Deep palpation of the abdomen. The liver is not palpable, what does this mean?

palpation

Palpation (feeling) - main clinical method research that gives an idea of ​​the properties of the organs and tissues being studied, their sensitivity and topographic relationships between them.

Depending on the purpose of the study, palpation is carried out differently. When determining the temperature of parts of the body, the hand is placed flat on the corresponding part of the body, the pulse is felt with three half-bent fingers in the place where the artery lies superficially, on a bone lining (for example, a. radialis).

Superficial palpation is performed with one or both hands with extended fingers, placed flat, palmar surface to the palpated part of the body. Using wide and small sliding movements, without pressure, the entire targeted area is sequentially examined. Especially great value superficial palpation occurs when examining the abdomen. With the help of this palpation, pain, tension of the abdominal wall, enlargement of some abdominal organs (liver, spleen), the presence of a ballot tumor (see), etc. are revealed.

Deep palpation serves to detailed research and more accurate localization detection pathological changes. It is performed with one, three, four fingers with more or less significant pressure. Species deep palpation: methodical deep sliding, bimanual and jerking. With the help of methodical deep sliding palpation (V.P. Obraztsov, N.B. Strazhesko and V.Kh. Vasilenko) it is possible to palpate individual organs abdominal cavity. It is called methodical because palpation of the abdominal organs is carried out in a certain sequence(see Belly). Deep and sliding - because with this type of palpation it is necessary to penetrate deep into abdominal cavity and palpate the organ, pressed with fingers against its back wall, with sliding movements of the hand directed perpendicular to the axis of the organ.

Bimanual palpation - special way palpation with both hands, in which the organ being examined is held in a certain position with the left hand or moved towards the right palpating hand. Used for palpation of the kidneys (see).

Push palpation is used to palpate the liver or spleen when fluid accumulates in the abdominal cavity. They escort her out as follows: three or four fingers extended and pressed together right hand installed perpendicular to the abdominal wall of a certain area. Next, without removing the fingers from the surface of the abdomen, they make a series of short and strong pushes, as a result of which the ends of the fingers can touch the organ being examined.

General rules of palpation. The patient should be placed in such a position to achieve the greatest relaxation of his muscles. They palpate, based on the objectives of the examination, in various positions of the patient (standing, sitting, lying down). It should also be noted that the patient is in the knee-elbow position, which is most convenient when palpating abdominal tumors and palpating in the bath for better relaxation muscles of the abdominal wall. Palpation of the abdominal organs should be done in a standing and lying position.

The position of the examiner (doctor or paramedic) should be comfortable, not causing tension and fatigue. His movements should be as light as possible, soft, not causing pain. Hands should be warm and their nails should be cut short. When palpating the abdominal organs, the patient’s respiratory movements should be used and controlled. To penetrate into the depths of the abdominal cavity, you should use the exhalation phase, when the muscles of the abdominal wall relax. Penetration should be gradual, slow and careful. People with increased nervous excitability should be distracted by talking so that the increased contraction of the abdominal muscles observed in them decreases. Palpation should begin with healthy areas, and always compare the diseased side with the healthy one (comparative palpation). Palpation chest- see Lungs.

Palpation(lat. palpatio stroking) - one of the main methods of clinical examination, based on the researcher’s sense of touch various conditions tissues and organs of the patient when palpating them, as well as the patient’s assessment of the sensations he experienced during the study. Allows you to determine the location of a number of organs, the presence of pathological formations, evaluate some physical parameters of the tissues and organs being studied - density, elasticity, nature of natural movement, temperature, as well as identify painful areas, determine the location and nature of the injury.

Palpation can be superficial and deep, performed with the fingers or the entire palmar surface of the hand, with one or two hands (bimanual palpation). Based on the nature of the movement of the palpating fingers, sliding P. is distinguished, which is used to study surfaces, boundaries and density volumetric formations; push-like L., used to detect fluid in a cavity with pliable walls (for example, in the abdominal cavity with ascites, in articular capsule By running for office patella, etc.); penetrating P., which is carried out by pressing the fingertips into the tissue of any area of ​​the body, mainly for the purpose of determining pain points .

Palpation should be carried out with clean warm hands(it is best to wash and warm warm water with the patient immediately before the examination), start with light touches to the patient’s skin, monitoring his reaction to low-pressure pressure, and only then, taking into account the patient’s reaction, conduct the examination.

