Examination of the abdomen

For examination and further examination of the abdomen, it should be sufficiently exposed. It is necessary that the inguinal areas be inspected in full. The patient should lie in a comfortable position. The room should be warm.

Examination of the abdomen

On the skin of the abdomen, so-called striae can be seen (whitish bands when stretched with edematous fluid or reddish brown with hypercorticoidism), superficial veins, the increased development of which is associated with liver pathology (collaterals with portal hypertension ).

The abdomen is involved in the act of breathing, the absence of respiratory movements is characteristic of acute peritonitis. In the epigastric region, pulsation of the abdominal aorta can be seen, more rarely it is caused by the hypertrophied right ventricle of the heart.

On examination, the shape and symmetry of both halves of the abdomen are evaluated. An increase in the abdomen can be with obesity, massive gas formation in the intestine, ascites, pregnancy, with a large ovarian cyst, sometimes with an increase in the gallbladder. Swelling and deformity of the abdomen, visible during external examination, are possible due to the presence of tumors of various localization, enlargement of the liver, spleen, kidneys. Through the thin abdominal wall, the normal peristalsis of the small intestine is sometimes seen. Hernias of different locations can cause local bulging of the abdominal wall. This applies to the umbilical hernia, the hernia of the white line of the abdomen, as well as the femoral and inguinal hernias.

[1], [2], [3], [4]

Palpation of the abdomen

It is important that the doctor's hands are warm. To relax the muscles of the front wall of the abdomen, the patient should be in a comfortable position with a low-lying head and arms stretched along the trunk.

Surface palpation begins with two hands from comparing the symmetrical areas of the abdomen (pain, muscle tension, etc.). Then, placing the entire palm on the stomach, the doctor begins to feel the stomach with the tips of the fingers of the right hand, starting from the sites furthest from the place of pain localization. When you move your hands on the surface of the abdomen, the abdominal wall tension, hernial opening, the abdominal wall muscle divergence, and soreness when probing certain abdominal parts are more accurately determined. Palpation as one of the main methods of physical examination of the abdominal cavity began to be widely used since the end of the last century, when in 1887 the domestic clinician VP Obraztsov first described in detail the results of targeted abdominal palpation. "Palpating in the horizontal position of the patient his stomach," writes VP Obraztsov, "I groped for three fingers below the navel, along the middle line, the gut in the form of a rather thick, mobile up and down, not giving a rumble of a cylinder, was traced to the right and left rising to the hypochondria and hiding behind them. With the same clarity and clarity ... I probed and dropped down two lateral cylinders, one of them, the left one, passed into the sigmoid and the other, the right one, into the blind gut. "

VP Obraztsov gives an important methodological advice (which is the basis of his proposed method of examining the abdominal organs): put your hands with slightly bent fingers on either side of the navel and start moving them up and down with the abdominal walls.

This method of direct physical investigation was called "methodical deep sliding palpation", because it combines the results of a sensation received by the doctor from the static (contact with the skin of the abdomen and the organ wall) and dynamic (penetration of the hand or fingers of the doctor deep into the body, slipping) palpation. Immersion of fingers should be carried out gradually, during each exhalation of the patient, which makes it possible to minimize the reflex tension of the abdominal muscles and press the organ under investigation to the back wall of the abdominal cavity: further palpation occurs when the fingers move in a direction perpendicular to the axis of the palpable organ. When carrying out these movements, it is necessary to move the fingers together with the abdominal skin and the underlying tissues. To begin palpation is better from the most accessible department - the sigmoid colon, then to pass to the blind, iliac, ascending, descending, transverse colonic, palpation of the liver, spleen.

Sigmoid colon can be probed by all healthy people, except for persons with large fat deposition. The sigmoid colon is normally palpated in the form of a dense, smooth cylinder, as thick as the thumb of the hand. It is usually painless, there is no rumbling.

The cecum is palpable in the right ileal region in the form of a painless cylinder, two fingers thick. It is possible to probe also other parts of the large intestine: the ascending, descending and transverse colon. More often their palpation remains ineffective. With more dense contents, these parts of the intestine can be palpated in the form of dense strands.

The large curvature of the stomach can be defined as a roller. It is found by feeling the epigastric region at different levels. The pylorus is probed to the right of the spine in the form of a strand of various densities. With pathological changes, the gatekeeper becomes more dense and painful. More often the stomach parts are not probed. However, in many patients with palpation, not only tenderness in certain areas of the epigastric region, but also the tension of the muscles of the abdominal wall (muscular protection), which is characteristic of peptic ulcer of the stomach, can be noted . Palpation of the stomach sometimes allows you to detect a tumor.

