Determination of the greater curvature of the stomach by the splash noise method. Splash noise detection technique according to Obraztsov

The stomach is palpated in the epigastric region with four half-bent fingers of the right hand folded together. They are installed 3-5 cm below the xiphoid process parallel to the position of the greater curvature of the stomach (Fig. 56, a). Superficial movement of the fingers up to the xiphoid process first creates skin fold. Then, during the exhalation of the patient, the fingertips are immersed in depth and, upon reaching the spine, slide them from top to bottom. While the fingers are over the stomach, you can feel the rumbling. It is caused by the movement of fluid and gases in the stomach, due to deep sliding palpation.

Better palpation of the stomach is facilitated by respiratory excursions. Therefore, the patient must be offered to calmly and deeply “breathe in the stomach”. In the exhalation phase, the greater curvature of the stomach goes up, and the examiner's fingers move down and slide off a small elevation in the form of a step formed by duplication of the greater curvature, which is felt at this moment as a soft elastic arched roller located on both sides of the spine.

To find a large curvature, you can apply the method of palpation with a "double hand" (Fig. 56, b). For this purpose, the fingertips of the left hand are placed on the terminal phalanges of the right hand and they make a deep sliding palpation. Normally, the greater curvature of the stomach is 3-4 cm in men, 1-2 cm above the navel in women and is palpable in 50-60% of cases. When the stomach is prolapsed, it may lie below the navel

Rice. 56. Palpation of the stomach:
a, b - large curvature in the usual way and the "double hand" method;
c - by palpation auscultation;
g - percussion method;
e - in the vertical position of the patient.

The correctness of finding the greater curvature is verified by comparing the palpation data with the results obtained using other methods for examining the lower border of the stomach.

On palpation of the stomach, in addition to determining its localization, attention should be paid to the consistency, surface and shape, as well as to the presence of pain. At healthy people the surface of the stomach is smooth.

Thickening of the greater curvature and pain during palpation are observed with gastritis, peptic ulcer. In the case of the development of a tumor of the stomach, its shape and consistency change, the surface becomes bumpy. This is better detected by palpation of the stomach in the upright position of the patient (Fig. 56, e).

To determine the lower border of the stomach, percussion palpation according to Obraztsov is used (according to splash noise; Fig. 56, d). Splashing noise can be caused if there is liquid and air in the stomach and if the latter is located in front of the liquid. To detect splashing noise, the ulnar edge of the slightly bent left hand should be pressed in the area of ​​the xiphoid process. In this case, the air of the gas bubble will be distributed over the surface of the liquid. Then, with four half-bent fingers of the right hand, short blows are made in the epigastric region, somewhat below the xiphoid process, and, gradually descending, cause a splashing noise until the fingers slip off the greater curvature of the stomach. The cessation of splashing noise indicates the lower border of the stomach.

In healthy people, the splashing noise is caused shortly after eating. If a loud splashing noise is caused on an empty stomach or 6-7 hours after eating, then motor function the stomach is reduced or its evacuation ability is impaired. This may be due to spasm or pyloric stenosis.

In addition to deep sliding and percussion palpation, the method of palpation auscultation can be used to determine the lower border of the stomach (Fig. 56, c). It comes down to the following. The stethoscope is placed over the stomach area. With the index finger of the right hand, light rubbing movements are made along the abdominal wall from top to bottom towards the navel. While the finger is above the stomach, a rustling is heard in the stethoscope, which disappears or weakens when the finger moves out of it. This simple method can establish the position of the greater curvature of the stomach, but sometimes it gives incorrect results.

The location of the lower border of the stomach can normally vary depending on the degree of filling of the stomach and intestines, the fatness of a person, changes in intra-abdominal pressure, and other reasons. Diagnostic value acquires a significant displacement of the lower border of the stomach with its expansion and omission.