During the initial examination of the patient, P. is carried out preferably in the following sequence: skin and subcutaneous tissue, bones, muscles, subcutaneously located lymph nodes, thyroid gland, chest (respiratory organs), heart, peripheral vessels, abdomen, organs genitourinary system. With the help of palpation, you can identify pain in the area where individual nerves exit and along the nerve roots and trunks.

Deep pain is always preceded by superficial pain, allowing the patient to relax and overcome the fear of possible pain. When examining supposedly painful areas of the body, palpation begins carefully, with stroking movements; the patient is asked to immediately report any pain. In children, P. is performed by distracting the child (for example, with a toy, conversation), while carefully monitoring changes in his facial expressions.

Palpation of the skin begins with superficial sliding of the palms over it to assess the degree of its moisture in different parts of the body. Local dry skin is observed with e, general dryness is observed with hypothyroidism, some types vitamin deficiency, dehydration of the body. U infants Be sure to determine the moisture content of the scalp, incl. back of the head (to identify a); in adolescents and adults - sweating armpits, on the palms and feet, the excess moisture of which indicates autonomic dysfunction of different nature. Raised neck and upper half trunk is observed in patients with exacerbation of chronic pneumonia.

The temperature of the skin of the forehead, different parts of the body, and limbs is determined by applying the palms of the hand or the back of the fingers to these areas. The temperature difference in symmetrical areas of the body is assessed as a local increase (for example, over an inflamed joint) or a decrease (for example, on the foot when the blood supply is impaired).

To determine the elasticity, firmness, thickness of the skin, it is collected into a fold with two or three fingers, the fold is slightly pulled back and palpated, as if kneading with fingers, then released; in normal skin condition, the fold straightens out immediately. Thickness and turgor are assessed similarly subcutaneous tissue with a deeper grip of the tissue with your fingers.

To determine subcutaneous crepitus, the tips of closely placed II and III fingers alternately press on the skin at the site of suspected subcutaneous emphysema, while a crunch is felt.

Palpation of the lymph nodes is carried out in the following sequence: occipital, lying near the mastoid processes of the temporal bones, mandibular, chin, cervical, supraclavicular, axillary, elbow, inguinal, popliteal. P. is carried out by pressing the skin over the lymph nodes with the pads of the fingers, which is then displaced with sliding movements. The number of lymph nodes in each group, their size, density, degree of adhesion to each other and to surrounding tissues, and pain are determined. Normally, many of the listed groups of lymph nodes, especially in adults, cannot be palpated. Enlargement of any group of lymph nodes and their pain are usually associated with nearby focal inflammation or tumor process. Moderate enlargement and compaction of lymph nodes are observed in some chronic generalized infections (for example, tuberculosis, brucellosis), in children - with e. Significant enlargement of lymph nodes of all groups, the formation of “packets” of enlarged lymph nodes require the exclusion of lymphogranulomatosis, acquired immunodeficiency, metastasis malignant tumors. When P. thyroid gland determine the presence of nodes in it, as well as its mobility and pain.

Palpation of muscles and bones allows you to assess the condition of the musculoskeletal system, identify pathological changes in bones, for example, the presence of rosary beads on the ribs in young children, pathological displacement of fragments and bone crepitus in bone aches.

Palpation of muscles is carried out with two or three fingers, covering an individual muscle or group of muscles. In children of the first two years of life, it is not always possible to palpate the muscles due to their insufficient development and slight difference in density from the well-developed subcutaneous tissue.

In adolescents and adults with P., the degree and symmetry of muscle development, their tone during relaxation and contraction, and soreness are assessed. Hypotrophy and hypotonia of individual muscle groups are observed when their innervation is disrupted (for example, with neuritis, e), some forms of myopathy: pain in P. of individual muscles is characteristic of a.

Palpation of the chest is carried out to examine both the musculoskeletal system and the condition of the lungs and heart. With the help of L., it is possible to identify changes in the volume of the chest, the lag of one of its halves during breathing (for example, with e, hydrothorax, etc.). In this case, P. is carried out while being behind the patient, who is standing or sitting; his chest is tightly covered from the sides with the hands, fingers spread out so that the ends of the first fingers are located at the corners of the shoulder blades, and the ends of the rest are attached or as close as possible to the anterior chest wall: the patient is asked to inhale and the degree of divergence of the first and third fingers on each side is determined and the first fingers on the back. To identify areas of altered density of lung tissue, palpation examines voice tremors .

