Palpation algorithm

Place of palpation in the general examination algorithm

The physical examination of a patient is based on a strict sequence of diagnostic actions. The very first step is always a general inspection, which is inextricably linked with a local visual examination (at this stage, the condition of the skin is primarily assessed). Immediately after the visual evaluation, and sometimes in parallel with it, the physician proceeds to the tactile examination.

The general clinical algorithm is structured as follows:

1. Inspection.
2. Palpation.
3. Percussion.
4. Auscultation.

The main goal of palpation is to obtain objective information about the physical properties of organs and tissues. At the same time, there is no universal movement: the specifics of manual techniques change dramatically depending on which specific organ system is being examined.

Diagnosis of pulmonary syndromes

When examining the respiratory system, palpation performs a crucial verification function. The key task of the preceding stage (inspection) is to identify possible chest asymmetry and record the uneven participation of its halves in the act of breathing (for example, lagging of one of the sides).

Palpation of the chest allows one to:

• Reliably confirm visual data regarding the asymmetry of respiratory excursion.
• Detailed assessment of lung tissue density using the vocal fremitus phenomenon (fremitus vocalis).

Changes in the conduction of vocal fremitus directly indicate the physical nature of the pathology:

• Enhancement of the symptom indicates compaction of the lung tissue.
• Weakening indicates a pathological accumulation of fluid or the presence of air in the pleural cavity.

After palpation, the physician proceeds to percussion to assess the basic aeration of tissues (detecting dullness due to dense elements or, conversely, tympanitis and hyperresonance in case of increased aeration). The cycle concludes with auscultation, which determines the type of breathing (vesicular or bronchial), the ratio of inspiration to expiration phases, as well as the presence of adventitious sounds (rales, crepitation, pleural friction rub). The combination of all these data allows formulating a pulmonary syndrome and proceeding to differential diagnosis.

Features of examination in gastric pathology

The examination of patients with suspected diseases of the stomach and duodenum is also strictly subject to clinical staging. Patients usually present with non-specific complaints that can occur with completely different organ disorders: dyspepsia (nausea, vomiting, eructation), changes in appetite, and pain.

All clinical manifestations are divided into four main groups:

1. Pain syndrome.
2. Dyspeptic symptoms.
3. Gastrointestinal bleeding.
4. Weight loss.

The examination algorithm begins with detailing the complaints, after which the physical stage (inspection and palpation of the abdomen) is carried out, and finally, decisive instrumental diagnostics (radiography, upper GI endoscopy).

Palpation of the epigastric region plays a key role in analyzing the pain syndrome, which is characterized by localization in the epigastrium, constant or spasmodic nature, and strict rhythmicity—a connection with food intake. For example, the presence of early pain (occurring 30–60 minutes after eating) usually indicates a topical lesion specifically of the stomach. Such pain lasts about 1–1.5 hours and gradually subsides as the food contents naturally empty.

Examination of the thyroid gland

Examination of the thyroid gland (glandula thyroidea) is a mandatory part of evaluating the local status of the head and neck. Within this examination, the same immutable algorithm is observed: inspection, palpation, percussion, and auscultation. It is important to note that local visual inspection of the neck should always be accompanied by a palpation study.

Palpation of the thyroid gland is strictly mandatory in two cases:

• During any specialized endocrinological examination.
• If the patient has complaints of pain or any discomfort in the neck area.

Class and exam questions

What else to study on this topic

• Changes in pulmonary percussion sound: mechanisms of dullness, tympanitis, and hyperresonance.
• Lung auscultation: differentiation of vesicular and bronchial breathing, characteristics of adventitious sounds.
• Differential diagnosis of abdominal pain: differences between early and late pain.
• Instrumental methods of GI examination: the role of upper GI endoscopy and radiography in making the final diagnosis.

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