The gallbladder is an integral part of our body. This organ is part of the human excretory system, part of the digestive system. If there were no such bubble, then our entire intestine would be in fat globules. Funny? But it's true. Feeling the gallbladder (palpation), one of the ways to diagnose diseases of the organ under study. How is this procedure carried out? What methods of implementation exist? What can be revealed by palpation of the organ?
What is a gallbladder?
This is a small organ (14 cm - length, 5 cm - width) involved in the process of digestion. Its location is on the right, under the lower part of the liver. The bladder has soft walls, it stands out a little under the liver (by 1 cm), so palpation of the gallbladder in its normal state is impossible.
On the contrary, if the organ is palpable, then this indicates some kind of deviation from the norm. Feeling this organ is very difficult, but palpation of the gallbladder is a fairly effective method for detecting its diseases.
Palpation points
He althy (without pathologies or with a beginning disease) the gallbladder is not palpable. The same applies to the liver. But small areas of these organs can be felt, even if they are he althy and not enlarged. For example, the left lobe of the liver has a frontal surface or the bottom of the gallbladder. At the same time, the points of palpation of the gallbladder are easier to detect than to feel the organ itself. Pain that appears at certain points indicates inflammation of the bile ducts, the bladder itself, or other abnormalities.
Palpation of individual areas is a special diagnostic method. By pressing on the known palpation points of the gallbladder, the degree of the person's response shows what kind of pathology the patient has. Such diagnostics makes it possible to identify diseases at the initial stage, when the bubble is not yet enlarged and is not palpable.
These points can be:
- In the area under the pit of the stomach.
- In the area next to the GCS muscle.
- Under the shoulder blade on the right.
- On the right shoulder.
- At the site where the abdominal muscle and cartilage of the lower ribs connect.
Algorithm for the palpation process
For the prevention of diseases, palpation of the gallbladder is carried out, the algorithm of which is different for superficial, deep and comparative palpation. With superficial, the doctor does not press hard on the stomach of the patient lying on his back. First, on the left in the groin (the patient must report his feelings), then the fingers move 5 cm higher, then the epigastric region, and finally, the ilium on the right.
When deeppalpation palpation occurs with fingers immersed in the patient's stomach. Bent fingers to the second phalanges are pressed into the abdominal cavity, they move parallel to the gallbladder with skin capture, so that the hand moves freely along the abdomen. The fingers sink quite deeply, but only when exhaling. The organ is felt in this way for about 4 breaths. In this case, the fingers should reach the back wall on the side of the diseased organ, slowly moving towards it.
During comparative palpation, the left side is checked first, then the right. First, the iliac zone, the area around the navel, the abdomen (left and right), the hypochondrium, epigastric (left), and then along the so-called white line on the right are felt.
Liver and gallbladder
The liver, like the gallbladder, is an organ involved in the process of digestion. They are located side by side, interconnected anatomically and in the process of functioning. Partially, these organs are located inside the ribs and for the most part are not available for palpation. Therefore, palpation of the liver and gallbladder is carried out jointly almost always and according to a single method. The gallbladder can only be felt if it is enlarged.
What causes the gallbladder to enlarge?
The increase in this organ is due to a malignant tumor, a decrease in the tone of the walls, water edema (the bladder is filled with edematous fluid), blockage of the biliary tract, overflow with accumulated pus due to a bacterial infection, the formation of stones, accumulation of bile, a tumor on the head pancreas. ATIn this case, in the process of palpation of the gallbladder, a large compacted organ is felt, resembling an egg or a pear in shape.
An increase in the organ occurs when the disease is already in the middle or final stage.
Why is it necessary to examine the gallbladder?
Palpation of the gallbladder is regularly performed for the purpose of a general examination of the body, despite the fact that there are no complaints, and also in order to have a general picture of the patient's physical condition. In some cases, this is done to prevent the development of diseases of this organ and biliary tract. This, of course, is ideal, but most often people come for examination when pain occurs and most often acute.
The main thing when feeling the gallbladder is to identify its location, size, shape, sensitivity, condition of the walls. This diagnostic method allows you to identify not only the nature of the pathology, but also the place of its occurrence, for example, directly in the gallbladder or in its ducts.
Diseases affecting the gallbladder
Pathologies affecting the gallbladder:
- benign and malignant tumors;
- bladder head cancer;
- metastases;
- empyema;
- dropsy;
- cholelithiasis, which is accompanied by blockage of the bile ducts;
- cholecystitis (acute; chronic);
- dysfunction of the gallbladder (functional failures);
- biliary dyskinesia (hyper- and hypotonic; hyper- and hypokinetic);
- cholecystocholangitis;
- cholangitis.
Pathologies occur due to parasites that appear in the gallbladder:
- giardiasis;
- Dicrocoeliosis, etc.
Diseases can occur due to disturbances in the development of the organ itself. There are congenital structural anomalies, and there are functional ones. They lead to the fact that the outflow of bile is difficult or stops altogether.
Techniques for palpation of the examined organ
Palpation of the organ is carried out using the following techniques:
- penetrating palpation,
- light palm strikes on the ribs,
- pressure on the points around the collarbone.
For palpation of the gallbladder, the doctor chooses the technique based on the patient's complaints. The algorithm of the procedure is as follows:
- Pressing or tapping on the lower ribs on the right (Ortner's symptom is determined). In this case, the pain confirms dyskinesia of the gallbladder (bile ducts) or cholecystitis.