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5. Palpation of the tumor (size, mobility)

Tumor palpation

On palpation of the tumor, the doctor must find out where it comes from: from the abdominal wall, organs abdominal cavity or retroperitoneal space. During the study, it is necessary to find out the size, consistency, mobility of the tumor. All this is necessary to establish the nature of the tumor, its operability and determine the surgical access to it.

In order to exclude a tumor from the anterior abdominal wall, the patient strains the muscles of the abdominal wall, for which he bends his head, pressing his chin to the body or slightly rises on his elbows.

Tumors of the abdominal wall are more superficial, do not move, are palpated worse, do not disappear when the anterior abdominal wall is tense.

Retroperitoneal tumors are located deeper, have a wide base and are not determined by contraction of the anterior abdominal muscles.

Intra-abdominal tumors give (a different clinical picture.

Tumors small intestine and greater omentum are more displaceable than tumors of the right and left halves of the colon (caecum, sigmoid). Most contain tumors that have a leg (cysts).

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Classification of intestinal obstruction

There are several options for classifying intestinal obstruction, taking into account various pathogenetic, anatomical and clinical mechanisms. Depending on all these factors, a differentiated approach to the treatment of intestinal obstruction is applied.

For morphofunctional reasons, they distinguish:

1. dynamic intestinal obstruction, which, in turn, can be spastic and paralytic

2. mechanical intestinal obstruction, including forms:

• strangulation (torsion, infringement, nodulation)
• obstructive (intraintestinal, extraintestinal)
• mixed (adhesive obstruction, intussusception)

3. vascular intestinal obstruction due to intestinal infarction.

According to the level of location of the obstacle for the passage of food masses, high and low small intestinal obstruction (60-70%), colonic obstruction (30-40%) are distinguished. According to the degree of violation of the patency of the digestive tract, intestinal obstruction can be complete or partial; on clinical course- acute, subacute and chronic. According to the time of formation of intestinal obstruction, congenital intestinal obstruction associated with embryonic malformations of the intestine, as well as acquired (secondary) obstruction due to other causes, is differentiated.

In the development of acute intestinal obstruction, several phases (stages) are distinguished. In the so-called "ileus cry" phase, which lasts from 2 to 12-14 hours, pain and local abdominal symptoms prevail. The stage of intoxication replacing the first phase lasts from 12 to 36 hours and is characterized by "imaginary well-being" - a decrease in the intensity of cramping pains, a weakening of intestinal motility. At the same time, there is no discharge of gases, stool retention, bloating and asymmetry of the abdomen. In the late, terminal stage of intestinal obstruction, which occurs 36 hours after the onset of the disease, severe hemodynamic disturbances and peritonitis develop.

Causes of intestinal obstruction

Development various forms intestinal obstruction due to their own causes. So, spastic obstruction develops as a result of reflex spasm of the intestine, which can be caused by mechanical and painful irritation with helminthic invasions, foreign bodies of the intestine, bruises and hematomas of the abdomen, acute pancreatitis, nephrolithiasis and renal colic, biliary colic, basal pneumonia, pleurisy, hemorrhage. and pneumothorax, rib fractures, acute myocardial infarction, etc. pathological conditions. In addition, the development of dynamic spastic intestinal obstruction may be associated with organic and functional lesions. nervous system(TBI, mental trauma, spinal cord injury, ischemic stroke, etc.), as well as dyscirculatory disorders (thrombosis and embolism of mesenteric vessels, dysentery, vasculitis), Hirschsprung's disease.

Paresis and intestinal paralysis lead to paralytic ileus, which can develop as a result of peritonitis, surgical interventions on the abdominal cavity, hemoperitonium, poisoning with morphine, salts of heavy metals, food poisoning, etc.

At various types mechanical intestinal obstruction is a mechanical obstacle to the promotion of food masses. Obstructive intestinal obstruction can be caused by fecal stones, gallstones, bezoars, accumulation of worms; intraluminal bowel cancer, foreign body; removal of the intestine from the outside by tumors of the abdominal organs, small pelvis, kidneys.

