The kidneys are not palpable. Palpation of the kidneys and bladder: Methods of holding. Palpanic kidney in adults and children

With any renal pathology, the examination of the patient begins with a visual inspection, a detailed survey, auscultation, palpation and percussion of organs. Palpation and percussion - two types of surveys, which the doctor performs his hands. To be clear, Palpation is feeling, percussion is trying.

And palpation, and percussion - antiques, known since ancient times. They are absolutely painless and safe for the patient, but, nevertheless, allow the doctor to draw up an presentation and on the overall state of the body, and the pathological changes in the internal organs. Consider them in more detail.

Distinguish surface and deep palpation.

Surface palpation

Surface kidney palpation is an approximate feeling that allows preliminary conclusions. The doctor has hands on the patient's body and symmetrical strokes feeling the body. Thus, the doctor may:

Determine the temperature, sensitivity, density and humidity of the skin.
Determine the body muscle tone, reveal their tension.
Detect subcutaneous infiltrates and seals.

Surface feeling is carried out with a straightened hand, no pressure in the body does not fulfill the physician. You can conduct a superficial examination with two hands at the same time.

Deep palpation

Deep feeling is applied to a detailed examination of the internal organs. The doctor, its conductive, should not only be good to imagine an anatomical projection of the internal organs, but also have enough experience in conducting manipulation. Deep palpation of kidneys and other organs is performed by one or more fingers of the brush, implies significant pressure on the body. The method is divided into the following types:

Deep sliding. This is a methodological palpation, which involves feeling the internal organs in a certain sequence. Doctor's fingers penetrate deeply inside the body and feel pressed to the rear wall of the organ.
Bimanual. This is feeling with two hands of a doctor. The optimal method for the kidney examination. The left hand of the doctor keeps the kidney in a certain position, and the right right, moving towards palpit. With bimanual palpation with left hand, it is possible to "submit" an organ for the study of the right.
Pushing. Apply to the diagnosis of pathologies of the spleen and liver. For renal survey, this species is not used.

Palpation technique

Kidney palpation can be carried out in the patient standing standing, lying on the back, lying on the side.

The Left Hand of the doctor is located up the palm of the patient's lower back, and the right - under the root edge on the stomach. The patient is offered to relax and breathe deeply. In the breath, the doctor penetrates the right hand deeper, and the left slightly "moves" the kidney ahead.

If a person has no pathologies, the kidney normally fails. Moreover, both in the standing position and lying. Sometimes the doctor manages to plump the lower renal edge on the right, because It is located below than the left. However, it is even impossible to do if the patient is overweight.

In complete people, it is not possible to carry out a manual examination in a vertical position, the result will not succeed. Felt the lower edge of the healthy right kidney is possible only in patients of thin build, and in children. When palpation is a standing position, the patient is offered to lean a little forward.

For more weight, it is more convenient to take feeling, lying on the side. In order to feel the right kidney, the patient lies on the left side, and on another for the survey of the left kidney.

Related palpation examination, percussion, which is carried out in the standing position, is called the symptom of Pasternatsky. Normally, the patient does not respond to the harvesting of the lumbar region. If this manipulation is painful, the renal disease can be suspected.

When the kidney is palpable

Kidney is well palpable only in pathological changes in the body. The doctor may feel them when omitting, in the presence of cystic and other neoplasms. With such pathologies, both hydro and pionephrosis are successfully tested by the Bulloting method. These are the silent movements under the lumbar region, which the doctor feels the second hand through the body of the authority.

It should be noted that in the norm no authorities are not running except the kidney.

Manual examination of ureteid points is applied in suspected pathology in this area. Normally, ureterals are painless and do not fit. If there is a pain in one of the 4 points of the projection of the ureters, the pathological process can be suspected.

Survey of kidney kidney

Children apply the same methods of manual examination as in adults. In healthy children, the kidney is also not told, but in pathologies can be determined. When holding a manual survey in children, the doctor prefers palpate the kidneys in the position lying on his back and on the side. Feeling standing is not always possible, especially if the child is restless.

Percussion

About the symptom of Pasternatsky, we mentioned above. Percussion (tapping) can also be applied for testing tumors, if there is a neoplasm or seal, the doctor will hear a stupid percussion sound. The tympanic sound at percussion may indicate the presence of fluid and other violations. Percussion of the kidneys requires great skills and the experience of the doctor.

When the patient comes to a reception to the doctor and makes him complaints, the specialist usually sets clarifying questions and conducts an inspection. He feels hands, where the body is located, as far as he is painful. Methods for conducting the survey will differ depending on which system of the body fails.

