Palpation of the stomach is carried out at the initial stage of examination of the gastrointestinal tract. The procedure refers to the physical methods of examining the patient. Palpation is carried out in the presence of problems with the digestive tract, the method allows you to determine the presence of hernias, neoplasms or cysts. There are four types of palpation, which differ in the sequence of examination of the abdominal cavity and the intensity of pressure with the hands.
Particular attention should be paid to the palpation procedure for children, because the skin of young patients is very delicate and sensitive.
Anatomy of the stomach
The stomach is an extension in the form of a bag designed for temporary storage and partial digestion of food taken. It performs important functions. The length of the organ reaches 20-25 cm, the volume is 1.5-3 liters. The size and shape of the stomach is determined by its fullness, the age of the patient and the condition of the muscle layer.
The stomach is located above the epigastrium, most of it is to the left of the median plane, and 1/3 to the right of it. The organ in a normal physiological position supports the ligamentousmachine.
The wall of the stomach consists of three layers, each of which has a specific structure. The gastric walls are protected by an inner epithelial layer - the mucous membrane. Beneath it is submucosal adipose and epithelial tissue, including capillaries and nerve endings. It contains the glands that produce the secret, mucus and peptides of the stomach.
Food enters the stomach through the esophagus and is digested under the influence of gastric juice and hydrochloric acid in the period of 2-6 hours. Then, due to periodic muscle contraction, the food bolus moves to the exit and is pushed out in portions into the duodenum.
Norm and deviations
Normally, the stomach is located on the left side of the body, but systematic overeating can cause it to shift to the abdominal zone of the organ. Near the esophageal opening and the transition to the duodenum there are thickening of the muscles in a circular shape. They prevent food from entering the esophagus. When the functions of the food valve are disturbed, gastric contents are thrown into the esophagus, causing heartburn. Damage to the sphincter causes bile, pancreatic juice to enter the stomach, or vice versa, the outflow of acidic contents into the intestine, which leads to irritation of the stomach walls and ulceration.
Normally, the position of the cardia is determined on the frontal wall of the abdomen in the region of 6-7 ribs. The arch or bottom of the stomach reaches the fifth rib, the pylorus - the eighth rib. The lesser curvature is located below, to the left of the xiphoid process, and the greater projection is arcuatefrom the fifth to the eighth intercostal space.
Depending on the specifics of the physique, specific forms and types of the human stomach are distinguished:
- Horn or cone shape. They occur when a person has a brachymorphic physique. The stomach has an almost transverse arrangement.
- The shape of a fishhook. It is typical for patients with a mesomorphic physique. The body of the stomach is located vertically, then sharply bends to the right, forming an acute angle between the evacuation path and the digestive sac.
- Stocking shape. It is fixed when the patient has a dolichomorphic physique. The descending zone of the stomach is lowered low, and the pyloric part is raised steeply upwards, placed along the midline or slightly away from it.
Shape data is inherent to a body in a vertical position. When a person lies on his side or on his back, the shape of the stomach changes. That is why the palpation procedure is carried out in the supine position in order to obtain the correct clinical picture characterizing a certain pathology.
Deviations from these norms and changes in the size of the stomach, as well as displacement of the organ indicate the presence of pathological processes and may be symptoms of a specific disease.
When is palpation performed?
Indications for the procedure are cysts, tumors of various genesis, hernia, displacement of organs, obesity, inflammatory processes. At the same time, the patient may complain of increased flatulence, pain in the stomach, it is possible to observe the clinical picture of appendicitis.
Doctor atThe initial examination also records weight loss in patients associated with food restriction, to clarify the presence of pain after eating, pallor of the skin, indicating hidden ulcerative bleeding, or gray skin, which is a symptom of stomach cancer.
Indicative inspection
Indicative examination helps to determine the tone of the muscle fibers of the stomach and the possibility of organ resistance in painful areas. This type of examination allows you to get a picture of the state of the organs in the abdominal cavity. Auscultoaffrication is used - light percussion with dashed finger movements. Palpation is carried out counterclockwise, by pressing and circular movements. Inspection begins on the left side, then the upper zone near the ribs is palpated and the procedure is completed by pinching the lower right side.
To clarify the diagnosis allows examination of the small circle of the gastrointestinal tract (around the navel). By palpation, the gastroenterologist determines the foci of pain and inflammation. With gastritis, palpation of the stomach causes severe pain, because its walls are inflamed, and even superficial tingling can increase pain.