Strangulation intestinal obstruction is characterized not only by compression of the intestinal lumen, but also by compression of the mesenteric vessels, which can be observed when a hernia is incarcerated, volvulus of the intestines, intussusception, nodulation - overlapping and twisting of the intestinal loops among themselves. The development of these disorders may be due to the presence of a long mesentery of the intestine, cicatricial bands, adhesions, adhesions between intestinal loops; a sharp decrease in body weight, prolonged fasting followed by overeating; sudden increase in intra-abdominal pressure.

The cause of vascular intestinal obstruction is acute occlusion of the mesenteric vessels due to thrombosis and embolism of the mesenteric arteries and veins. The development of congenital intestinal obstruction, as a rule, is based on anomalies in the development of the intestinal tube (doubling, atresia, Meckel's diverticulum, etc.).

Symptoms of intestinal obstruction

Regardless of the type and level of intestinal obstruction, there is a pronounced pain syndrome, vomiting, stool retention and flatulence.

Abdominal pains are cramping unbearable. During the fight, which coincides with the peristaltic wave, the patient's face is distorted in pain, he groans, takes various forced positions (squatting, knee-elbow). At the height of the pain attack, symptoms of shock appear: pale skin, cold sweat, hypotension, tachycardia. The subsidence of pain can be a very insidious sign, indicating necrosis of the intestine and the death of nerve endings. After an imaginary lull, on the second day from the onset of the development of intestinal obstruction, peritonitis inevitably occurs.

Another characteristic symptom of intestinal obstruction is vomiting. Especially abundant and repeated vomiting, which does not bring relief, develops with small bowel obstruction. Initially, the vomit contains the remnants of food, then bile, in the late period - intestinal contents (fecal vomiting) with a putrid odor. With low intestinal obstruction, vomiting, as a rule, is repeated 1-2 times.

A typical symptom of low intestinal obstruction is stool retention and flatus. A digital rectal examination reveals the absence of feces in the rectum, the prolongation of the ampulla, the gaping of the sphincter. With high obstruction of the small intestine, there may be no stool retention; the emptying of the underlying sections of the intestine occurs independently or after an enema.

With intestinal obstruction, bloating and asymmetry of the abdomen, peristalsis visible to the eye, draws attention.

Diagnosis of intestinal obstruction

With percussion of the abdomen in patients with intestinal obstruction, tympanitis with a metallic tinge (Kivul's symptom) and dullness of percussion sound are determined. Auscultation in the early phase revealed increased intestinal peristalsis, "splash noise"; in the late phase - weakening of peristalsis, the noise of a falling drop. With intestinal obstruction, a stretched intestinal loop is palpated (Val's symptom); in late dates- Rigidity of the anterior abdominal wall.

An important diagnostic value is the conduct of rectal and vaginal examination, with the help of which it is possible to detect obturation of the rectum, tumors of the small pelvis. The objectivity of the presence of intestinal obstruction is confirmed during instrumental studies.

Plain radiography of the abdominal cavity reveals characteristic intestinal arches (a gas-inflated intestine with liquid levels), Kloiber bowls (domed enlightenments above the horizontal liquid level), and a symptom of pennation (the presence of a transverse striation of the intestine). X-ray contrast examination of the gastrointestinal tract is used in difficult diagnostic cases. Depending on the level of intestinal obstruction, barium passage through the intestine or barium enema may be used. Colonoscopy allows you to examine the distal parts of the large intestine, identify the cause of obturation of the intestine and, in some cases, resolve the phenomena of acute intestinal obstruction.

Ultrasound of the abdominal cavity with intestinal obstruction is difficult due to severe intestinal pneumatization, however, the study in some cases helps to detect tumors or inflammatory infiltrates. In the course of diagnosis, acute intestinal obstruction should be differentiated from acute appendicitis, perforated gastric and duodenal ulcers, acute pancreatitis and cholecystitis, renal colic, ectopic pregnancy.