Palpation of the kidney does not cause patient pain, if everything is in order with the organ. In addition, if the kidneys are in place, they have a normal size, they are quite difficult to forgive them. Already on these features it is clear whether there are any deviations.

With such pathologies, as nephroptosis, the kidney changes its position - it drops, becomes movable. With neoplasms or inflammations, the body becomes uneven, changes the form, increasing in places of localization of tumors.

Below we offer to familiarize yourself with pathologies in which the kidney palpation is possible:

pyelonephritis;
hydronephrosis;
panephritis;
urolithiasis disease;
new formation.

Palpate organs in two ways:

superficial;
deeper.

In the first version, the doctor receives generalized information about the kidneys. It will be clear to the temperature of the body, as far as the muscles are tense, whether there are seals or infiltrates under the skin. With a deep method, the authority can be felt as accurate as possible. This includes the following techniques:

tearing with sliding movements;
bimanual method;
tashed tacking.

For the kidney examination, bimanual technique is the most suitable.

Palpation technique

The patient will need to lie on the back or on the side, as well as the doctor may ask him to get up. Sometimes a specialist manages to grope the edge of the right kidney. It is usually located below compared to the left. This is possible only in thin people or in children.

If the patient is quite fat, then the bodies are completely impossible even with a pathological picture. So that at least somehow the doctor is able to get to the kidney, a person with overweight should stand.

The doctor offers the patient to get up and relax as much as possible, align the breath. It should be deep. When the patient is inhaled, the doctor on the back side is trying to push the kidney ahead. He will suck it with the second hand. It is this hand that should penetrate deeply.

Palpation methods of kidneys. Source: Studopedia.su.

Palpation of the kidney can be performed:

according to the samples when the patient should lie on the back;
according to Botkin - the patient stands.

Palpation for samples. A specialist places the thumb under the fins in front of the patient. The remaining fingers are behind. The doctor puts the second hand on the front of the abdomen. When the patient does breathe, the kidney goes down. The doctor will fix it with one hand, and the second presses on the stomach. The body, being squeezed between the fingers, will slip away. At this moment, the kidney and you can thoroughly forgive.

Palpation on Botkin. This kidney palpation method algorithm has similar to the previous one. The difference is that the patient should get up and turn to a specialist sideways. The torso leans a little forward, and the hands should be folded on the chest.

Both ways are suitable for people thin having weak muscles and soft belly.

If the patient is well developed muscles or is overweight, then the examination is carried out lying on the side.

Palpation of the kidneys in children is similar to the actions that the doctor performs when examining adults. At the same time, the features of small patients should be taken into account. Children are not always ready to stand calmly. That is why their internal organs are more often palpable in the lying position.

Percussion

When examining the kidneys, the percussion means tapping at the lower back. In this case, focus on the symptom of Pasternatsky. With pronounced pain, it is considered that the result is positive. Often it is about the ICD, paranefritis, pyelonephritis. It is impossible to exclude such pathologies as radiculitis or myositis that are not related to the urinary system. With these diseases, percussion causes an increase in pain.

Kidney percussion is performed in the sitting position or standing. The patient must fix the hand in the abdomen area and bend a little forward - lean.

The doctor becomes rear. He sets his left hand in the region of 12 ribs, and the right performs non-links, but at the same time rather sharp. Then repeats the movements on the other side.

Thanks to this kind of tapping and feelings, a specialist can understand whether there is pathology or not. Additional research will be appointed for the suspension. Sometimes enough and ultrasound. If doubts remain, computer tomography will be appointed or a deeper examination. After that, it will be possible to diagnose and proceed to the choice of the optimal treatment option.

Palpation is a clinical method of human body survey, determining the structure, density, size, topographical ratio of organs and tissues by feeling. It is applied not only to assess the general physical condition, but also to primary identifying internal pathologies. Diseases of kidneys - no exception. Thanks to Palpation, the doctor determines whether the allocation authorities in additional surveys need. It is important that all the steps of palpator diagnostics are conducted consistently and correctly.

Why do you need kidney palpation, which reveals

Palpation of the kidneys is carried out by patients who have a doctor suspect the disease of the urinary system. Initially, the specialist listens to the patient's complaints, finds out the presence of kidney pathologies in the past, and then proceeds to a palpator survey.

By feeling detects:

the location of the kidneys is relatively other anatomical structures;
the size;
shape;
consistency;
mobility;
soreness.

