Various examination methods in determining the diagnosis allow the most accurate conclusion about the causes of impaired body functions. One of the common methods for suspecting a malfunction of various organs of the digestive system is palpation of the abdomen.
Symptom of Voskresensky: clinical manifestations
During palpation of the abdomen in the epigastrium, it is determined that the patient does not have or is significantly weakened pulsation of the abdominal part of the descending aorta. This symptom is a characteristic sign of acute pancreatitis.
But the symptom of Voskresensky is not pathognomonic. That is, similar phenomena can be evidence not only of acute pancreatitis, but also retroperitoneal hematoma, an increase in some lymph nodes, etc.
Justification from the topographic anatomical point of view
It is known that the pancreas is projected onto the anterolateral abdominal wall in the epigastric region and on the left hypochondrium. The lowermost part of the pancreas and the lower edge are projected at a distance of about 5 cm above the navel, and the upper is about 10 cm above the navel. The location of the pancreatic head is to the right of the VI-VII ribs, and the tail is the left hypochondrium.
The retroperitoneal location of the head determines its close connection with the duodenum. Behind the pancreas is the abdominal part of the descending aorta.
If there is no pathology, aortic pulsation is easily determined during palpation of the abdomen in the epigastrium.
The absence of pulsation in the abdominal region of the descending aorta in the presence of acute pancreatitis can be explained by the fact that the enlargement and tightening of the pancreas leads to the fact that it blocks a significant area of the aorta in front, which prevents the palpation of its pulsation.
Other symptoms of pancreatitis
Symptom of Voskresensky with pancreatitis is one of the most important manifestations of this particular disease.
Pancreatitis is an inflammatory and dystrophic disease of pancreatic tissue. More often occurs as a chronic form and has a rapidly progressive character. The final stage is characterized by the cessation of the pancreas performing its functional.
The most typical causes of this ailment are:
- Frequent and excessive use of alcoholic beverages.
- Diseases of the biliary system (usually in women).
- A diet low in protein and fat.
- Hereditary pathologies associated with impaired amino acid metabolism.
The predominant part of complaints is associated with the occurrence of severe pain of various localization. Acute pancreatitis causes unbearable pain in the upper abdomen, extending to the back. Chronic pain syndrome is characterized by lower intensity and sometimes resembles a heart attack in terms of pain.
The objective symptoms of pancreatitis, including the Voskresensky symptom, are not associated with the pain threshold of the patient, therefore, these signs become in this case the main criterion in determining the diagnosis. These also include apparent yellowing of the sclera of the eyes; the patient's complexion changes from pale to earthy; eye cavities become pronounced; there are bloody spots on the abdomen and in the inguinal region; the tongue becomes yellow; breathing quickens; severe pain during palpation.
Examination methods for suspected acute appendicitis
In women, acute appendicitis is much more common than in men. It appears, as a rule, suddenly. There are severe pains in the epigastric region, aggravating and spreading throughout the abdomen. Then there is a localization of pain in the right iliac region (Kocher symptom). Often there may be a single vomiting, delayed stool. In some cases, diarrhea is also possible, which intensifies if the inflamed appendix is localized in the pelvic region. Possible irradiation of pain in the lumbar region or right leg, which is called the "symptom of tying the shoe."
If there are destructive forms, then the weakening of pain and the appearance of chills are characteristic; increased heart rate and a slight increase in temperature. In this case, thirst occurs, and the stomach remains the correct form. Inspection allows you to diagnose a delay in breathing in the area of the right lower abdomen. There is hyperesthesia of the skin in the right iliac region, which is called the symptom of Razdolsky. There are also clinical manifestations of the Crimean symptom, consisting in soreness in the process of feeling the right inguinal ring
The retrocecal location of the appendix in case of acute appendicitis provokes activation of muscle protection in the lumbar triangle (Petitov's symptom).
Symptom of slip (Voskresensky) in acute appendicitis
The symptom is that the doctor, being on the right side of the patient, pulls his shirt down with his left hand, and gently glides with his fingertips in the direction from the epigastric region to the right iliac. It is important that upon completion of the slip do not immediately remove the fingers from the abdominal wall. The fact is that it is at the end of the slip that the patient feels a sharp pain. Moreover, when sliding in the opposite direction, pain does not occur.
The symptom of a shirt is a name that is often used in this case. But it is somewhat incorrect. It is more correct to use the term “slip syndrome”.
In what cases is this symptom positive?
So, the symptom of Voskresensky is positive when the patient has acute pancreatitis. A symptom of glide, also discovered by this scientist, is observed in the case of acute appendicitis.