To determine the type of pathology of the kidneys and bladder, a variety of examination methods are used, which include palpation of the kidneys, percussion and examination. Each type of diagnostic has its own characteristics and provides a certain set of information.
Kidney palpation
So, more details. Palpation of the kidneys in a he althy person does not give results, since they are not palpable. This procedure can be carried out only if there is an organ pathology. Or very thin people.
Palpation of the kidneys is carried out in two positions: lying and standing. In the supine position, the abdominal muscles are lowered, they are relaxed, as a result of which the procedure is facilitated. While standing during the examination, you can feel the mobile kidney, which has a downward displacement under its weight.
Palpation of the kidneys is carried out with two hands. The patient lies on the couch on his back, legs should be straight, hands should be freely placed on the chest. In this position, the abdominal muscles relax as much as possible, breathing becomes even, calm. The doctor is to the right of the patient. He puts his left hand underthe lower back, just below the last rib so that it is located close to the spine. When examining the left kidney, the hand is placed under the back further, behind the spine.
The right hand of the doctor is located on the stomach slightly below the costal arch outward from the rectus muscles. On exhalation, the specialist plunges the hand into the abdominal cavity towards the fingers of the left hand.
Next. On palpation of the kidneys, during the approach of the hands, the patient is invited to take a breath. Very deep. As soon as he exhales, the specialist can feel the descent of the kidney, the edge of which will come to the right hand and pass under her fingers. If the organ has a strong increase, the doctor will be able to completely palpate its anterior wall, find both poles. This examination method allows you to determine the shape and size of the organ.
There is also a method of palpation of the kidneys in the position of the patient, lying on his side. In this case, the procedure is carried out according to the same rules as in the supine position. But when the patient is located on his side, the doctor sits, and the patient should be turned to face him. His torso leans forward slightly, muscles relax. When examining in this case, it is possible to detect nephrosis. In the first stage of the disease, only the lower pole of the organ is probed. On the second, the entire organ is easily detected. In the third stage of nephrosis, the organ is freely displaced in any direction. Sometimes there is pain during palpation.
Sometimes, during the procedure, you can confuse an organ with a filled area of the colon, enlargedthe right lobe of the liver or with a tumor. To prevent this from happening, you should know the shape of the organ: it resembles a bean with a smooth surface. The kidneys are characterized by lifting up and returning to their original position. After palpation, protein and an admixture of erythrocytes appear in the urine.
You can examine the patient in a standing position. In this case, the doctor sits opposite the patient, and the patient stands in front of the specialist, leaning forward slightly and crossing his arms over his chest. The doctor places his hands in the same way as when examining the kidneys from behind.
Results
During palpation of the kidneys in children and adults with an enlarged organ, the following pathologies can be assumed:
- jade;
- hydronephrosis;
- hypernephroma;
- developmental anomaly in the form of a lowered kidney.
Everything is very serious. In addition to palpation, percussion of the organ is evaluated. Read more.
Percussion
In order. In order for the doctor to more accurately establish the diagnosis, it is necessary to palpate and percussion the kidneys. The last examination method allows you to detect changes in sound above the organ.
Tympanic sound is normal. This is due to the fact that the kidneys are covered by the intestines. If a dull sound is heard, then this indicates a sharp increase in the organ. In this case, the bowel loops move apart.
Pasternatsky's symptom
The definition of Pasternatsky's symptom is of great importance during the examination. This is a tingling method in which the soreness of an organ is assessed. During the procedure, the doctor is behind the back.patient. The left hand is placed on the area of the twelfth rib and slightly to the left of the spine. With the edge of the palm of the other hand, short, light blows are applied to the left hand. Depending on the severity of pain, the type of symptom is determined: positive, mild, negative.
A positive symptom of Pasternatsky is determined with ICD, pyelonephritis, paranephritis and some other ailments. It should be understood that the patient can feel soreness with osteochondrosis, disease of the ribs, lumbar muscles. Less commonly, pain occurs due to pathologies of the gallbladder, pancreatitis and other ailments.
Bladder palpation
Next moment. Palpation of the kidneys and bladder is performed to identify a variety of pathologies. That is. To examine the bladder, the patient is in the supine position. In this case, the doctor places a hand longitudinally on the stomach. When immersed in the abdominal cavity, a fold is formed, directed to the navel. This action is performed several times, gradually moving the hand to the pubic joint.
Normally, an empty bladder is not available for palpation, as it is located behind the womb. The filled organ is felt. With inflammation, the bladder is palpated outside the womb. The patient may feel pain when pressed.
Bladder percussion
To determine the upper limit of the bladder, the percussion method is used. During this type of diagnosis, the doctor places a finger-plessimeter (which knocks) horizontally to the organ. Tapping is carried out along the midline, alongdirection from top to bottom, starting from the level of the navel and ending with the pubis.
When the bladder is empty, a tympanic sound is heard, which persists until the pubic articulation. In case of overflow of the organ in the region of the upper border, the sound becomes dull. This place is marked as the upper limit.
Conclusion
Physiological diagnostic methods allow to identify a variety of pathologies of the kidneys and bladder. With their help, determine the size, location of organs, as well as the presence of fluids in them. After examination, palpation and percussion, urinalysis is mandatory. OAM is mandatory.