Palpation is not the main, but important diagnostic method.Guided by only them, the doctor does not make a final diagnosis, but raises the question of the following ailments:

Nephroptosis - kidney omission. In the first stage of the disease, the lower part of the organ is tested, but only when inhaling. The second stage is characterized by the omission of the body outside the lower edge in the standing position. When the patient falls, the kidney returns to the place. At the third stage, the omission is expressed, so a specialist is easily forgiving the sick organ significantly lower Ryuber or in a small pelvis. The higher the degree of nephropolosis, the lower the kidney is lowered relative to the ride arc
Hydronephrosis is a pathological expansion of internal renal structures, as a result of which the organ is overwhelmed with liquid. Over time, the kidney increases in size, and at the expense of atrophy (die) its cells are disturbed by tissue consistency.
In the hydronephrosis, increased in the kidney sizes
Single kidney cyst is an education that is tested with impressive sizes and location closer to the lower pole. Feels like a protrusion or seal.
To the touch cyst kidney is determined, but often does not cause pain in a patient
Malignant kidney tumors. They are able to change the consistency, form, the size of the organ, provoke his battle with the surrounding tissues.
, cartoons. Multiple formations violate the renal structure, form, organ size.
Multiple cysts are able to significantly change the size and structure of the kidney, so it is not difficult to properly
Nephritis (kidney inflammation), urolithiasis. With these pathologies, palpation provokes pain.
The soreness of the kidney during palpation is characteristic of diseases associated with inflammation in urinary organs

Along with palpation, percussion is used. The method presupposes the tendering (tapping) of the kidney region. The patient is in the standing position. The doctor puts the left palm horizontally on the lower back in the kidney projection. An edge or fist of the right hand, a specialist performs a fit of the left palm. First, weak strikes are applied, then stronger.

During the fulfillment of the kidney percussion, the doctor monitors the correctness of the movements of his own hands, gradually reinforcing the tender

The study is carried out on both sides alternately. If the patient feels pain, it speaks about a unilateral or double-sided positive sample of the tender. Guided by it, the specialist may suspect the inflammation of the kidneys or the octopic tissue, the exacerbation of the urolithiasis. At the same time, pain when tapping may indicate the presence of other pathologies -, osteochondrosis, myositis, pancreatitis, etc. Percussion of kidney is informative only in the complex with characteristic complaints and relevant surveys.

Percussion is needed not only to detect pain. During the tendering of the kidney, the sounds arise, which will tell an experienced doctor about the diseases in the patient. For example, in the presence of a tumor in the projection of the organ, a dull percussion sound is heard. If liquid has accumulated in the kidney, tympanic (loud) sound.

Pickup for evaluating percussion sound is made by index and middle fingers of the left brush on the middle finger right, which is located on the lower back in the kidney projection

Indications and Contraindications to Palpator Survey

Tearing the kidney is a safe and affordable method of physical examination. Palpation is carried out:

if the patient expresses the complaints characteristic of nephrological ailments, pain in the lumbar region, impaired urination, persistent increase in blood pressure;
if there is a history of kidney disease;
for differential diagnosis with diseases of other abdominal organs - liver, pancreas, intestines, etc.
during a planned medical examination in a clinic or when entering the hospital.

Palpation of the kidneys is contraindicated in cases where the area of \u200b\u200bfeeling is amazed by burns, extensive wounds, purulent formations, or fresh postoperative seams are present on the abdomen and back.

Palpation is carried out with caution:

in the threat of internal bleeding;
people with rigidity (excessive tension) of the muscles of the lower body;
if the doctor suspects a purulent process in the abdominal cavity (abscess, phlegmon, peritonitis, etc.);
during pregnancy, more than twelve weeks, with a threat of miscarriage.

The examination is difficult if the patient:

obesity with excess deposits in the abdomen;
intestinal distention;
ascites (accumulation of fluid in the abdominal cavity).

Rules of implementation

Palpation procedure is informative in the case when executed according to the rules and does not cause discomfort in the patient. A warm room is examined. The hands of the doctor should not be cold. The algorithm of the procedure is as follows:

The doctor asks the patient to bargain the area of \u200b\u200bthe abdomen and lie on the topchair (or stand with his hands lowered along the trunk).
The doctor washes his hands with soap warm water, hees a towel.
Visually examines the skin of the patient for damage and defects.
First, the surface palpation is performed, and then moves to deep.

Help medical gloves during palpation is not recommended, as their material may disrupt the feeling of who performs the procedure.

