Palpation of the pancreas is a complex procedure, as the organ is located deep in the peritoneum. If the organ is healthy, only 1% of men and 4% of women get a feel for it. But pathology often does not reveal itself at all, deviations in the state of health for a long time remain unnoticed.
Inspection tasks
The pancreas is usually found only when it is compacted and enlarged. When palpation is established the location, shape and size of the organ. If a deviation or an increase is detected, then differential diagnosis is performed between anomalies in the structure of the organ, inflammation and neoplasm.
Inspection
Inspection begins with the collection of complaints. Pain can be of duration and nature of different. Attacks occurring 3-4 hours after eating are characteristic of calculous pancreatitis.
Especially strong painful sensations are noted in acute pancreatitis. If they persist for a long time, then this is possible with tumors.
General examination provides an opportunity to detect a general depletion of the patient, the presence of jaundice.
In pancreatitis, skin pallor and cyanosis are observed, which develops against the background of intoxication. In chronic forms, weight loss, dry skin and a decrease in turgor are observed.
Percussion
This procedure allows you to identify the presence of blunted tympanic or blunt sound. This phenomenon is often observed with cysts or tumors.
It is carried out on topographic lines from the level of the navel up. In healthy people, the pancreas during percussion is inaccessible.
In pancreatic diseases, the procedure allows to identify:
- tympanitis,
- pain,
- ascites,
- stupidity area over protection zone.
Thus, only very large tumors or cysts can move the stomach and loops of the intestines. In this case, in the middle part of the abdomen, a dull sound is heard during examination.
Palpation of the pancreas
Palpation is performed in the supine position after cleansing of the intestine with an enema. Sometimes a gastric lavage is prescribed. If the body is good, then the skin is epigastric painless, no stress. The thickness of the subcutaneous fat layer on the left and on the right should be the same.
With superficial palpation, attention is drawn to the sensitivity of the skin.
Painful sensations can be with acute pancreatitis or during an exacerbation of chronic form. Stress reflects the severity and prevalence of inflammation. But at the onset of the disease, this symptom may be absent.
The main points are investigated:
- Point of Desjardins. It is in the intersection of the conditional lines that connect the armpit to the right and the navel. With pain you can talk about the defeat of the head of the pancreas. Point of Mayo-Robson. It is located at the bottom of the line from the navel to the left armpit. Severe pain at the point suggests the inflammation of the tail.
- The point of Shoffar. She also talks about problems with the head. Find it on the right side of the middle of the abdomen by the umbilical angle bisectrix.
The Grotto method is used more often. The classic method allows to identify the problem only in the presence of tumor problems, as well as with a very flabby abdominal wall. In this case, the iron is probed as a fixed flat strand, located in the horizontal direction.
When it is possible to grope the normal gland, a feeling of rolling the fingertips through a painless roller with a diameter of about 1.5-2 cm is created. The organ should be immovable, do not grumble, do not change shape in response to the measures taken. This is different from the nearby organs.
Inspections begin with healthy tissues. The tail of the gland is palpated with the right palm. It is placed at the outer edge of the abdomen( left rectus muscle).Do this so that the fingertips are at the level of the left costal arch.
For convenience, doctors use the method of bimanual palpation. In this case, the left palm is put on the right side under the back of the patient. During the examination, the doctor exhales the posterior abdominal wall in the direction of the probing hand.
Auscultation
If there is an increase in the pancreas, squeezing of the abdominal aorta occurs. In this case, with a full exhalation, systolic noise is heard.
A phonendoscope is used for the procedure. With each exhalation he plunges deep into the abdomen. This action leads to a squeezing of the aorta and the appearance of stenotic noise.
Video of pancreatic palpation by Obraztsov: