One of the informative diagnostic methods is palpation. With its help, you can identify a number of serious pathologies in humans. A special technique is palpation of the points of the gallbladder. This body has certain features. It is impossible to palpate it in a he althy person, since its size is small, and the walls are soft. Therefore, doctors use special techniques to diagnose various diseases. They will be discussed further.
Features of the procedure
Knowing the points of palpation of the gallbladder, the norms of the patient's reaction to such influences, the doctor can identify various pathologies in the body. This organ is located at the bottom of the right lobe of the liver. It has a relatively small size. It reaches a length of 14 cm, and a width of only 5 cm. Its texture is soft. In he althy people, the gallbladder protrudes from under the liver by only one centimeter. Therefore, it is impossible to probe this organ if there are no serious pathologies in it.
There is a whole list of ailments that can thicken the walls of the gallbladder. The most common cause is inflammatory disease. The structure of his tissues is also disrupted by tumors, multiple adhesions (appear after pericholecystitis, which the patient once had).
Gallbladder disease
If the gallbladder is unnaturally large, palpable, this may indicate the development of such ailments:
- tumors (benign and malignant), metastases;
- pancreatic head cancer;
- dropsy;
- cholelithiasis, which is accompanied by the formation of a large number of stones in the body, blockage of the ducts;
- empyema (accumulation of purulent contents in the gallbladder due to bactericidal infection).
In these cases, the specialist probes the organ under the lower border of the liver. The gallbladder in this case is located outward from the lateral edge of the (lateral) rectus muscle on the abdomen. It is located approximately at the intersection of the line (horizontal) that runs parallel to the ninth pair of ribs.
Since the organ is usually not palpable, if there are no pronounced diseases, the impact on the points of the gallbladder and pancreas is carried out. This is an effective diagnostic method that allows you to identify abnormalities at an early stage.
Inspection tasks
Every specialist who performs palpation knows pain pointsgallbladder. This allows not only to determine whether the organ is enlarged. This technique detects diseases, even when the gallbladder is not enlarged. By pressing on certain points, the doctor observes the patient's reaction. If soreness appears in one place or another, this indicates the development of a certain ailment.
Palpation of the acupuncture points of the gallbladder reveals a number of inflammatory pathologies in the organ, as well as in the ducts and canals that go to it. There are a number of specific symptoms that indicate the presence of pathology. For example, a doctor can determine if a patient has Ortner's symptom. It appears when tapping along the edge of the costal arch with the edge of the palm. The doctor performs this manipulation in the place where the gallbladder is located. If this symptom is present, the patient develops an inflammatory process in this organ.
To confirm this assumption, the doctor performs a few more manipulations. As a result, in most cases, Obraztsov-Murphy and Zakharyin's symptom also appears. Tapping with the palm of the hand in the area of the gallbladder causes pain. Moreover, it is acute during inflammation.
Palpation allows you to determine not only the type of disease, but also to determine the place of its development. So, for example, there are points of the gallbladder canal, its ducts. Similarly, chronic and acute forms of organ disease are diagnosed. During the procedure, the doctor can assess the size of the lesion, determine the nature of the walls of the gallbladder, etc.
Pain points
To identify the disease in the early stages of development, the doctor performs palpation according to a certain system. He presses on the points of the gallbladder on the abdomen and back, determining the reaction to such influences. Palpation is carried out in different parts of the body.
The technique includes examination in the following areas:
- The point at the lateral edge of the rectus abdominis muscle tissue to the costal arch.
- Epigastric region.
- The choledochopancreatic zone is palpated 5 cm to the right of the navel.
- Between the legs of the sternocleidomastoid muscle is the point of the phrenic nerve, which belongs to the cervical clutch. When you press it, you may experience pain in the shoulder, under the collarbone. Sometimes it is concentrated in the hypochondrium on the right. This projection is called "phrenicus-symptom".
- The acromial point is located on the right shoulder. It protrudes most towards the acromial scapular process.
- Scapular point. Located near the lower right corner of it.
- Points of the 8th, 9th and 10th vertebrae. This is the area of Baos.
Considering the points of the gallbladder and the symptoms of certain pathologies of the organ, it should be noted that sometimes pain appears with pressure on the right side of the region from the tenth to the twelfth vertebrae. You can also detect gallbladder disease by tapping with the edge of your palm just to the right of the area from the ninth to the eleventh vertebra of the thoracic region. The doctor may also apply pressure as well as tapping.
Features of palpation
When palpation of the gallbladder, identical techniques are used, as in a similar procedure for the liver. There are different methods to carry out such a procedure. Some of them are not even spelled out in special textbooks, but they turn out to be much more effective. One of the original methods of palpation is pressure on the points of the body when a person is in a sitting position. In the classical technique, the patient must be in the supine position during the procedure.
Tapping of the gallbladder canal or its other parts can be carried out according to the original method. The patient should sit on a couch or a hard chair. Then he should lean forward a little. Hands need to lean on the couch or chair. In this position, the abdominal muscles will be relaxed.
During the palpation, the doctor tilts the patient's torso more or less forward. He is also asked to perform certain breathing exercises. At this time, the doctor presses on certain points on the body. During breathing exercises, the patient performs the movement of the abdomen. The doctor is in front and to the right of him. The medical specialist holds the patient's shoulder with his left hand. So he can periodically change the angle of the torso. This allows you to achieve relaxation of the abdominal muscles.
The right palm of the doctor at the time of such an examination is first at the right outer edge of the rectus muscle on the abdomen. It should be perpendicular to the anterior abdominal wall. When the patient exhales, the doctorplunges into the hypochondrium. So he can get almost to the very back wall.
Then the patient takes a slow deep breath. The liver at this moment falls on the palm of the doctor with its lower edge. This organ can be well felt at this moment. The doctor can evaluate at this moment the elasticity of its tissues, sensitivity and general characteristics of the lower edge of the organ. At this point, it is possible to palpate the gallbladder. This allows you to identify certain pathologies. With the classical method of palpation, it is much less possible to feel the gallbladder.
Choice of technique
Points of the gallbladder are probed in different ways. Classical palpation has a number of disadvantages. Only the doctor's fingertips touch the organ being examined. Therefore, only the most protruding areas of the liver can be examined in this way.
If the procedure is carried out when the patient is in a sitting position, the liver and gallbladder are felt over the entire surface of the phalanges. This is where the fingers are most sensitive. This method allows you to feel a large area of the organs at the time of the study.
By palpating the points of the gallbladder on the body, the doctor using the presented technique can identify the causes of pain in the organ. The method of probing in a sitting position is the most informative.
Other diagnostic methods may be used. So, the patient is in a supine position. The doctor puts his left hand on the costal arch. In this case, his thumb should be on the meridian of the gallbladder. pointson the surface of the chest are pressed with the rest of the fingers.
At the moment of inhalation, the doctor feels the area where the gallbladder should be. At the same time, it performs multidirectional sliding movements. The researcher must consistently dive into the area under the ribs. This is how the lower border of the organ is felt. During the examination, the doctor uses several different techniques.
Diagnostic techniques
Projection points of the gallbladder can be palpated using various techniques. There are a number of officially approved techniques that the researcher uses during this procedure. They provoke the occurrence of pain symptoms. According to what sensations the patient has during such manipulations, the doctor can determine the features of the pathology of the organ. There are a number of specific symptoms that occur during palpation.
So, for example, to determine the symptoms of Kerr and Obraztsov-Murphy, penetrating palpations are used. To establish the presence of symptoms such as Grekov-Ortner, the researcher taps the side of the palm adjacent to the little finger (ulnar) along the costal arch on the right.
With the help of special techniques, it is possible to identify the “phrenicus symptom”. To do this, the doctor presses with his index finger on the point between the legs of the sternocleidomastoid muscle. When pain occurs, it can be said that pathological processes develop in the organ. However, they can be localized near the body. Muscles in itarea tense.
Multiple studies have confirmed that palpation of special points can reveal inflammatory processes that occur in the gallbladder and its ducts, supply tracts. If the muscles are tense in the projection area of the organ, this may indicate an inflammatory process that also develops in the peritoneum.
The most painful sensations can be determined in the area of the gallbladder itself, as well as the Chauffard triangle. This is an area that is limited by an imaginary horizontal line drawn 6 cm above the navel. The second side of the triangle is the midline of the body. The hypotenuse of this area is a straight line drawn from the navel to the right and up at an angle of 45º.