Surface palpation is carried out with all diseases of the internal organs. With its help, they define muscle tone, temperature, density and humidity of the skin, subcutaneous infiltrates and neoplasms. This is important because the unsatisfactory condition of the abdominal wall interferes with deep palpation.

Methods and techniques

To pinch the kidneys, apply:

The method of deep sliding palpation is that the kidney is pressed against the back surface of the abdominal cavity, after which it is palpable with sliding movements.
The bimanual method is feeling simultaneously with two hands. The left hand of the doctor holds the kidney in a comfortable position, and the right piping.
Bulling - Palpation with brief shocks. The doctor sets hands on the abdomen below the twelfth rib. The left hand is carried out in the right hand. When omitting the kidney organ is felt partially or completely.

Based on these methods, a series of palpator techniques for the kidneys survey has been developed.

Palpation for sampling

Study on sampling applied by doctors most often. Performed by deep sliding palpation:

The patient is lying on his back with an elongated legs, hands are freely folded on the chest, the abdominal press is relaxed.
The doctor sits on the right of the patient, put his left hand under the lower back below the edge so that the fingers were not far from the spine, but did not touch him. To forgive the left kidney, the doctor moves the hand for the spine to the right kidney.
The right hand is located on the stomach below the edges perpendicular to them.
The patient is relaxed, breathes deeply and smoothly.
During the exhalations, the specialist immerses the fingers gradually deep into the back of the back.
Left hand puts pressure on the lower back towards the fingers of the right hand.
When the hands are as close as possible, the doctor offers the patient to do inhale with the help of the abdominal muscles, but without tension. If the kidney is below an anatomical lodge, it drops even more and tested with the fingers of the right hand.
The doctor then presses the kidney and slides his fingers down the front surface.

Palpation of kidneys in exemplary is applied with any kidney pathologies, because it is considered highly informative

Thus, it is possible to obtain an idea of \u200b\u200bthe size, surface character, form, location, consistency, kidney pain.

Technique for Botkin

Palpation feature by S.P. Bottina is that it is performed in the patient's position standing or sitting. The disadvantage of technology is that it is not informative in people with overweight.

If the patient is worth it, his torso leans a little forward. From the palpation side, the patient flexs his leg. The remainder implementation technique is similar to the previous one.

The advantage of the palpation of the kidneys along Bottn is that the organs are investigated under the influence of gravity. This makes it possible to identify the wandering kidney and the degree of nephropotosis.

Taketing on Glenra

Glenara palpation is used to diagnose kidney omission, as well as to detect tumor formations and increase the organ.

Execution technique:

The patient is placed on the back.
The left hand is a doctor wrapping the side of the studied so that the thumb is in the hypochondrium, and the rest were on the lower back.
The right hand is placed in the hypochondrium, continuing the thumb left.
The patient exhales. The kidney moves the bottom to the thumb left.
The organ is captured, and it moves under pressure up to the hypochondrine.
The sliding palpation on the front surface of the kidney is performed with the fingers of the right hand.

Glenara Palpation is suitable for more patients with asthenic and normal physique.

Video: Features of palpation of kidneys

Results and norms

If the kidney is within its own anatomical bed, it is not increased, it is impossible to forgive it. In people of asthenic buildings during deep palpation, the doctor can feel the lower renal pole. This is not pathology. In some cases, the lower surface of only the right kidney is tested, since it is anatomically located below the left.

The kidney rate is within the edges, have a form resembling a bob, a smooth capsule, a homogeneous consistency

Table: Palpator characteristics of the kidneys are normal and illness reporting

Characteristic	Norm	What diseases are evidenced by deviations
Location	within the limits of the rebel arcs, so do not palpate	the position below the grated arcs and excessive mobility speak of nephroptosis
Mobility	insignificant; During deep breathing, running, slopes and jumps do not exceed 2-3 cm
The form	boboven	changes in shape, size and consistency are found at: hydronephrosis; cystroid; glomerulonephritis; kidney wrinkling due to various diseases; malignant formations.
Consistency	homogeneous, moderate density
The size	longer kidney - about 12 cm, diameter - approximately 6 cm
Surface	smooth and smooth due to a dense capsule	dumpness may indicate: kidney cyst; multi-storey; kidney cancer; cleaning the organ.
Surability	absent	the pain is present in such pathologies as: nephritis; panephritis; kidney stones; II-III stage of nephroptosis.

Features of diagnostics in children

The smaller the child, the more difficult the renal palpation procedure.

In children under the year, the study is advisable to carry out with the help of Gueon technology. It resembles Palpation on Strazestly, except that they feel one, and not with all the fingers of the right brush. This is a kind of balloting (oscillation). The doctor, bending my fingers, push the kidney forward, helping the palpant finger to prove the organ and its structure.

