed, and even superficial pinching can intensify the pain.
Comparative method
The method is used to diagnose symmetric zones of the abdominal cavity and to examine the epigastric region. The procedure allows you to determine the correct location of the body and deviations of its size from the norm, if any anomalies exist.
The procedure is performed from the bottom of the abdomen, comparing the iliac sites. The diagnostic process includes examination of the navel and inguinal area. A comparative type of palpation is distinguished by the technique of the procedure. During palpation, the patient is in a sitting position, which allows to identify pathological changes in the walls of the abdomen. The procedure makes it possible to determine whether the stomach is in the right place, and what is the degree of change in organ size.
Superficial palpation
In the presence of a pathological condition, palpation is accompanied by pain. The procedure allows you to determine the size and shape of the stomach, the level of tension of the abdominal muscles (at normal, it should be insignificant), to detect pain points and the lower border of the stomach. The method helps to make an approximate diagnosis of appendicitis with a painful abdomen and muscle tension on the right side.
Superficial palpation is carried out by weakly pressing the fingers of one hand on the abdominal wall in specific areas. The procedure begins on the left, in the groin area, after the arm is moved to the epigastric zone, in the right iliac region. Patient position - lying down, hands should be along. The doctor throughout the procedure clarifies with the patient exactly where he feels pain in the stomach during palpation.
Deep moving
The examination is scheduled after a visual inspection. Perform the procedure with fingers slightly bent along the middle phalanx, which are parallel to the stomach. The patient’s exhaled hand slowly plunges into the abdominal cavity, the fingertips of the doctor slide along the back of the stomach, which helps to establish the mobility, soreness and structure of the organ. You need to exhale from 2 to 4 times in one click of a doctor. Deep palpation of the stomach is carried out starting from the intestine and ending with the pylorus. When pain occurs, determine their nature and localization. During the procedure, the position of the organs relative to each other, their size and the possibility of displacement, the nature of sounds, the presence of seals or tumors by determining the lower boundary of the stomach are also recorded.
The procedure can also be performed when the patient is standing. In the vertical state, it is possible to find a small curvature and highly located neoplasms of the pylorus.
Auscult-percussion, auscult-affrication
The purpose of these examinations is to determine the size of the stomach and its lower border. With auscultic percussion of the stomach, the doctor using one finger makes superficial strokes in a circular motion with respect to the phonendoscope.
With auscultation, a finger is carried along the abdominal wall, making raking movements. While the finger goes over the stomach, a noise is heard in the instrument, when they go beyond these boundaries, the rustling stops. The area where the noise has disappeared indicates a lower limit. From this point, the doctor begins to make a deep palpation. Detection of a solid stomach during palpation indicates a tumor. Very often under the fingers there is a large curvature of the epigastrium.
Percussion
Manipulation is carried out by means of superficial strokes of the finger, starting from the navel and moving towards the lateral zones of the abdomen. The patient is placed on his back. The method makes it possible to determine the Traube space, that is, the presence of a gas bubble at the bottom of the epigastrium. This type of palpation is performed on an empty stomach, if the volume of gas is insignificant on an empty stomach, a preliminary diagnosis of pyloric stenosis is made.
In this way, the presence of fluid in the stomach is also detected. The patient is asked to lie on his back. The doctor also asks the patient to breathe deeply, using the stomach in the respiratory process. The gastroenterologist with four bent fingers of the right hand makes quick, short jerks in the epigastric zone. With his left hand, the specialist fixes the abdominal muscles in the lower sternum. If there is fluid in the stomach, a gurgling sound appears. The procedure makes it possible to determine the lower boundary of the stomach and the tone of the organ.
The specifics of palpation in children
To carry out the procedure in infants, the following requirements must be observed:
- the child should lie on his back, the muscles in the baby should be relaxed;
- Before conducting a doctor, you need to warm your hands;
- when there is pain, to which the child reacts with crying, you must immediately stop the procedure.
The palpation procedure allows you to determine the lower border of the stomach in young children, as well as to identify the syndrome of greater curvature of the stomach. It is necessary to pay attention to the thickness of the skin of the child and the elasticity of the muscles.
Diagnosis in children begins with the stomach and ends with the navel, where the intestines are palpated. Palpation of the stomach is an important link in the process of diagnosing gastrointestinal diseases. Proper procedure allows you to make an accurate diagnosis and timely start treatment therapy.