Treatment of intestinal obstruction

If intestinal obstruction is suspected, the patient is urgently hospitalized in a surgical hospital. Before a doctor's examination, it is strictly forbidden to give enemas, administer painkillers, take laxatives, and perform gastric lavage.

In the absence of peritonitis in a hospital, the gastrointestinal tract is decompressed by aspiration of the gastrointestinal contents through a thin nasogastric tube and setting a siphon enema. With cramping pains and severe peristalsis, antispasmodics (atropine, platifillin, drotaverine) are introduced, with intestinal paresis - drugs that stimulate intestinal motility (neostigmine); novocaine pararenal blockade is performed. In order to correct the water and electrolyte balance, it is prescribed intravenous administration saline solutions.

If, as a result of the measures taken, intestinal obstruction does not resolve, one should think of a mechanical ileus requiring urgent surgical intervention. The operation for intestinal obstruction is aimed at eliminating mechanical obstruction, resection of a non-viable part of the intestine, and preventing re-disturbance of patency.

In case of obstruction of the small intestine, resection of the small intestine can be performed with the imposition of enteroenteroanastomosis or enterocoloanastomosis; deinvagination, untwisting of intestinal loops, dissection of adhesions, etc. In case of intestinal obstruction caused by a colon tumor, hemicolonectomy and temporary colostomy are performed. With inoperable tumors of the large intestine, a bypass anastomosis is applied; with the development of peritonitis, a transverse stomy is performed.

AT postoperative period compensation of BCC, detoxification, antibacterial therapy, correction of protein and electrolyte balance, stimulation of intestinal motility are carried out.

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Physical examination they begin with a general examination, while the pained expression on the patient's face suggests that the patient is in pain. A pale face with pointed features, sunken cheeks and eyes is suggestive of a disease involving inflammatory process peritoneum (face of Hippocrates). Examination of the eyes can reveal jaundice, anemia. Dryness skin it is expressed in diseases accompanied by disturbances in water and electrolyte balance.

Examination of the abdomen. In the vertical position of the patient, the normal configuration of the abdomen is characterized by a moderate retraction of the epigastric region and some protrusion of the lower half of the abdomen. In the supine position in a non-obese patient, the level of the anterior abdominal wall is below the level of the chest. Uniform protrusion of the abdomen is observed with obesity, intestinal paresis, accumulation of fluid in the abdominal cavity (ascites). Uneven protrusion of the abdominal wall can be with hernias of the abdomen, with intestinal obstruction, with infiltrates, abscesses of the abdominal wall and localized in the abdominal cavity, with tumors emanating from the abdominal wall and abdominal organs. A change in the configuration of the abdominal wall is observed with an excessive increase in the peristalsis of the stomach and intestines. A retracted abdomen occurs in malnourished patients, with a sharp tension in the muscles of the abdominal wall (a symptom of muscular protection is a visceromotor reflex when the peritoneum is irritated). In the presence of postoperative scars, their localization, size, defects in the abdominal wall in the area of ​​scars (postoperative hernias) should be noted.

In the umbilical region, a radiant arrangement of dilated convoluted saphenous veins (“jellyfish head”) is observed with difficulty in outflow of blood through the portal vein. In the lower lateral parts of the abdomen, the appearance of dilated venous anastomoses between the femoral and inferior epigastric veins indicates a difficulty in the outflow of blood through the system of the inferior vena cava.

Observe the displacement of the abdominal wall during the act of breathing. The absence of displacement of any area or the entire abdominal wall during breathing occurs when muscles are tense as a result of a visceromotor reflex resulting from irritation of the peritoneum. Active inflation of the abdomen (Rozanov's symptom) is checked. The patient is offered to inflate the stomach, and then retract it. In acute inflammatory processes in the abdominal cavity, patients cannot inflate the stomach due to a sharp increase in pain. In inflammatory processes localized extraperitoneally (pleuropneumonia, diaphragmatic pleurisy), sometimes accompanied by pain in the abdomen and tension in the muscles of the abdominal wall, inflation and retraction of the abdomen is possible. Rozanov's symptom becomes important for distinguishing acute inflammatory processes in the abdominal cavity from extraperitoneal processes.