Breastfeed kidney palpation is carried out as neat as possible, with the help of one hand fingers

It is more difficult to carry out the inspection of preschool children, especially if they are afraid of doctors. To persuade the child to relax the belly is almost impossible, it will not work out all the more. To carry out palpation, the doctor should be found to the kid. To do this, give a child a pre-prepared toy (if not, the phononendoscope is suitable), for the time of inspection, remove the white robe. Talk to a calm voice, smile. Such a relaxed behavior forms a confidence in a child to an unfamiliar adulthood. Palpation make warm hands, unobtrusively and slowly. Along the way, talk to the baby or ask parents to distract it with something. Percussion for the detection of pain symptom is possible only in children who willingly go to contact with the doctor and distinguish true pain from sensations arising from the phableing.

In order to effectively hold the child's palpation or percussion by the child, the doctor must cause the confidence of a small patient

Similar to adults in children, the kidney is not palpable. Only in the asthenic physique or exhaustion there is a chance to try to face the lower edge of one or two kidneys. This is not pathology, however, it is necessary to remember that fat tissue deficit is a predisposing factor in the development of nephropotosis. Therefore, it is important for thin children to regularly examine the kidneys for the timely detection of their possible omission.

Palpation procedure in preschool and younger school age children are almost no different from those in adults. She is stepdown:

The child is placed on the back, asking to close her legs and bend a little in the knees.
The doctor has a left hand under the flaw, the right lays on the stomach.
First conduct surface palpation.
Then, during a deep breath, it is strongly pressing in the projection first one, then another kidney. If you managed to try the body or part of it, it is advisable to apply the tanning technique.

To inspect adolescents is possible in the standing position, sitting or lying on the side with the help of listed techniques. But it is believed that informativeness is higher in the position of Löz.

The kidney percussion in children is carried out by applying light blows by one or two fingers in the lumbar region.

Palpation is not the main method of diagnosing kidney disease, but suggests their presence. Palparatory study does not require much time, additional equipment and financial costs, which makes it widely applicable and affordable. The result of feeling is determined by the right choice and quality of the technique, as well as the ability of the doctor to interpret the information received.

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Odnoklassniki.

Palpation types for kidneys

There are 2 types of palpation, which are used during patient surveys:

Surface palpation - a doctor is feeling a body, primary focusing on the presence or absence of pathology. When conducting primary palpation, it is already possible to make a preliminary conclusion about the state of the patient. The hands of the stroking movements explored in the straightened state are feeling the area of \u200b\u200bthe location of the organs, without paying any pressure. Thus, the doctor determines the characteristic of the patient's skin, muscle tone and the presence of voltage.
Deep palpation - used for a detailed study of the internal organs of the patient. The doctor does it with several fingers right hand, applying a strong pressure on the stomach. Typically used sliding deep - a methodical study of internal organs, which has a certain sequence. A strong pressing doctor presses the kidney to the rear wall and the body feels in detail.

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Bimanual method

To perform the doctor of this method, the patient can be both horizontally and in a vertical position. In the event that the studied lies, it must stretch the legs, and put the hands on the chest. If the organ of the right is investigated, the doctor sits on the right side of the patient and produces feeling with the left brush of the lumbar part under the edge. The location of another kidney remains unchanged. If the study is carried out when the patient stands, feeling is carried out similarly.

Bulloting technique

This method is carried out with brief jolts. When examining the left kidney, the doctor, applying short shocks on the left side, the right hand feels the kidney, which strikes it. This examines the level of omission of the organ. In the case when only the bottom is felt, it means that the patient is the first degree of omit. The second degree is characteristic of the fact that you can feel the entire surface of the kidney. The third degree of kidney is not only free to face, but also moves freely to the parties.

Percussion (tender method)

The percussion technique often applies when it is necessary to investigate the tumor that appears or other neoplasm. Pathology is characterized by stupid performer sound when tapping. The so-called tympanic sound testifies to the accumulated fluid or similar violations. Percussion requires a doctor of the necessary skill and experience for conducting a doctor.

Percussion makes it possible to differentiate a tumor, which is in the kidney from the tumor, which is located in the abdominal cavity on other organs.

If there is a large tumor or hydronephrosis, sometimes the intestine is shifted in the medial direction and in this case the sound is created over the tumor during the percussion. This may occur with a crowded bladder. Such situations are infrequent, but they lead to the wrong preliminary diagnosis.

