Deep Palpation of the Abdomen

Principles and mechanism of Obraztsov's method

The classical technique is based on a combination of two consecutive phases of tactile perception:

1. Static palpation. This is the initial stage where the physician's hand only touches the skin of the patient's abdomen and the anterior wall of the organ being examined. At this moment, the superficial tissue resistance is assessed.
2. Dynamic palpation. The active phase of the examination. The physician receives information during the penetration of the fingers deep into the abdominal cavity, targeted pressure on the organ, and, most importantly, at the moment of sliding off it.

It is precisely the dynamic sliding transverse to the axis of the organ that allows for determining its true shape, consistency, diameter, presence of tenderness, and sound phenomena.

Universal execution algorithm

Regardless of which specific part of the gastrointestinal tract is being examined, the deep palpation technique always includes a standardized set of actions:

• Formation of a skin fold. Before immersion, it is necessary to shift the skin so that it does not restrict the movement of the hand later and moves together with the underlying tissues.
• Gradual immersion. The fingers are inserted deep into the abdomen slowly and strictly during the patient's expiration. This is a critically important condition: during expiration, the reflex tension of the abdominal muscles is minimal, which allows unhindered access to the posterior wall.
• Compression of the organ. The goal of immersion is to reliably press the examined structure against the dense posterior abdominal wall.
• Actual palpation (sliding). The movement of the fingers is carried out perpendicularly to the longitudinal axis of the organ. The physician smoothly slides over it, returning the hand to its original position. The properties of the intestine or stomach are assessed precisely at the moment of "rolling over" their wall.

Topographic sequence

The examination is carried out in a strict order, moving from anatomically simple and accessible areas for palpation to more difficult ones. The classical scheme looks like this:

1. Sigmoid colon (colon sigmoideum).
2. Cecum (caecum).
3. Ileum (ileum).
4. Ascending and descending colons.
5. Transverse colon.
6. Liver (hepar) and spleen (lien).

Features of palpation of the large intestine sections

Each section of the colon has its own anatomical nuances that require adaptation of the universal technique.

Sigmoid colon Palpated in the left iliac region in almost all healthy people (difficulties arise only with pronounced obesity). The colon is located parallel to the inguinal fold. The hand movement is performed perpendicularly to the axis of the colon, towards the navel. Normally: determined as a smooth, painless, fairly dense cylinder 1–2 cm in diameter. Gurgling upon palpation of a classical sigmoid colon is absent (however, in some cases, a palpable segment 2–3 cm thick may produce characteristic gurgling).

Cecum Examined in the right iliac region. Unlike the sigmoid colon, it has a more vertical axis relative to the body's midline. The technique of fold formation and sliding is completely analogous.

Ascending and descending sections For these areas, bimanual palpation (examination with two hands) is used:

• The left hand is placed under the patient's lumbar region. This creates a firm base and reliably fixes the posterior abdominal wall.
• The right hand is positioned perpendicularly to the axis of the colon.
• The immersed fingers perform a sliding movement outward.

Transverse colon Found 2–3 cm below the pre-determined lower border of the stomach. It can be palpated in two ways: either with the right hand alone (sequentially to the right and left of the linea alba, stepping back from it by 4–5 cm), or bimanually — with the fingers of both hands simultaneously on both sides of the midline.

Palpation of the stomach

Examination of the stomach requires special care. Main landmarks:

• Greater curvature: Palpated in the epigastric region (the level may vary depending on constitution). Tactilely felt as a dense ridge.
• Pylorus (Pylorus): Localized to the right of the spine. Normally palpated as a cord of varying density. In pathological changes, the pylorus becomes markedly dense, painful; tumor masses may also be determined in the same zone.

Briefly: answers to topical questions

Class and exam questions

What else to study on this topic

• Method of superficial abdominal palpation (as a mandatory preparatory stage)
• Pathological changes in the properties of the pylorus and their clinical significance
• Features of the topography of the greater curvature of the stomach in patients of different body types
• Sound phenomena during palpation: diagnostic value of intestinal gurgling
• Subtleties of bimanual palpation of the transverse colon

Other topics in the "Digestive System" section

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.