Certainly, palpation of the pancreas provides very important data for assessing its condition, but it should be understood that this applies, in general, to cases when the disease has caused a significant change in the volume of the body as a whole or its individual sections, or a change in consistency. In addition, an important role is played by some factors, for example, emaciation of the patient, untrained abdominal press and some others, since this greatly facilitates access to the points. In some cases, with sufficient experience of the doctor and favorable conditions of the survey, it allows to detect even a small tumor or a slight condensation in pancreatitis. In addition, it should be noted that tumors of the tail or body of the pancreas feel much easier than changes in her body.
Palpation is informative, even when the changes are not yet so obvious as to notice them by touch, as it shows which parts of the patient are experiencing pain. The palpation of the pancreas is performed on an empty stomach after the bowel has been emptied. The effectiveness of the study will increase if the patient is washed on the eve of the intestine, give a laxative, and put an enema an hour before the examination. When feeling, the patient should either stand or lie, while for each method of feeling there are rules and certain points, which need to be paid close attention.
The presence of inflammatory diseases contributes to increasing the resistance of the muscles of the human abdominal press, which makes it difficult to detect even significant pancreatic tumors( the size of an orange or a chicken egg).In addition, the presence of inflammatory diseases, and, as a consequence, adhesions around the neoplasm of the organ, makes it difficult to diagnose them with the help of palpation, since there is no respiratory and passive mobility.
There are often cases when palpation of the pancreas allows you to clearly define not only the tumor itself, but also roughly indicate its shape, consistency, degree of tuberosity, size, sensitivity, and also determine the type( hematoma, echinococcus, cyst).That is why, when properly conducted, this method of examination is of great importance for the diagnosis and the appointment of an effective treatment.
Palpation of the pancreas in the Grotto is carried out in a prone position with bent hip and knee joints. The right hand is behind your back. The fingers of the hand palpate the left side of the abdomen in a straight muscle and, when exhaled, they sink to the back wall of the peritoneum. The gland feels like a roller. Painful sensations in the region of the tail and the head, irradiating to the waist, indicate chronic pancreatitis. According to the Grotto symptom, a reduced content of subcutaneous fat is observed in the examined segment of the abdomen. During the manual study of the abdomen, the front wall of the abdominal cavity in the pancreas region is felt.
Intensive pancreatic palpation with pancreatitis causes pain syndrome. The pain in the Mayo-Robson point tells about the defeat of the tail, three centimeters upward from the navel - the body, in the Schoffar triangle - the head. Diagnosis of exacerbation of pancreatitis allows:
- painful sensations when you press the left nerve muscle and in the left hypochondrium;
- cutaneous hypersthesia in the region of innervation Th8 of the left segment( Kacha symptom);
- increased pain in the supine position on the right side in the Mayo-Robson area;
- pain with palpation six centimeters above the navel.