Conducting child surveys

During the examination of children, they are placed on the side or back, since often the big mobility of the child prevents the diagnosis in sufficient detail. Detailed Palpation Method: The child falls on the back. Legs are a little bent. The doctor puts his left hand under the lower back, and the right - on the abdominal cavity. With a strong press during a deep breath in pathology, the lower part of the kidney is felt. Then, if the kidney palpation is tested, checking the balloting.

If children are examined in a standing position, then the torso is tilted at right angles. Hands lowered. The doctor puts his left hand on the lumbar region, and the right abdominal muscles right from the outside side, next to the level of rib arc. Palpation technique is the same as in a horizontal position. Using percussion in a child determine the level of renal pain. With unpleasant sensations, a preliminary diagnosis of inflammation of the kidneys or a sparkular tissue is put.

Alexander Butchestnikov in the program "On the most important thing" talks about how to treat the diseases of the kidneys and what to take.

One of the main methods of clinical research is Palpation, that is, feeling. It allows you to get an idea of \u200b\u200bthe properties of organs, their location and sensitivity. This method can be carried out in different ways, depending on the body under study. In suspected of any renal pathology, the doctor begins to inspect a survey and analyzing complaints, kidney palpation and percussion (climbing) organs. These methods are already used for more than one hundred years and have sufficient informativeness to obtain an idea of \u200b\u200bthe general condition of the body and understand whether there are pathology.

What gives inspection

The kidneys is such a body that is not palpable at normal sizes and location, that is, when everything is in order with them, they cannot be forgiven. Normally, during persons and percussion, the patient does not feel any discomfort.

Thus, these simple methods that do not require any techniques help in the diagnosis of the condition of the body and identify diseases.

When the kidneys are felt

Protecting this body is possible in cases where its position and dimensions change. This occurs in the presence of some diseases or with nephroptosis (kidney omit). Inflammatory or tumor diseases lead to the fact that the contours of one or both kidneys change, they can acquire another form or simply evenly increase. In addition, many pathologies lead to the fact that the patient feels pain in palpation or kidney percussion.

Diseases in which the kidneys are available for inspection:

hydronephrosis;
pyelonephritis;
panephritis;
urolithiasis disease;
cystic education and tumors.

If the organ managed to properly, in addition to the definition of its size and pain, one can estimate the nature of the surface (smooth or buggy), the features of the shape, mobility.

Varieties

It is customary to distinguish between two types of this study: superficial and deep palpation. Superficial is used to obtain a preliminary information of a general nature. With its help, the doctor determines the body temperature, muscle tone, can reveal the areas of subcutaneous infiltrates and seals.

Deep Palpation is a method of detailed examination, which can be performed in the following ways:

deep sliding tackling;
bimanual;
pushing.

For the study of the kidneys, the bimanual palpation is most suitable, which is performed by two hands. It allows one hand to hold the organ or "serve" it, and the second to feel.

How the study is carried out

The doctor can perform palpation when the patient is in the standing position, lying on the back or on the side. If everything is in order, in some cases it is possible to forgive only the lower edge of the right kidney in children or thin patients, because it is below the left. People with normal or overweight it is impossible. Moreover, in full patients, such a survey is carried out only in the position of lying, because even with pathologies, this method of examination will not give anything in the vertical position.

The patient occupies a position that the doctor defines, relaxes and breathe deeply deeply. During the inhalation, the doctor with one hand, located on the side of the waist, holds and as it would be navigating the kidney ahead, and the other is feeling. And the hand, which is performed feeling, penetrates the abdomen.

Most often, when examining the kidneys, Palpation techniques for samples are used (lying on the back) and on Botkin (standing).

Palpation steps lying on back

The doctor puts the thumb from the abdomen under the ribs, the rest are behind. The second hand is on the front wall of the belly. The patient takes a deep breath.
During the inhalation of the kidney descends. The doctor picks her hand located below, and presses the other hand on the stomach.
When squeezing the kidneys between the fingers, it slips, at this point and the feeling of its surface occurs.

Bottina study

The method of execution is the same as in the previous case, only the patient is in the standing position and turning to the doctor sideways. Torch slightly tilted forward, hands usually ask to fold on the chest.

Both examination techniques are well suited for non-extensive patients, and for those who have a soft belly with a weak muscles. For people with good muscles or excess weight, palpation is applied with a patient's position lying on the side.

During the examination of children, the same methods are used as in adults, however, their age characteristics should be taken into account. Children can not always be in a calm state, it prevents the survey, so preference is given to the position lying, especially when the child is still small, it is easier to ensure his peace of examination.

