Palpation is a method of examining a patient in which a sense of touch of the fingers is used. The method complements the examination data and allows you to identify soreness, local temperature, skin moisture, mobility and size of the lymph nodes. Palpation examines all external structures, bones, muscles, joints, superficial vessels. This method determines the presence of edema and hematomas. Of particular importance in the diagnosis of diseases is palpation of the chest and abdomen. Consider the features of this survey.
Palpation of the abdomen is one of the main methods for examining the internal organs of the abdominal cavity. Using this method, you can determine some pathological changes in organs, as well as their location. In clinical practice, superficial and deep palpation of the abdomen is used.
Before palpation, it is necessary to sit to the right 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 torso, bend his legs at the knees. The hands of the palpator should be warm, dry, with short nails. Superficial palpation of the abdomen determine:
- tension of the muscles that make up 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;
- discrepancy of the rectus abdominis muscles , hernia, a symptom of peritoneal irritation.
Using this method, preliminary information about the condition of internal organs is obtained.
Before palpation begins, 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. A healthy patient does not have any pain during superficial palpation, the possible muscle tension in the abdominal wall is very slight and symmetrical on both sides.
With peritonitis, superficial palpation of the abdomen causes severe pain and muscle tension over the entire surface of the abdominal cavity. In 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. Using superficial palpation of the abdomen, a lot of 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 Obraztsov-Strazhesko method. This method was proposed at the end of the 19th century by a Kiev general practitioner V.P. Obraztsov and was further supplemented by Obraztsov's student - therapist N.D. Strazhesko.
Deep palpation of the abdomen is performed in a sliding way. The doctor suggests the patient to relax the muscles of the abdominal wall. During exhalation, the doctor plunges the hand into the abdominal cavity until you feel the surface of the investigated organ. Then the hand slides along the surface with the tips of the fingers located perpendicular to its axis. Hand movements are regulated by respiratory movements. Using the deep palpation method, it is possible to 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 the 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, spleen and kidneys. Thus, each patient is examined by palpation, regardless of what disease is suspected.