Palpation of the heart is performed by applying the entire palmar surface of the hand to the anterior chest wall to the left of the sternum, then above it and to the right of it. First, the hand is placed so that the second and fourth fingers are located along the fourth to sixth intercostal space and the ends reach the left mid-axillary line (as if covering the apex of the heart); then the area of ​​palpation is changed, shifting the position of the longitudinal axis of the hand counterclockwise until the fingers are located above the sternum and to the right of it. In the process of P., the localization, area, strength, and rhythm of the apical impulse of the heart, the presence or absence of a cardiac impulse are determined (it is detected with hypertrophy of the right ventricle of the heart as a concussion of the anterior chest wall synchronous with the pulse),

General information about palpation

Doctor palpating patient's abdomen

Using palpation, the pulse and cardiac impulse are examined. In addition, when palpating, we judge the sensitivity or soreness of those formations and areas of the body that we examine; We learn about this either from the words of patients, or from their reaction to pain (muscle resistance, reflex movements, appropriate facial expressions, groaning, etc.). We also use palpation to determine the so-called vocal tremor.

Palpation is an old method, known to ancient doctors; Thus, in Hippocrates we find indications of palpating the liver and spleen. At the end of the 19th and beginning of the 20th centuries, this method, as applied to the study of internal organs, was improved by Russian clinicians, especially Obraztsov.

Palpation at first glance seems to be a very simple method, but in reality it requires great experience and skills. Some doctors, by systematically practicing, acquire a significant art of palpation, others, not diligently and attentively practicing this method, make gross mistakes, being unable, for example, to feel a fairly large and shallowly lying tumor, to detect the pole of the kidney, etc. different persons the sense of touch is developed very unevenly. Let us add to this that significant difficulty is sometimes presented by the interpretation of data obtained by palpation, especially data from palpation of internal organs hidden by outer integuments, sometimes quite thick. The condition of internal organs based on palpation data is determined not only blindly, but sometimes in a distorted form. When feeling any body with his fingers, for example, in the abdominal cavity, the doctor should, using his knowledge topographic anatomy, call for help, in addition, the logical judgment “palpating, thinking and, thinking, palpating.” That is why no other method is fraught with such serious errors, but at the same time it is precisely this method that often gives decisive and clear results.

Conditions favorable to palpation of internal organs

To successfully use this research method, a number of technical conditions must be met.

Patient position

The patient's position is very important. It should be such that it is easiest for palpating fingers to find access to certain internal organs. Depending on which organs are felt, this position can be different: lying, on the side, standing; sometimes you have to resort to the knee-elbow position (the patient stands on all fours on both elbows and knees), which creates comfortable conditions for palpating some abdominal organs. Sometimes the doctor turns the patient in a wide variety of ways. different directions and only with one rotation of the body does it achieve positive palpation results. One of the main points that interferes with the palpation of internal organs is tension in the muscle layer. To relax this tension, it is necessary to offer the patient to change the position of the torso and limbs. So, to relax the muscles of the abdominal wall, the patient, lying on his back, must bend his legs at the hip and knee joints, his head should be slightly raised, etc. If necessary, palpate the patient in a warm bath (under these conditions the muscles relax).

Doctor's position

To others an important condition For successful palpation, the appropriate position of the doctor is used. It should be comfortable, as it provides freedom of movement; It is especially important that the palpating hand be placed comfortably, since otherwise it quickly gets tired and tactile perceptions become dull. It is most advisable for the doctor to sit to the right of the patient’s bed, facing the latter (this gives him the opportunity to observe the pain reaction) so that his forearm is in horizontal position at the level of the patient's body.

The examiner's hands should be warm, flexible, gentle, nails trimmed, movements light, elastic and at the same time careful.

Using breathing movements

When palpating, you have to use the breathing movements of the person being examined. In order for the palpating hand to penetrate deeper (this applies to palpation of the abdominal organs), it is necessary to use the moment of exhalation, but the moment of inspiration should also be used for diagnostic conclusions. In addition, the displacement of the palpated body during breathing is one of the very important signs for diagnostics. The patient should breathe deeply, through the mouth, using the so-called abdominal type of breathing. To eliminate muscle tension, which very often depends on alert and nervous condition the patient being examined and his “sensitivity”, one must strive to divert the patient’s attention by occupied with the regulation of breathing, conversation, etc.

