Palpation is the most important diagnostic method of intestinal research. This method can only be carried out by a highly competent doctor who knows all the subtleties and rules for probing abdominal organs.
It is divided into 2 main types: superficial and deep. Each of these types allows you to obtain sufficiently important data about the patient's internal organs and their condition.
Palpation allows you to determine the presence of pain in any part of the intestine and make a preliminary diagnosis. Also, using this method of diagnosis, a doctor can determine the presence of various diseases. To confirm the diagnosis, it is enough to conduct some additional, instrumental studies and analyzes.
Inspection tasks for
The main tasks of the examination of patient 3, namely:
- Detection of neoplasms that can be benign and malignant. If any tumors are detected in the intestinal tract, additional procedures and instrumental studies may be prescribed, among which the most significant is a biopsy.
- Changes in the structure of tissues. At palpation, the doctor can detect obvious changes in the structures of the intestinal tissues, this can be looseness, thickening or thinning of any parts of the organ, which indicates the disease.
- Inflammatory processes of are also easily detected by palpation.
- Soreness - is the most important sign of ailment. It is this symptom that can indicate which part of the intestine is affected by the disease and how seriously the disease is. In determining the painful area during the feeling of the abdominal cavity, the doctor may prescribe a diagnosis.
Thus, there are a lot of tasks for this method of inspection. They also depend on the type of palpation( deep or shallow).
How is palpation of the intestine?
Palpation of the intestine involves two types of probing the abdominal cavity: superficial and deep.
If the patient has painful areas, an important rule that the doctor observes is the following: the feeling should never be started from a place that hurts. Usually the doctor starts from the opposite part of the abdomen.
Most often, palpation starts with the left ileal region and involves feeling the bowels in a circle and counter-clockwise.
Video on the technique of intestinal palpation:
With a superficial method of palpation, the doctor needs to relax the patient as much as possible. For this, the patient is placed in a horizontal position with legs slightly bent at the knees. So the muscles of the press relax as much as possible.
If the patient is still too tense, the doctor may distract him from the procedure by forcing him to perform respiratory gymnastics.
The probe is very smooth and neat. The area that hurts is probed last, since if you start the procedure from a painful area, the muscles of the anterior abdominal wall will stiffen, which will prevent a full examination.
A deep type of palpation is performed to diagnose serious changes in the structure of the intestine. The most important condition for probing the deep type is a clear doctor's knowledge of the projection of the internal organs on the anterior abdominal wall.
For the accuracy of diagnosis, when performing deep palpation, the doctor feels not only the intestine, but also other organs of the abdominal cavity.
During deep palpation the patient should breathe deeply, evenly and gently, through the mouth. In this case, breathing should be diaphragmatic. To facilitate the procedure, the doctor artificially creates the folds of the skin on the patient's stomach and then shifts the palm in the desired position.
When the palpation of the intestine the doctor always follows the following order of probing organs:
- sigmoid colon;
- the caecum;
- ascending and descending;
- colon of the colon.
When a deep type of palpation, the doctor necessarily determines the diameter, motility, rumbling and painful areas of all parts of the intestine.
Pain to the right of the navel most often speaks of a small intestine disease. Palpation allows you to determine the condition of the small intestine. Most often, both types of palpation are used, but it is the deep and sliding type of palpation that is more effective.
With the correct approach to the diagnosis and professionalism of a doctor, it is not difficult to carry out this procedure.
Palpation of the large intestine allows you to examine abdominal pathologies, assess their size, position and shape.
So, the conditions for carrying out palpation are in fact the same as in the study of the abdominal surface area. However, in this case, the doctor should be extremely focused and attentive, so as not to overlook important details.
The caecum is located in the right ileal region and has an oblique course. In fact, at right angles, it crosses the umbilical-ostal line.
Palpation should be performed in the right iliac region. The doctor's palm lies on the anteroposterior bone. The fingers are directed towards the navel and are in the projection of the cecum. When feeling, the skin fold is shifted towards the direction from the intestine.
According to generally accepted standards, the cecum must be soft and smoothly elastic, and also have a diameter of two transverse fingers.
The gut is palpated exclusively in the umbilical region at the same time with both hands. Palpation is carried out through the rectus abdominal muscles.
For palpating the doctor puts his hands on the front abdominal wall so that the fingertips are located at the level of the navel. The skin fold should be shifted towards the epigastric region.
Normally the transverse colon has an arcuate shape that is curved downwards. The diameter of the intestine does not exceed 2.5 centimeters. It is painless and easily displaced by palpation. If there are any abnormalities, you can find some soreness, enlargement, densities, tuberosity.
The sigmoid colon is located in the left ileal abdomen. It has an oblique course and almost perpendicular crosses the umbilical-ostal line. The doctor's brush should be placed so that the base of the palm is on the umbilical area. The tips of the fingers should be directed towards the anterior superior ostium of the left ileal bone.
Thus, the palpating brush should be in the projection of the sigmoid colon.
Feelings are painless, the gut does not grumble and rarely peristals. In the presence of abnormalities palpation is more difficult and slow.
The rectum examination is performed rectally in the knee-elbow position of the patient. It is preferable to perform an examination after defecation, since this can cause some difficulties.
When the patient is in serious condition, the examination is carried out lying on the left side with legs clamped to the abdomen.
First the doctor examines the anus and the skin of the buttocks of the perineum, as well as the sacrococcygeal region. It helps to detect fissures of the anus, hemorrhoids and others. After this, the patient should be asked to strain.
Then proceed to a finger examination of the intestine. The index finger of the right hand rotational movements are introduced through the anus in the rectum. Thus, the tone of the sphincter and the presence of tumor-shaped formations are determined.
Causes of pain
The causes of pain can be quite a lot, but the most common are the following:
- abdominal abscess;
- intestinal spasm;
- helminthic invasion;
- adhesions in the organs of the abdominal cavity;
- tumors in the intestine;
Pain can have a different character, which very often depends on the cause, which led to uncomfortable sensations.
Normally, the intestine does not cause painful sensations when palpating both superficial and deep. The patient does not feel any discomfort, tingling, or dull, aching pain. Acute pain syndrome is also absent.
The doctor does not detect any seals or loose areas of the intestinal tissues. Inflammatory processes, expressed by a strong swelling or enlargement of part of the intestine, are not observed.
An important aspect is the location of the intestine. The correct arrangement of all its parts indicates the absence of a curvature of the intestines or pathological processes. Also, with deep palpation, the doctor does not detect seals and neoplasms.
In the normal state of the organs, the doctor can test the blind, sigmoid, transverse colon. The descending and ascending sections of the large intestine are not constantly palpable.
The norm is also that when pressing the blind gut slightly rumbles. The transverse colon has a soft, not loose structure, seals and no formations.
Palpation of the rectum occurs by rectal-finger examination. Normally the absence of inflamed tissues, ruptures of tissue structures and hemorrhoids.