In the clinical practice of any medical institution, the first skills with which the doctor assesses the condition of the patient and determines the preliminary diagnosis are general examination and examination, as well as detailed regarding each body system, auscultation of the heart and lungs, palpation and percussion.
This is especially true for the doctor of the emergency room, who is allocated extremely little time for each patient, and if he arrives urgently, then in a matter of minutes. So often just a positive symptom of Shchetkin-Blumberg allows you to diagnose the patient with
signs of peritonitis and urgently transfer him to the surgical department. In the technique of palpation distinguish between superficial and deep, which directly assess the condition of internal organs. This technique is used mainly for suspected diseases of the gastrointestinal tract and genitourinary system, since the abdomen is most suitable for such a non-invasive, but often painful, study.
Some palpation techniques
For example, one of the main methods is the symptom of Shchetkin-Blumberg, Kera, Murphy, Shoffar, Mayo-Robson, as well as some diaphragmatic ones that project into the attachment of the sternocleidomastoid muscle to the clavicle. These methods reveal pain at certain points, which manifests itself in certain diseases. So, often a positive symptom of Shchetkin-Blumberg appears with appendicitis, peritonitis, perforation of hollow organs; Kera and Murphy - with inflammatory diseases of the gallbladder and its pathways. And the soreness at the points of Shoffar and Mayo-Robson (projections of the head and tail of the pancreas) indicates the acute phase of pancreatitis. However, the most important of them is, perhaps, precisely the symptom of Shchetkin-Blumberg, since its positive variant indicates irritation of the peritoneal interoreceptors, which means internal bleeding or the spread of the inflammatory process from the abdominal organ to this main serous membrane. And this condition is in any case an emergency.
Symptom of peritoneal irritation
To correctly check the Shchetkin-Blumberg symptom in a patient, it is necessary to give the hand a half-bent position in the interphalangeal joints (as if holding a small ball in your hand) and place three working fingers (index, middle and ring) in the abdomen. Then ask the patient to take a deep breath (at this time you need to collect the skin fold and pull it down), exhale (deepen your fingers 3-4 cm) and sharply pull them back. A positive symptom of Shchetkin-Blumberg is considered if, with the last act, soreness in this place increases sharply. It can also be negative and doubtful. Most often, such a check is done if the patient enters an
emergency room or clinic with
acute abdominal syndrome and complains of prolonged progressive pain. Most often, the symptom of Shchetkin-Blumberg is positive with
flood peritonitis and appendicitis. In this case, the patient is urgently transferred to surgery, so that specialists have already specified the reason for the manifestation of this symptom.