Diagnostic value is the occurrence of pain when coughing and its localization.

Abdominal percussion produce to determine the boundaries of the liver, spleen, the size of pathological formations in the abdomen (infiltrate, tumor, abscess). A sonorous percussion sound is given by: accumulations of gas in the intestines (flatulence), accumulations of gas in the abdominal cavity (pneumoperitoneum), with perforation of a hollow organ (disappearance of hepatic dullness). To identify the accumulation of free fluid in the abdominal cavity (ascites, exudate, hemoperitoneum), a comparative percussion of both halves of the abdomen is performed in the direction from the midline to its lateral sections, then on the right and left sides. A change in percussion sound (dullness instead of tympanitis) occurs in the presence of freely moving fluid in the abdominal cavity. In the vertical position of the patient, percussion of the abdomen is carried out in the direction from top to bottom along the midline and midclavicular lines.

A zone of dullness of percussion sound above the womb with a horizontal concave upper border is a sign of free fluid in the abdominal cavity. A blunting zone with a horizontal upper border and tympanitis above it is a sign of fluid and gas accumulation. If the upper border of the zone of dullness of percussion sound above the bosom forms a line convex upward - this is a sign indicating an overflow of contents Bladder, an increase in the uterus, the presence of an ovarian cyst.

To identify fluid in the abdominal cavity, the undulation method is used. The doctor puts a palm on one side of the abdomen, on the opposite side with bent fingers of the other hand produces a jerky push, which, in the presence of fluid, is determined by the “listening” palm. In order to avoid an erroneous conclusion, it is necessary to exclude the transmission of shock along the abdominal wall. To do this, the doctor asks the patient or nurse place the edge of the brush along the midline of the abdomen. With this technique, a distinct transmission of a push proves the presence of fluid in the abdominal cavity.

In the localization of the pathological process, the zone of percussion pain (a sign of local irritation of the peritoneum) allows you to navigate. Tapping with bent fingers or the edge of the hand on the right costal arch can cause pain in the right hypochondrium (Ortner-Grekov symptom) with inflammation of the gallbladder, bile ducts, liver.

Palpation of the abdomen produced in various positions of the patient. When examining a patient in a horizontal position, it is necessary to ask the patient to bend his legs in order to relax the muscles of the abdominal wall. knee joints and slightly spread them apart. The study is carried out so that the painful place is examined last. Approximate superficial palpation is performed in order to identify the tension of the muscles of the abdominal wall and the localization of pain. The study is performed by making light pressure on the abdominal wall with a hand. Muscle tension is judged by the severity of the resistance felt by the palpating hand when touching the abdomen. It is necessary to compare the tone of the muscles of the same name on the right and left sides of the abdominal wall at the same level, first examining less painful areas. According to the severity of muscle tension, there are: slight resistance, pronounced tension, board-like tension. Muscle tension can be expressed in a limited small area or has a diffuse character. Muscle tension is a manifestation of a visceromotor reflex as a result of irritation emanating from the parietal peritoneum, mesentery of the abdominal organs. it major symptom inflammation of the peritoneum. However, it can also be observed in diseases of organs located extraperitoneally (diaphragmatic pleurisy, lower lobe pleuropneumonia, myocardial infarction, renal colic), in the presence of hematomas, abscesses in the retroperitoneal space, with bruises of the lower ribs, to which the muscles of the abdominal wall are attached.

Superficial palpation in the presence of peritoneal irritation, along with the protective tension of the abdominal wall muscles, it reveals the greatest pain in the area corresponding to the localization of peritoneal irritation. The peritoneal genesis of pain can be proved by the definition of the Shchetkin-Blumberg symptom. This symptom consists in the fact that when pressing on the abdominal wall, the resulting pain due to stretching of the peritoneum increases sharply when the peritoneum is shaken at the moment of sudden withdrawal of the palpating hand from the abdominal wall. The peritoneum can be more easily accessible for palpation in the umbilical region, when examining the posterior wall of the inguinal canal, and during rectal examination.