Feeling or palpation, there is a research method using the sense of touch, as well as muscular and spatial (stereometric) senses. Palpation, as a rule, is combined with the movement of the palpating hand, and this active movement significantly enhances the sharpness, subtlety and accuracy of tactile perceptions. Through this method, we get an idea of ​​a number of properties of the organs and tissues being studied, such as: the nature of the surface, temperature, humidity, consistency, shape, position, size and relationships.

In addition, palpation determines the sensations experienced by the patient - sensitivity and pain, which we learn about either from the patient’s words or from his pain reaction (facial expressions, reflex movements).

Palpation, as a research method, achieved significant development in ancient times (palpation of the liver and spleen), but then was forgotten and only in the last 50 years has it been vigorously developed again. The school of V.P. Obraztsov, which developed an excellent technique for palpation of the abdominal cavity, achieved especially great success in this direction.

Palpation, like percussion and auscultation, can be divided into direct, which will be discussed here, and mediocre, or instrumental. Direct palpation is usually called and will be called in our further presentation simply palpation, while mediocre palpation in each individual case has special names.

Palpation methods
Depending on the conditions of place and time and on the purpose that is in mind, various ways palpation. First of all, it is necessary to distinguish between two types of palpation: 1) superficial palpation and 2) deep palpation.

Superficial palpation performed with one or both palms placed flat, with fingers extended and without pressing on the palpated surface. Using wide and light sliding movements, the entire targeted area is consistently examined. This method of palpation uses mainly touch and is used in the study of the abdomen, chest, joints, as a preliminary stage of more detailed palpation, as a general indicative study. Using superficial palpation, you can initially diagnose gastric ulcers, cirrhosis of the liver and dozens of other diseases.

Deep palpation is based primarily on muscular and spatial sense and serves for the purposes of detailed examination and more accurate localization of pathological changes. It is performed with fingers (four, three, one, depending on the circumstances), with more or less significant pressure, depending on need, and to determine the nature of the surface of the organs being palpated, usually also with stroking. For very deep palpation or if it is necessary to overcome a significant obstacle, palpation is used with both hands in such a way that the palpating hand remains passive, and its fingers are applied with the fingers of the other hand. strong pressure.

One of the types of deep palpation is sliding palpation(Samples), with the help of which it is possible to palpate individual sections of the normal gastrointestinal tract.

The principle of deep sliding palpation is described as follows: “Deep palpation is based on the fact that we penetrate deep with the tips of our fingers, carefully moving step by step, as if sneaking; To do this, we take advantage of the relaxation of the abdominal walls that occurs with each exhalation in order to gradually reach back wall or to a deep-lying organ. When we reach a sufficient depth, according to Obraztsov’s principle, we slide the tips of our fingers in a direction transverse to the axis of the organ under study, also using the moment of exhalation for this. The fingers pass across the organ being examined and press it lightly against the posterior abdominal wall, fixing it on it. Depending on the direction of the organs, sliding movements lead from top to bottom (stomach, transverse colon) or from the inside out (cecum, sigmoid colon), moving in a more or less oblique direction as these organs deviate from the horizontal or vertical course. Thus, sliding movements are made along the frontal plane of the abdomen in different directions, begin at a certain distance from one side of the palpable body and end when the fingers move to the other side; in this case, sliding movements are performed not on the skin, but together with it.” This palpation method is used to examine organs and tumors of the abdominal cavity.

A type of deep palpation is penetrating palpation, when the tip of one (thumb, index or middle) or the tips of two or three vertically placed fingers produce strong pressure in a strictly limited space. It finds application in determining pain points, mainly in the abdominal cavity.

Next we need to focus on the so-called bimanual palpation. This is a special way of palpating with both hands, in which with one hand (usually the left) the area or organ being examined is held in a certain position or moved towards the other (usually the right) palpating hand. This technique makes palpation easier and in some cases makes it possible to grasp an organ (kidney, for example) or a tumor with both hands and clearly determine its size, shape, consistency, surface properties, mobility, etc. Bimanual palpation is used when examining the kidneys, liver, spleen , pregnant uterus, tumors and (in gynecology) female internal genital organs.