Percussion is carried out by the pounding of the lumbar region. If the patient has painful sensations, it means that the positive symptom of Pasternatsky is diagnosed, which is an indicator of pathology. This is usually pyelonephritis, paranefrit or urolithiasis. However, it should be borne in mind that painful sensations in the projection of the kidneys during phableing can be at mositic or radiculitis.

Kidney percussion is carried out when the patient stands or sits on a chair. He puts his hands on the stomach, and he leans a little ahead.

The doctor comes from behind, the left hand puts on the lower back in the area of \u200b\u200bthe twelfth edge, the edge of the palm of his right hand makes sharp, but mesmer strikes on the left hand. Such a tender is performed first on the one hand, then on the other.

As a result of Palpation and Percussion, the doctor receives primary information about the state of the kidneys. If their pathological state is revealed, it is necessary to carry out additional studies that will help put the final diagnosis.

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Pyelonephritis more often sick girls, women. Hypernefrom, on the contrary, is more common in men.

In case of inspection, renal edema, which are located on the face, especially on the eyelids, and are intensively expressed in the morning, the face is pale. Sicks of renal diseases often have pale skin covers, which is associated with a violation of the synthesis of erythropoietin in the kidneys, resulting in anemia, as well as spasms of renal vessels. Amyloidosis of the kidneys is also accompanied by a pronounced patient's pallor.

The condition of patients with kidney diseases is different. So, when examining the patient with a utility terminal stage of renal failure, the patient lies in bed. There is a characteristic smell of urea, emanating from the patient. This is due to the fact that the kidneys are not able to carry out an excretory function, and then other organs begin to be carried out - the skin, the organs of the respiratory system. The selection of skin toxins leads to the fact that it becomes covered with a white bloom, traces of combs are visible on the skin, since the stuffing substances cause itching. Patients with urolithiasis at the time of the attack do not find places, are moving in bed, shout, they can not find a position in which the pains would be weaker.

Inspection of the area of \u200b\u200bthe kidneys and bladder, as a rule, gives little information, except for the appearance of visually defined unilateral increases in the field of large tumors, especially in exhausted subjects.

Percussion of kidneys

Diagnostically important is the symptom of the tender, consisting in the harm of the area of \u200b\u200bthe renal projection, for which the palm of one hand does not impose a doctor on the kidney area, and the other hand produces a tender (not very strong). A positive symptom is the appearance of pain when painting. This symptom is positive in renal disease, paranefritis.

Percussion of the bladder

Depending on the filling of the bladder at percussion over Lyon (in the area of \u200b\u200bits projection), a dull tympanic sound is marked. In case of acute urine delay percussion reveals a stupid sound.

Palpation of kidneys

Palpation of kidneys in most people is usually difficult. The kidneys are palpable when changing their position or size, for example, when omitting (in a vertical position), the presence of a large tumor, wandering kidney. When the kidney palpation, like when palpation of other organs, the patient should lie on a flat comfortable surface, it is desirable to cross on the chest. The doctor sits on the right of the patient, to approach the kidney to the palpant hand put the palm of his left hand under the lower back, and the palm of his right hand puts on the belly outside of the lateral edge of the abdominal muscle perpendicular to the rib arc. The abdominal press muscles during palpation should be relaxed for which the patient's attention distracts.

On the exhalation, the right hand of the doctor is immersed in the abdominal cavity, and with the help of the left hand, the kidney is trying to bring closer to the palpant hand.

On the exhalation of the kidney, it is descended, and you can face her lower edge. Assess the amount, pain in palpation, smoothness or the peculiarity of the surface, form, displacement. Palpation soreness is observed in inflammatory diseases of the kidneys (paranefritis, pyelonephritis), urolithiasis, tumors (for example, hypernefrom). With panefritis of the kidney sharply painful during palpation, increased, loses the bean shape.

To determine the type of scattering pathology and bladder, a variety of survey methods apply to which kidney palpation, percussion and inspection. Each type of diagnosis has its own characteristics and gives a specific set of information.

Palpation of kidneys

So, more. Palpation of the kidneys in a healthy person does not give results, as they do not fit. This procedure can be carried out only if there is a pathology of the organs. Or very thin people.

Kidney palpation is carried out in two positions: lying and standing. In the lying position, the abdominal muscles are omitted, their relaxation, resulting in the procedure facilitated. Standing during the examination, you can adversely forgive the kidney, which has a shift down under its mass.

