Superficial and deep palpation of the abdomen according to Obraztsov-Strazhesko: algorithm, video

Palpation of the abdomen is an important element of diagnosis. This superficial study, conducted by a specialist, can give a fairly wide range of information about the condition of the patient's internal organs.

Correctly performed palpation is painless and is able to indicate inflammatory processes, hernias, neoplasms and cysts. The amount of information obtained depends on which of the types of palpation the doctor performed: superficial or deep.

Principles of the

Examination Palpation of the abdomen is a very important study that is necessary to detect inflammation of the internal organs and the presence of tumors.

The main principle of such an examination is the sequence of actions when probing each area of ​​the abdomen and a full palpation of all parts of the abdominal region.

An important element is the professional approach of a doctor who conducts an examination of the abdominal cavity. The specialist should be short-cut nails, the palms should be warm.

These conditions are mandatory for the comfort of the study. Also, the cold hands of a doctor can lead to tension in the muscles of the abdominal press, which will complicate the process of palpation.

Tasks and algorithm for performing abdominal palpation of the abdomen

Palpation is necessary for examination of the internal organs of the abdominal cavity. This method of research can give an idea of ​​the properties of an organ, indicate the presence of neoplasms or inflammatory processes.

Also characteristic pain in any area of ​​the abdomen with palpation, allows you to narrow the range of causes that could lead to ailment and characteristic symptoms, in connection with which the patient turned to the doctor.

There are two important rules that a doctor who performs superficial palpation should observe:

  1. The most important rule of palpation is the following: to begin probing the abdominal cavity it is necessary exclusively with a painless abdominal area. Usually this site is located symmetrically in the painful part.
  2. Do not dig your fingers deep into the abdominal cavity. Also, fingers can not do circular movements immersing them deeper than necessary for superficial palpation.

Approximate

Surface belly feeling always begins with an approximate palpation. With its help, you can determine the level of muscle tone in the anterior abdominal wall of the abdomen.

This type of palpation allows you to determine the degree of resistance of the abdominal muscles in painful areas, as well as the possible divergence of the abdominal muscles( diastase) in the region of the white line of the abdomen or umbilical ring.

An orientation type palpation is required counter-clockwise, with exceptionally soft, non-circular movements. The palpation from the left ileal region begins. This is explained by the fact that this area is more often painless.

After feeling this area, the fingers are gently and gradually moved 4-5 cm upwards. Approaching the costal arches, palpation is performed taking into account the light touches of the ribs with the tips of the fingers. After that, the hands are moved to the opposite area, to the right flank. The palpation circle ends with the probing of the suprapubic region.

Immediately after this, the doctor begins a second round of probing( small circle).In this case, the doctor mainly focuses on the feeling of the perigipuric region. In case the stomach is very small, one circle of palpation is usually enough. In case the abdomen is large, both circles of the orienting palpation are mandatory.

The second, small circle of palpation also begins with the left ileal region. The movements are also soft and counter-clockwise.

An orientation type palpation is capable of giving a sufficiently large amount of information about the condition of the internal organs and the abdominal wall of the patient.

Comparative

The main objective of comparative palpation is the comparison of symmetrical areas of the anterior abdominal wall. Also, comparative palpation is needed for feeling the area of ​​epigastrium, hypogastrium and mesogastrium.

Begins palpation from the lower abdomen. The left and right iliac regions are compared. Later probed lateral and hypochondrium. This technique of palpation is also called "herringbone" palpation.

For this type of palpation, the doctor also examines:

  • umbilical ring;
  • inguinal rings;
  • abdominal area with postoperative scars.

This kind of feeling is different in that it is better to conduct it not in the classic horizontal position, but vertically when the patient sits. This position helps increase intra-abdominal pressure and allows more effective detection of abdominal wall defects.

Objectives of the deep

Therapist usually performs a deep feeling of the abdominal organs after performing a superficial palpation.

The aim of this study is to determine the position of the organs, their shape and consistency, and their size. Deep palpation also aims to identify pathological tumors, tumors and cysts.

The doctor pays special attention to the painful areas of the abdomen in the patient with deep palpation. This factor most often indicates a sick or sore organ. With the help of deep feeling, one can also determine irradiating pain.

The main condition for carrying out a deep type of palpation is the doctor's knowledge of the projection of each organ on the anterior abdominal wall.

The sequence of the sensation of each organ can vary, but the classical version of palpation is the following sequence:

  1. Large intestine.
  2. Pancreas.
  3. Stomach.
  4. Gallbladder.
  5. Liver.
  6. Spleen.

Research of that organ, which when sensed gives pain, is held at the very end. Investigation of the pancreas, stomach and colon produce on exhalation. Conducting deep palpation has a number of other rules, according to which it is carried out by a doctor.

How to conduct correctly?

The conditions under which deep palpation is performed are the same as for the surface type of the study.

The physician should relax the patient as much as possible. To reduce the tension of the muscles of the press, the patient should slightly bend his legs and put the soles on the bed. In more rare cases, palpation is also carried out in the vertical position of the trunk.

In order to maximally accurately palpate individual organs and understand their boundaries, research methods such as auscultation and percussion can also be performed.

  • Auscultation is a method in which a doctor listens to the patient's internal organs to identify specific sounds in them.
  • Percussion is a method in which a doctor gently rattles the patient's stomach and listens to the patient's reaction.

During the study, the patient should breathe smoothly, using diaphragmatic muscles. The doctor's fingers sink into the fabric gently and smoothly. At the same time, the goal of penetration is to pass the muscles of the press and reach the back wall of the abdominal cavity.

Examination in children

When palpating the abdomen in children, very important aspects that the doctor notes are:

  • moisture or dryness of the skin;
  • turgor - elasticity of the skin, muscle and fatty tissues;
  • elasticity of the skin;
  • temperature.

Abdominal palpation is the most important study. Carry it out very carefully. The most important aspect of a successful feeling is the relaxation of the muscles of the press. To achieve this goal, the hands of the doctor must be warm.

If the baby's skin is very sensitive and the baby reacts to touch, like tickling, then before the palpation begins, the doctor holds the palm on the stomach for a while.

Children of school and preschool age are palpated in the horizontal position of the trunk. The child is laid on his back, while the head is at the same level with the body. Palpation begins with the periapical region or the right iliac trunk.

Even at the first stage of feeling, the doctor can notice bloating or his sagging, and also understand what the tone of the muscles of the press is.

Pain syndrome

Pain in the abdomen with palpation is also referred to as ache. There is such a pain syndrome when pressing on a certain area of ​​tissue.

Often this pain signals a disease of an organ. What kind of body is sick you can understand by exactly where the pain appears during the palpation of the stomach.

Epigastric Stomach, pancreas, left liver fraction
Left hypochondrium Stomach, spleen, upper pole of left kidney, part of colon
Right hypochondrium Right hepatic lobe, upper pole of right kidney, part of colon, gallbladder
Left and right lateralarea Part of the colon, part of the small intestine, lower poles of both kidneys
Left iliac region Ureter, sigmoid colon
Right ileal region Cecum, right ureter, h
navel area navel, ureters, renal gates, pancreas head, small intestine loops
Suprapubic region Uterus, bladder, small intestine

Thus, pain in one part of the abdomen during palpation can indicate corresponding problems in nearbybodies.

Norm

The norm is the correct arrangement of organs in their places without going beyond the healthy area of ​​location.

Stomach, liver, pancreas and spleen are not enlarged, palpable clearly and are soft in texture, not loose. Normally, the gallbladder is not probed and does not cause pain in the patient. Bowel loops are located in their departments.

Video for superficial abdominal palpation:

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