Jerky (balloting) palpation- a unique type of deep palpation - used to palpate an enlarged liver or spleen, as well as large tumors in the abdominal cavity when fluid accumulates in it. Its technique boils down to the following. Three or four extended and pressed fingers of the right hand are placed perpendicular to the abdominal wall in a chosen place. Then, without removing them from the surface of the abdomen, they make a series of short and strong pushes. If successful, the ends of the fingers encounter the desired dense body.

General rules of palpation
They relate to the position of the patient, the position of the doctor, the doctor’s hands and the technique of palpation itself.

Patient position. The main requirement regarding the position of the patient during palpation is to achieve the greatest comfort for the patient, the greatest relaxation of his muscles. Its position itself may vary depending on the circumstances, the area being studied and the purpose of the study: standing, sitting and lying; the latter can also be different: lying on the back, position on one side or the other. The most comfortable and commonly used supine position requires the following: additional conditions: the head along with the shoulders should be slightly raised (to achieve the greatest relaxation of the muscles of the abdominal wall), the arms should be freely located along the body and legs or extended (freedom of movement is maintained for the doctor’s palpating hand) or, if this is necessary for relaxation abdominal muscles, slightly bent at the hip and knee joints and slightly abducted. A lying lateral position with legs extended usually already provides sufficient relaxation of the free flank (side); if the latter is not enough, the legs are also bent.

Here it is necessary to mention also the knee-elbow position of the patient when palpating mainly tumors of the abdominal cavity and about palpating the patient in the bath, if otherwise it is not possible to achieve relaxation of the abdominal walls.

Doctor's position. The position during palpation should be quite comfortable, not causing tension and fatigue (otherwise the researcher’s attention will be distracted and dulled very quickly). The comfortable position also provides the doctor with freedom of movement. This position, for example, when palpating the abdominal cavity, is sitting position on a stool (the stool must be the same height as the bed!) next to the bed, to the right of the patient; in this case, the forearm of the doctor’s right hand should be in a horizontal position if possible. It is also important that this position of the doctor gives him the opportunity to see the patient’s face in front of him and monitor his expression during the examination (pain reaction!).

Doctor's hands. During the examination, the doctor’s hands should be warm and the nails on them should be cut short, so as not to cause a reflex contraction of the muscles of the palpated area in the patient through thermal or mechanical irritation. Further, it goes without saying that the palpating hand should be in sufficiently trained.

Palpation technique.. Palpating movements should be as light, soft and gentle as possible; any increase in movement should be gradual (again, to avoid reflex muscle contractions). Palpation, as a rule, should not cause pain, except in cases of superficial skin hyperesthesia or especially painful lesions tissues and organs (inflammation of the serous membranes).

When palpating the abdominal organs, it is very important point: is the use breathing movements patient and their management. Breathing should be uniform, deep, diaphragmatic (“breathe with the stomach”) and done through the mouth. To penetrate deep into the abdominal cavity with a palpating hand, you need to use the moment of exhalation, when the muscles of the abdominal wall relax; penetration should be gradual, slow and careful. A big obstacle to palpation of the abdominal cavity occurs in cases where patients do not know how to breathe with the diaphragm (“stomach”); in such cases they need to be taught abdominal breathing. In patients with increased nervous excitability (neurotics), a sharp contraction of the abdominal muscles is often observed at the slightest touch to the abdomen and even before that; here it is necessary to very carefully and gradually accustom the patient to this method of research; Often it also helps to distract the patient’s attention by talking or focusing his attention on breathing correctly. Finally, there are people in whom no measures can be taken to relax the contracted abdominal muscles; These are people with the so-called “closed abdomen”, who have to: refuse more detailed palpation of the abdomen.

By general rule palpation should begin with healthy places and from the healthy side and then move on to the sore spots or side. In addition, you should always compare the diseased side with the healthy side (comparative palpation).

General semiotics of palpation data
By palpating the skin, we can judge the condition of its surface (smooth - rough, soft - hard, dry - wet), its mass (thin - thick), its elasticity, sensitivity, the presence of rashes on it, swelling, etc. When palpating the subcutaneous tissue, the mass (quantity), its consistency (soft - dense), the lymph nodes embedded in it in certain places, as well as swelling and other changes are determined. When palpating muscles, attention is paid mainly to muscle mass and its tone. When palpating the bones, one can note the condition of their surface (smooth - rough - lumpy) and the degree of their sensitivity or pain. When palpating organs accessible to palpation, their size, shape and position, mobility and consistency, surface condition and degree of sensitivity are determined.