Comparative method
The method is used to diagnose symmetrical zones of the abdominal cavity and examine the epigastric region. The procedure allows you to determine the correct location of the organ and its size deviations from the norm, if any.
The procedure is carried out from the bottom of the abdomen, comparing the iliac areas. The diagnostic process includes examination of the navel and inguinal area. Comparative view of palpationdiffers in the technique of the procedure. During palpation, the patient is in a sitting position, which makes it possible to identify pathological changes in the walls of the abdomen. The procedure makes it possible to determine whether the stomach is in the correct place, and what is the degree of change in the size of the organ.
Superficial palpation
In the presence of a pathological condition, palpation is accompanied by pain. The procedure allows you to determine the size and shape of the stomach, the level of tension in the abdominal muscles (normally it should be insignificant), to detect pain points and the lower border of the stomach. The method helps to make an approximate diagnosis of appendicitis with a painful abdomen and muscle tension on the right side.
Superficial palpation is carried out by gently pressing the fingers of one hand on the abdominal wall in specific areas. The procedure begins on the left, in the groin area, after which the hand is moved to the epigastric zone, to the right iliac region. The position of the patient is lying down, the arms should be along. During the entire procedure, the doctor clarifies with the patient exactly where he feels pain in the stomach during palpation.
Deep MA
Examination is scheduled after a visual inspection. The procedure is carried out with fingers slightly bent along the middle phalanx, which are placed parallel to the stomach. As the patient exhales, the hand slowly sinks into the abdominal cavity, the doctor's fingertips slide along the back wall of the stomach, which helps to establish the mobility, soreness and structure of the organ. Make exhalationsneed 2 to 4 times per doctor press. Deep palpation of the stomach is carried out starting from the intestine and ending with the pylorus. When pain occurs, their nature and localization are determined. During the procedure, the position of the organs relative to each other, their size and the possibility of displacement, the nature of the sounds, the presence of seals or tumors are also recorded by determining the lower border of the stomach.
The procedure can also be performed when the patient is standing. In the vertical state, it is possible to grope for a small curvature and highly located neoplasms of the pylorus.
Ausculto-percussion, ausculto-affrication
The purpose of these examinations is to determine the size of the stomach and its lower border. During ausculto-percussion of the stomach, the doctor, using one finger, makes superficial strokes in a circular motion in relation to the phonendoscope.
With ausculto-affrication, a finger is passed along the abdominal wall, making raking movements. As long as the finger goes over the stomach, noise is heard in the instrument; when these boundaries are exceeded, the rustling stops. The area where the noise has disappeared indicates the lower limit. From this point, the doctor begins to make a deep palpation. Detection of a hard stomach on palpation indicates a tumor. Very often, a large curvature of the epigastrium is felt under the fingers.
Percussion
Manipulation is carried out by superficial strokes with a finger, starting from the navel and moving towards the lateral zones of the abdomen. The patient is placed on his back. The method makes it possible to determine the Traube space, that is, the presence of a gas bubble at the bottom of the epigastrium. Heldpalpation of this type on an empty stomach, if the volume of gas on an empty stomach is insignificant, a preliminary diagnosis of pyloric stenosis is made.
This method also reveals the presence of fluid in the stomach. The patient is asked to lie on his back. The doctor also asks the patient to breathe deeply, involving the stomach in the respiratory process. The gastroenterologist with four half-bent fingers of the right hand makes quick, short jolts in the epigastric zone. With the left hand, the specialist fixes the abdominal muscles in the lower region of the sternum. If there is liquid in the stomach, a gurgling sound appears. The procedure makes it possible to determine the lower border of the stomach and the tone of the organ.
Specificity of palpation in children
To perform the procedure on infants, the following requirements must be met:
- the child should lie on his back, the baby's muscles should be relaxed;
- before the doctor needs to warm his hands;
- when pain occurs, to which the child reacts by crying, the procedure should be stopped immediately.
The palpation procedure allows you to determine the lower border of the stomach in young children, as well as to identify the syndrome of the large curvature of the stomach. It is necessary to pay attention to the thickness of the child's skin and the elasticity of the muscles.
Diagnosis in children begins with the stomach area and ends with the navel, where the intestines are palpated. Palpation of the stomach is an important link in the process of diagnosing diseases of the gastrointestinal tract. The correct procedure allows you to make an accurate diagnosis and start treatment in a timely manner.therapy.