Percussion of the abdomen

The main goal of percussion of the abdomen is to determine how much the increase in the abdomen is due to the presence of gas, liquid or dense formation. For bloating associated with gas formation, tympanic sound is characteristic. Dullness of percussion sound is usually noted in ascites. In these cases, the stomach is often enlarged in volume, and the percussion sound becomes blunt in the lateral parts of the abdomen. When the patient turns to the side on the opposite side, tympanitis begins to be determined, which is associated with the movement of fluid into the lower abdominal parts.

The rectum is felt through the index finger inserted into the rectum through the anus ( finger examination of the intestine ). In this case, it is possible to establish in the rectum the presence of hemorrhoids, tumors, and also to feel the prostate gland adjacent to the rectum, the uterus, the ovaries, infiltrates in the abdominal cavity.

Auscultation of the abdomen

When peristalsis of the intestine, sounds appear that can be heard when the stethophonendoscope is applied to the abdomen. More often these sounds are heard every 5-10 seconds, however these intervals can vary. Peristalsis of the intestine disappears with intestinal obstruction due to obstruction of the intestinal lumen. The appearance of arterial noises when listening to the aorta and renal arteries at the point of their projection is associated with their narrowing. Occasionally, noise of friction is heard, resembling the noise of friction of the pleura in dry pleurisy, due to the presence of perisplenitis or perihepatitis.

[5], [6], [7], [8],

Additional research methods

Study feces. Includes a study on latent blood, microscopy and bacteriological research.

A study on occult blood is important for the diagnosis of gastrointestinal and hematological diseases. A positive result may be the only initial sign of a colon tumor, since bleeding is episodic and it is necessary to obtain results from at least three studies within a few days. In the presence of hemorrhoids, the material for investigation should be obtained with the help of a proctoscope.

The most suitable is a sample with guaiac resin. During oxidation, guaiac resin turns blue due to the activity of hemoglobin, which is similar to that of peroxidase.

At a microscopic examination, the stool particle is mixed on a glass with a drop of isotonic sodium chloride solution. At a microscopy erythrocytes, macrophages which are found out in a considerable quantity at ulcer lesions of a colon can be found. It is also possible to detect cysts and eggs of parasites, undigested meat fibers.

At bacteriological research in a feces always enough in considerable quantities enough various microorganisms find. Changes in the ratio of their proportion are noted in so-called dysbiosis. In this case, a special quantitative study of feces for the presence of bacteria is carried out.

Endoscopic examination. The appearance of gastrofibroscopes made it possible to significantly expand the use of the endoscopic method for diagnosing diseases of various parts of the digestive tract. In this case, the rectum and the inferior part of the sigmoid colon are examined using a solid endoscope. To study the colon, the patient should be sufficiently prepared (it is necessary to clean the guts with enemas). During the examination, in addition to the examination, a biopsy of altered tissues is made for microscopic examination. Currently, endoscopes remove relatively small pathological formations, for example polyps.

X-ray examination. First, an overview of the abdominal cavity is made, in which the kidneys, rarely the spleen, can be seen, stones in the kidneys and bile ducts are sometimes detected, and phlebolites in the pelvis are less common. Of particular importance is a picture of the abdomen in a standing and lying position for evaluation of the so-called acute abdomen. In this case, it is possible to detect the fluid level and the distribution of gas along the gastrointestinal tract.

Contrast radiography allows you to clarify the state of the digestive tract. When ingesting a barium suspension, one can detect narrowing or widening of the esophagus in one or another section. In the stomach, filling defects due to the presence of a tumor or ulceration of the mucosa may be detected. The duodenum and other parts of the small intestine are examined.

The large intestine is examined when a barium suspension is administered with an enema. Preparation of the patient consists in complete cleaning of the colon with the help of laxatives and enemas. Sometimes this causes certain difficulties and unpleasant feelings in the patient and serves as a relative contraindication to this procedure.

When X-ray examination of the gastrointestinal tract is important preparation of the patient, consisting in compliance with the diet for 2-3 days before the procedure. This excludes products that cause strong gas formation (fresh milk, peas, cabbage and other vegetables).

Endoscopy and contrast radiography of the digestive tract are considered as complementary studies. When an accurate diagnosis is established with the help of one of them, another is not required. Both methods are used when the Diagnosis is questionable and in any case if there is a suspicion of a tumor that may require surgical intervention.

Ultrasound examination. This method is used to obtain a two-dimensional image of the abdominal cavity, in particular, dense organs, such as the liver, spleen, kidneys, lymph nodes of the abdominal cavity.

Computer tomography. The method is used to estimate the dimensions of dense formations in the abdominal cavity, in particular the pancreas.

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