Symptoms
During the palpation procedure, various pain syndromes occur in the presence of pathology. They may be different. Each symptom has a name and a specific description. There are the following symptoms:
- Kerra and Lepene. Revealed with classical palpation. The doctor presses on the exhalation on the point of the gallbladder. In this case, the Kera and Lepene symptom is confirmed if the pain is localized in the area located directly above the organ.
- Murphy. Appears when breathing is interrupted during a deep breath. This is a sharp pain in the abdomen. It appears when pressing the thumb on the area below the costal arch approximately in the area of the gallbladder. Other fingers of the doctor at this moment should be located on the edge of the arc. Murphy's symptom can also appear on palpation of the patient in a sitting position. Doctor inthis time is behind the person. He places his fingers on the gallbladder area. If the patient's breathing is interrupted during deep inspiration at the time of palpation, this is also called Murphy's symptom. There is also severe pain. In some patients, such sensations develop spontaneously against the background of a deep breath. The doctor may not even press on the gallbladder.
- Lepene. Pain is aggravated by tapping the edge of the hand on the area of the right hypochondrium, when the patient takes a deep breath. At the same time, when you exhale, discomfort decreases.
- Lida. Occurs in chronic cholecystitis. At the same time, the muscles become flabby and atrophy in the right hypochondrium.
- Baos. Reveals the development of acute cholecystitis. Soreness appears with pressure on the right (recede 4-5 cm) from the twelfth vertebra with a slight displacement of the tissues.
- Skvirsky. Reveals cholecystitis. The pain appears when pressing the edge of the palm on the area, which is located between the ninth and eleventh vertebrae on the right.
- Mussi-Georgievsky (“phrenicus-symptom”). Appears in the presence of pathologies of the liver and gallbladder. The pain appears at the moment of pressure on the point, which is located between the legs of the muscle on the right at the upper edge of the clavicle. This is where the nerve of the diaphragm is located. With the development of the disease, this acupuncture point is irritated. The gallbladder duct, liver and gallbladder tissues are checked for this symptom.
- Ortner-Grekov. Allows you to identify the inflammatory process in the gallbladder. Pain syndrome occurs whentapping with the edge of the palm along the lower edge of the costal arch on the right.
These are the main symptoms by which one or another pathology can be diagnosed. The doctor may identify one or more of these manifestations. After that, a decision is made on further actions.
Gallbladder Enlargement
By pressing on the painful points of the gallbladder, the doctor reveals many inflammatory processes. However, with the appearance of diseases in the middle and advanced stages, the organ will be enlarged. It can be felt. Against this background, painful symptoms may appear when acupuncture points are pressed.
The gallbladder may increase due to the development of such diseases:
- appearance of stones inside the body;
- accumulation of bile, increase in its quantity;
- accumulation of pus in the organ cavity.
These processes cause more or less pain. After palpation, the doctor prescribes additional diagnostic procedures. Only then is an appropriate diagnosis made. In addition to these reasons, the gallbladder may increase due to dropsy. In this case, the organ is filled with edematous fluid instead of bile.
Wall sealing
There are different diseases of the gallbladder. The points that the doctor presses on react differently in the presence of different pathologies. Additional data can be obtained by palpation of the organ itself. If, with the appearance of some pain symptoms, when pressing the points, it is found that the tissues of the gallbladder have become denser, become elastic, thisindicates a number of pathologies.
Such changes may appear when the duct is blocked by a stone. At the same time, the organ itself does not increase. The walls do not stretch, but are strongly compacted. Also, their structure becomes heterogeneous. When pressing on the gallbladder, pain appears.
If the cause of the painful symptoms lies in the blockage of the duct by a tumor, the organ will increase in size. It accumulates bile. It can take on an egg or pear shape. The walls will be elastic.
If a tumor develops in the head of the gallbladder, the walls tense up. Pressure does not cause pain. When breathing, the organ may move slightly to the side.
Having considered the features of diagnosing diseases of the gallbladder, palpation points and methods of influencing them, one can understand the methods for identifying various ailments of this organ.
