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Hi Friends,
Need some information on palpation diagnosis.
More specifically a strong palpation felt a little to the left of umbilicus.
Thanks a million

Macleod's Gastrointestinal Examination

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Dear Dr. Valerian
Here is some information about Palpation : It is defined as a method of examining the size, shape, and movement of the internal organs by laying the flat of the hand on the skin of the patient. For palpation we must prepare the patient first.
Preparation of patient :
The patient should be in comfortable dress (from xiphisternum to pubis) and lying comfortably with the head a little elevated and well supported (one pillow). The arms should be placed alongside the body. This relaxes the abdominal muscles.
1.A warm room, comfortable patient and a calm and reassuring approach from the doctor will create the necessary relaxation. If the patient is tense, very little information can be gained and if we hurt the patient there will be tension and loss of confidence.
2.Explain what we are about to do and ask permission to start.
3.Our own comfort is also important. The height of the examination couch should permit a comfortable examination whilst standing upright. A bed in a patient's home is usually lower and sitting on a chair may be preferable.
4.Obesity and a pendulous abdomen may make the examination more difficult.
Before going for Palpation one should keep following points in mind :
1. A pillow under the knees may sometimes aid relaxation of abdominal musculature.
2. Ask the patient to point to the site of any pain.
3. During palpation, be aware of the response of the patient's abdominal muscles and watch their face for signs of discomfort.
4. Start with light palpation to gain the patient's confidence and relax them and then perform deeper palpation.
5. Use the flat of the hand with the flexor surfaces of the fingers for deep palpation, sometimes superimposing the other hand's fingers for an even distribution of pressure. This technique can reach progressively deeper through each relaxation phase of respiration.
6.Look for signs of localised swelling (the reflex tensing of the abdominal muscles over the painful area which represents peritonism) and rebound tenderness (initial pressure does not cause pain but when the examining hand is released, pain is felt). Rebound tenderness suggests peritoneal irritation.
7.Generalised 'board-like' rigidity indicates peritonitis. In peritonitis, the abdomen also does not move during respiration and bowel sounds are absent.
Important abdominal organs near left of umblicus which should be differentialy diagnosed are,
1.Left edge of the Liver,
2.The Spleen,
3.Body and Tail of the Pancreas,
4.The Stomach,
5.Left half of the Transverse Colon or large intestine,
6.The Descending Colon,
7. Sigmoid Colon,
8. Left Adrenal gland,
9. Left Kidney,
10. Left Ureter,
11.Left Ovary in women,
12. Left Fallopian tube in women,
13. Blood vessels on the left side of the abdomen including the aorta .
14. Muscles of the wall of the left side of the abdomen,
15. Nerves on the left side of the abdomen,
16. Skin covering the left side of the abdome .
We must be vigilant about Some Structures which are not found on the abdomen that could still cause pain on the left side of the abdomen include:
a) Lower part of the Left Lung
b)Left half of the diaphragm
c)The heart
d) In a few individuals, their appendix, and all other structures found normally on the right side of the body could be on the left, in a medical condition called Situs Invertus. In those individuals, causes of left sided abdominal pain are actually those causing right side abdominal pain in normal individual.

Common causes of left side abdominal pain includes:
Stomach ulcer
Stomach tumour
Irritable bowel syndrome
Crohns disease
Ulcerative colitis
Polycystic ovarian syndrome - PCOS
Twisted or Ruptured ovarian cyst
Ectopic pregnancy
Pelvic Inflammatory Disease - PID
Coelic disease
Constipation .
I hope this information will do the needful.
Dr.Vikas Verma


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