Detection of kidney pathologies in a patient begins with a survey, visual examination, listening to the organ( auscultation), as well as percussion and palpation of the abdominal cavity. Inspection directly "manually" passes exclusively with percussion( percussion) and palpation( palpation).
Palpation of the kidneys
Palpation refers to one of the oldest method and allows you to make primary conclusions about the health of internal organs. Normally, palpation does not cause painful sensations in the absence of pathologies.
There are 2 types of palpation of the kidneys: probing is superficial( not requiring strong pressure deep into the body) and deep. During the diagnosis, the patient should be in the supine position. Exceptions include Obraztsov's school - the examination is performed both horizontally and vertically( standing, sitting).
The examination is guided by an easy feeling for primary findings about the state of the kidneys. Straightened hands of the doctor simultaneously perform a symmetrical stroking to feel the body( without pressure).
Surface palpation allows to determine:
- Sensitivity( presence of pain), temperature, humidity level and skin density of the patient.
- Seals and infiltrates under the skin.
- The tone of the abdominal muscles and the level of their tension.
For more accurate examination of the kidneys, a deep-type probe is used. Palpation is performed by several fingers( or one) with pressure inward to the patient's body.
The deep type of palpation defines such types:
- Bimanual - a feeling with the help of two hands is considered the most optimal method for diagnosing the kidneys. It is performed as follows: the left hand holds the organ in a comfortable position, and the right hand palpates the kidney. Hands move towards each other.
- Slip - a consistent slow palpation of the kidneys and other internal organs. The organ, pressed to the back wall, is felt by several fingers of the doctor.
There is also a third type of deep palpation - jerky, but it is used for diagnosis of the kidneys. It is used for examination of the liver and spleen.
Deep palpation can diagnose diseases such as:
- Nephroptosis is the omission of the kidney.
- Dystopia is an abnormal location( displacement) of the kidney.
- Hydronephrosis - an increase in the cavities of organs.
- Polycystic is a cyst in the kidneys.
Palpation of the internal organs can take place in the supine position( on the side, on the back), in the knee-elbow position, while sitting, as well as standing.
Techniques for performing
According to Obraztsov-Strazhesko
The first in the list of techniques for performing palpation is the most common technique for Obraztsov-Strazhesko-deep sliding palpation. Before the discovery of Vasily Parmenovich Obraztsov, it was believed that it was possible to probe exceptionally serious changes in internal organs. Vasily Parmenovich proved that the abdominal cavity can be palpated in a healthy patient, and not only in a patient.
The Obraztsov technique is called methodical, since it is performed sequentially: examination begins with the sigmoid colon, then the caecum, the iliac( terminal section) and the transverse colon, the ascending and descending part of the large intestine, large and small curvature of the stomach, pylorus, departmentsliver, spleen and pancreas.
Rules for the execution of technology:
- Slightly bend the fingers on the right hand and begin to feel the necessary organ. Let's pay attention, that for performance of a palpation it is necessary to know in detail a site of the concrete body.
- Next, we form the skin fold.
- The tips of the fingers( or one finger) slide along the organ in the abdominal cavity towards the back wall.
Thanks to the deep methodical sliding palpation it is possible to find out the consistency( density), size, level of soreness of the organ.
On video, the technique of performing palpation of the kidneys according to Obraztsov-Strazhesko:
According to Botkin,
, Sergei Petrovich Botkin, for the first time suggested carrying out a binomial palpation of the kidneys not in the recumbent, but in the standing( or sitting) position of the patient's body. The method is applicable only to patients with normal or moderate weight, and also in children - in full people in an upright position, the enlarged abdominal wall hangs. Of particular importance is Botkin's technique in nephroptosis( a wandering kidney, or, more simply, an organ displacement in the pelvic region).
In the vertical position, the kidney is lowered under the influence of its severity, which allows the doctor to more accurately determine the anomaly - excess mobility of a streamlined body sliding between the fingers.
On the video palpation of kidneys according to Botkin:
According to Glenar
The technique of palpation according to Glenar is used much less often than the two described above methods.
The diagnosis is carried out as follows:
- The patient is placed in a supine position( on the back).
- The left arm of the doctor grasps the patient's side so that the thumb passes into the hypochondrium, and the other fingers in the lumbar region, from behind.
- The second hand is placed in the hypochondrium, as if continuing the thumb of the left hand.
- The patient takes a deep breath, so that the right or left kidney moves with the lower part to the thumb of the left hand.
- The kidney is captured and it under pressure moves upwards to the hypochondrium.
- The right hand fingers perform a sliding palpation of the anterior surface of the organ.
Glenar's method, like Botkin's, is effective for determining the presence or absence of nephroptosis in a patient, as well as the detection of tumors or enlargement of the kidney.
According to Gyuon
Another modification of the Obraztsov-Strazhesko technique is that the body is also positioned horizontally, but the difference is that the patient's left arm is slowly moving to his right hand. The technique is used to diagnose diseases in children, and palpation is used only with one finger of the hand( this is due to the small size of the patient's organs).
Palpation for Guyon is called kidney balloting and allows palpation of the kidney when none of the other methods are appropriate. It is carried out this way: by bending fingers, the doctor moves the kidney with jerky movements forward.
Using percussion makes it possible to differentiate the presence of tumors( malignant, benign).If deep and superficial palpation is characterized by stroking and pressing, percussion is a tapping( or tapping).
Sometimes with percussion, you can listen to a tympanic sound - this means that there is fluid formation or other abnormalities. It is not recommended to perform percussion alone - tapping a kidney requires a lot of experience and appropriate skills.
Video on percussion of the kidneys:
Apply penetrating type palpation for the diagnosis of soreness in the ureters and kidneys. The procedure is mandatory if the patient has pain, swelling, blood when urinating or painful urination, sand in the urine and other complaints.
After palpation, it is necessary to undergo a series of actions to make a diagnosis:
- General analysis of urine.
- X-ray of the kidneys.
- Ultrasound organs.
- Radiological examination.
- Renal biopsy, immunofluorescence, light and electron microscopy.
Palpation of the abdominal cavity is an integral part of the diagnosis of kidney disease, but a more accurate picture of the patient's condition is possible only after the tests and X-rays.