The area of ​​application of palpation is extensive and extends from head to toe. Palpation usually follows directly from the examination, and we can say that the well-trained hands of the doctor are like a second pair of eyes for him. Although palpation is at first glance very simple method research, however, to obtain reliable results, long-term and systematic exercise in it is required and, in the future, in each specific case, its conscious use: you need not only palpate with your fingers; one must, in the words of Boas, palpate while thinking and think while palpating. Then you can get a lot from this method.

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Palpation is medical method patient research. Produced as a preventive and curative measure. The doctor examines the patient’s pulse and controls how various internal organs react to touch. The study has been common since the 19th century. This is the only one these days medical method, allowing full contact between the patient and the doctor.

Operating principle

Palpation works on tactile sensations provoked by touching, squeezing with fingers, one or even two palms of the doctor. The specialist works directly with the patient’s body, determining the features and deficiencies of the outer integument, finding out the condition of the organs inside. At high level specialist palpation guarantees precise definition:

— location (which is especially important with displacements, congenital deformities);

— dimensions of internal organs, shape;

- mobility.

Palpation is important method, which allows you to determine how painful a specific organ in the human (but not only) body feels.

Subtypes of technology

There are large subtypes: deep, superficial.

Superficial palpation is the study external factors. The specialist pays attention to the joints, skin, vessels. The process involves one or both palms. They are placed on the skin of the diseased part of the body, and the vessels are palpated with the tips of the fingers. This variety is used quite narrowly, usually in consultations.

Deep palpation is a technique necessary for a detailed examination to determine how well the internal organs are functioning. It is indispensable when the superficial one is unable to produce results due to the location of the diseased area. Since the technique is widespread, several subtypes have been developed:

— Deep dive. In this case, when diagnosing, the doctor plunges his fingers directly into the diseased areas. This way you can monitor how well your joints and muscles function, and check the condition of your bones and adrenal glands.

— Deep sliding. This technique is necessary when studying the abdominal cavity. The doctor obtains data about problem areas by examining the abdominal wall, while sliding his fingertips directly across the cavity. Literally the first seconds allow you to receive a response from the body, on the basis of which it is possible to accurately establish the diagnosis and source of the problem.

— Balloting, known as the “push method.” Such examination and palpation is indispensable for liver diseases and abdominal tumors. The effectiveness of the method is highest if we're talking about about ascites. Abdominal wall pushed with gentle movements, due to which the organ occupies correct location. The effectiveness of the approach is also noted for other diseases.

Peculiarities

Percussion and palpation are two widely used methods that allow you to place accurate diagnosis. Both technologies became basic in the development of medicine in the field of physical examination.

Palpation is carried out while the patient is lying or standing. First, a superficial study is carried out, which helps to localize pain during palpation and determine which internal organs it corresponds to. When performing the procedure, they focus on the patient’s breathing.

Methodology

If it is necessary to ensure an examination of the stomach, the doctor slightly bends and puts his fingers together, then carefully, while exhaling, passes into the abdominal cavity so as to reach the posterior wall. At the same time, the stomach is pressed. The organ should slip under your fingers. The information obtained during the study helps to determine how large the organ is and what its shape is. Pain on palpation allows you to assess possible damage and establish an accurate diagnosis. Using the method, the presence of tumors is determined or data is obtained that the curvature of the stomach is not normal. However, you need to remember that if the tumor has arisen in the cardiac part of the organ, it will not be possible to find it by palpation; it is necessary to take an x-ray.

Palpation: rare methods

In addition to the two types of research described above, there are two more options for studying the body. They are less widespread, but nevertheless occur:

- bimanual;

- jerky.

Balloting push is carried out using a fist. The doctor performs jerky movements in a short series of fairly strong blows. Using this technology, you can understand what is in the abdominal cavity and intestines. If the organs are overfilled with fluid, a splashing sound is heard.

With bimanual palpation, palpation is performed with both hands simultaneously. This technique ensures simultaneous coverage large area. You can find out the presence of a tumor, examine the entire abdominal cavity and kidney at the same time.

The method is widespread in veterinary medicine, as it is applicable to small living creatures. One of the options for conducting the study: both hands are placed on the surface of the body and one presses on one side, and the other on the opposite side.

But if health problems are associated with the rectum or oral cavity, if pain is tormented in organs accessible rectally, it is necessary to resort to internal palpation of the patient.

Source: fb.ru

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