- Pressing the doctor's hand under the right lower rib with simultaneous exhalation of air by the patient (Murphy-Obraztsov's symptom is determined). The resulting discomfort is a sign of acute cholecystitis.
- Applying light blows to the body over the gallbladder of a patient lying on his back (Zakharyin's symptoms). Signs of acute cholecystitis in this case are pronounced. The patient may experience pain. If it is acute, then this indicates the development of an inflammatory process.
- The same light blows over the gallbladder area on the right side(symptom of Vasilenko). If pain occurs while inhaling, then this is a symptom of cholecystitis, cholelithiasis, urolithiasis.
- Press on the point between the 10th and 12th vertebrae (right). Pain indicates the presence of pathology.
- Palpation of the gallbladder (signs of cholecystitis). If the patient feels pain, then pathology develops.
- Blows on the lower part of the ribs when inhaling (Lepene's symptom). There are painful sensations - symptoms of cholecystitis are present.
- Not strong blows on the right lower costal arch with the edge of the palm (Ortner-Grekov symptom). If pain is felt, then this is a symptom of an inflammatory process in the bladder.
- Press on a point to the right of the 12th vertebra (Boas symptom) - pain indicates the presence of symptoms of acute cholecystitis.
- Squeezing a point near the top of the right clavicle (Mussi-Georgievsky symptom). The nerve of the diaphragm passes here, the pain at the same time confirms the inflammation of the tissues of the gallbladder or bile ducts. Pain can sometimes radiate to the right arm, shoulder, right side.
- Palpation at the time of inhalation of the point of the gallbladder (Kera and Lepene symptom). Pain concentrated over the organ is a symptom of cholecystitis.
- Feeling an organ in a person (leaning on a couch) who is sitting and slightly leaning forward. The doctor, tilting the patient’s shoulder, finds a position in which the organ is best palpated, puts the edge of the palm to the body and presses his fingers under the ribs, after the patient has taken a perfect breath, the organ is very well palpated (to determine the cause of pain), since when inhalingthe liver and bladder droop slightly.
- The diagnostician puts his hand on the chest of the lying patient (four fingers), with his thumb presses on the organ under study. After the patient inhales, the bladder is felt with the thumb.
- The thumb is pressed under the lower rib approximately where the organ is located, the other fingers at this time are on the lower edge of the costal arch. If, when the patient breathes in, breathing is interrupted and he feels a sharp pain in the abdomen, then this indicates the development of cholecystitis (Murphy's symptom). The same symptom on palpation of the gallbladder can be found in a patient who is sitting. The doctor, being behind him, puts his fingers on the location of the organ. The patient inhales simultaneously with pressure on the bladder with his fingers. If at the same time breathing is interrupted, then this indicates the development of pathology. Sometimes breathing is interrupted without pressure on the bladder. This also confirms the presence of the disease.
- The edge of the palm is pressed on the area between the 9th and 11th vertebrae on the right (Skvirsky's symptom). If there is pain, then the patient has cholecystitis
- When feeling the bottom of the gallbladder, its elongation is felt. In this case, the organ protrudes noticeably from under the edge of the liver when enlarged (Courvoisier symptom). This is a sign of acute cholecystitis, or blockage of the bile duct by a tumor.
- Pressing on the xiphoid process with a finger (Pekarsky's symptom). The presence of pain in this case is a symptom of chronic cholecystitis.
The most complete picture of the disease will be shown by palpation of points and the organ itself. Theseresearch methods complement each other.
How to detect cholecystitis?
Pain or discomfort in the right side below the ribs is a wake-up call for the patient. These are signs of a developing disease. Palpation of the gallbladder in chronic cholecystitis will help determine the size of the gallbladder, how it is located, what shape it has, and what condition the walls of the bladder are in.
The condition of the bubble walls
How dense and elastic the walls of this organ depend on the diseases that cause its increase. When the bile ducts become clogged with stones, the bladder does not enlarge. But the walls become uneven and compacted. In this case, pain is felt in the gallbladder on palpation. When a tumor occurs that blocks the bile ducts, the organ increases very much, as bile accumulates in it. The walls of the bubble do not lose elasticity, and in shape it becomes similar to the touch of a pear or an egg.
A tumor on the head of the bladder makes the walls tense, but there is no pain when you feel it, and when you inhale, the bladder moves to the side.
Examination of children
In children, the gallbladder performs the same function as in adults, namely, it participates in the process of digestion. Diseases are practically the same, but with some peculiarities.
With lesions of the gallbladder, children complain of pain (under the ribs) in the right side, bitterness in the mouth, nausea, flatulence. Often there is vomiting of bile. This causes the skin and whites of the eyes to turn yellow.
As for sizeand the location of the gallbladder, it is not large and is located inside the chest. That is why palpation of the gallbladder in children is impossible.
Circumstances preventing palpation
If the patient's abdominal muscles are strongly pumped up, the patient is obese or at least overweight, the abdominal muscles are strongly strained and do not relax them, bloating has appeared, then palpation is impossible.
Also, the organ is not palpable if the liver is rotated around the anterior axis. At the same time, its bottom is shifted up, and its upper part is down and back. With tense abdominal muscles, it will not be possible to feel the liver and gallbladder.