Palpation of the kidneys is carried out by two hands. The patient falls on the couch on his back, legs should be straight, hands - free to place on the chest. In such a position of the abdominal muscle, relaxes as much as possible, breathing becomes even, calm. The doctor is located to the right of the patient. He puts his left hand under the lower back, just below the last rib in such a way that it is located near the spine. During the examination of the left kidney, the hand is put under the back further, for the spine.

The right hand of the doctor is located on the stomach slightly below the root arc of the dust from direct muscles. On the exhalation, the specialist immerses his hand into the abdominal cavity towards the fingers of the left hand.

Further. When the kidney palpation, during the rapprochement of hands, the patient is invited to do. Very deep. As soon as he exhales, the specialist can feel the omission of the kidney, the edge of which is suitable for his right hand and passes under her fingers. If the organ has a strong increase, the doctor will be able to completely properly proper his front wall, find both poles. Such a survey method allows you to determine the form and size of the organ.

There is also a kidney palpation technique in the patient's position, lying on the side. In this case, the procedure is carried out according to the same rules as in the back position. But when the patient is located on the side, the doctor sits, and the patient must be turned to his face. His torso slightly leans forward, the muscles relax. During the examination in this case it is possible to detect nephrisosis. In the first stage of the illness, only the lower pole of the organ is pregnant. On the second with ease, the entire body is found. At the third stage of nephrosis, the organ freely shifts in any direction. Sometimes during palpation there is soreness.

Sometimes, during the procedure, it is possible to confuse a body with a filled sector of the colon, an increased right share of the liver or with a tumor. That this does not happen, you should know the form of the authority: it resembles a bob with a smooth surface. For kidney, it is characterized up and returning to its original position. After palpation, the urine appears protein and an admixture of erythrocytes.

You can examine the patient in the standing position. In this case, the doctor sits opposite the patient, and the patient stands in front of a specialist, slightly leaning forward and arms crossed on his chest. The doctor puts the hand just like when surveying the kidneys from behind.

results

During palpation of kidneys in children and adults, the following pathologies can be assumed with an enlarged authority:

nephritis;
hydronephrosis;
hypernefrom;
anomaly of development in the form of lowered kidney.

Everything is very serious. In addition to Palpation, the percussion of the organ is estimated. Read more.

In order. In order for the doctor to be more accurate to determine the diagnosis, it is necessary to carry out palpation and kidney percussion. The last method of the survey allows you to identify changing sound above the body.

Norma is heard a tympanic sound. This is due to the fact that the kidneys are covered with intestines. If a stupid sound is heard, then this indicates a sharp increase in the organ. In this case, the intestinal loops are moving away.

Symptom Pasternatsky

Huge importance for the examination is the definition of the symptom of Pasternatsky. This is the method of deploying, in which the disease soreness is evaluated. During the procedure, the doctor is behind the patient's back. The left hand places on the region of the twelfth rib and a little left of the spine. The edge of the palm of the other hand is applied short-sighted shocks on the left hand. Depending on the degree of expression of pain, the type of symptom is determined: a positive, weakly expressed, negative one.

The positive symptom of Pasternatsky is determined at the ICD, pyelonephritis, paranefritis and some of other ailments. It is worth understanding that the patient may feel sickness in osteochondrosis, the diseases of the ribs, the muscles of the lower back. Less often pain arises due to the pathologies of the gallbladder, pancreatitis and other ailments.

Palpation of the bladder

The next moment. Palpation of the kidneys and bladder is carried out to identify a variety of pathologies. I.e. For a bubble examination, the patient is in the lying position. At the same time, the doctor has a longitudinally on his stomach hand. 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 Lonnoy articulation.

Normally, an empty bladder for palpation is not available, as it is located behind Lona. The filled body is felt. When inflammation, the bladder is tested outside of the climb. The patient can feel soreness when pressing.

Percussion of the bladder

To determine the upper boundaries of the bladder, the percussion method is used. During this type of diagnostics, the doctor has a finger-plastermeter (which knocks) horizontally. Tapping is carried out in the midline, in the direction from top to bottom, starting from the level of the navel and ending with the pubic.

With an empty bladder, a tympanic sound is heard, which is preserved to the Lonny Jim. In the event of an overflow of the organ in the field of the upper limit, the sound is in stupid. This place is celebrated as the upper border.

Conclusion

Physiological diagnostic methods make it possible to identify a variety of kidney pathologies and bladder. With their help, the sizes, the location of the organs, as well as the presence of liquids in them. After inspection, palpation and percussion, urine tests are necessarily assigned. No compulsory conducts OAM.

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