After superficial palpation, deep palpation of the abdomen according to the Obraztsov-Strazhesko method. Palpation of the internal organs of the abdomen should be carried out in time with the respiratory movements.

Auscultation of the abdomen allows you to detect changes in intestinal noise, the presence of arterial vascular noise. Normally, bowel sounds occur at irregular intervals and cause a muffled gurgling sound. The continuity of intestinal noise, acquiring a sonorous tone, is characteristic of mechanical intestinal obstruction with increased peristalsis. The absence of bowel sounds indicates intestinal paresis.

Identification of the noise of the splash of fluid in the stomach is achieved by applying short shocks to the abdominal wall with the tips of half-bent fingers. The noise of the splash of liquid, determined on an empty stomach, indicates a violation of evacuation from the stomach (stenosis of the exit from the stomach, atony of the stomach). The noise of splashing fluid in the intestines can be detected with intestinal obstruction. With stenosis of the abdominal aorta, a systolic murmur is heard at a point immediately below the navel and 2 cm to the left of the midline.

Finger examination of the rectum. Determine the tone of the sphincter, the contents of the intestine (feces, mucus, blood), the state of the prostate gland. A digital examination of the rectum can reveal tumors of the anal and lower ampullar sections of the intestine, infiltrates in the small pelvis, cancer metastases in the pelvic peritoneum (Schnitzler metastases), tumors sigmoid colon, tumors of the uterus and ovaries. At acute diseases abdominal organs digital examination of the rectum provides important information. Soreness with pressure on the walls of the rectum indicates inflammatory changes in the peritoneum of the recto-uterine cavity (Douglas pocket) and the pelvic organs. A protrusion or overhang of the anterior wall of the rectum occurs when an inflammatory exudate accumulates in the pelvic cavity during peritonitis or blood during intraperitoneal bleeding.

Handbook of clinical surgery, edited by V.A. Sakharov

More articles about hernias:

- Abdominal pain. The nature of pain in various diseases

- Belly. Borders of the abdomen. Projections of organs on the abdominal wall

- Relaxation of the diaphragm

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2. Symptom "splash noise".

Gurgling sound in the stomach, heard in the supine position with short, quick strokes of the fingers on the epigastric region; indicates the presence of gas and liquid in the stomach, for example, with hypersecretion of the stomach or with a delay in the evacuation of its contents. with pyloric stenosis)

Ticket number 2.

1. Determination of the size of the hernial orifice.

Determining the size of the hernia orifice is possible only with reducible hernias (with irreducible strangulated hernias, it is impossible to determine the hernial orifice).

After reduction of the hernia with the tips of one or more fingers, the size of the hernial orifice in two dimensions or their diameter (in cm), as well as the condition of their edges, are determined.

The most accessible to research hernial orifice in umbilical, epigastric and median postoperative hernias, with hernias of other localization, they are less accessible.

Definition of hernial gate at umbilical hernia produced by palpation of the bottom of the umbilical fossa.

At inguinal hernias the study of the hernia gate (outer inguinal ring) in men is carried out in the position of the patient lying down, with the index or 3rd finger through the lower pole of the scrotum.

2.Technique and interpretation of these cholegrams before and intraoperative.

Interpretation of the data of endoscopic retrograde choledochal pancreatography (ERCP): the size of the intrahepatic bile ducts, hepaticocholedochus, the presence of calculi in the gallbladder, choledochus, narrowing of the distal choledochus, contrasting of the Wirsung duct, etc.

Intraoperative cholangiography technique:

b) a water-soluble contrast agent (bilignost, biligrafin, etc.) is injected by puncture or through the cystic duct; after the injection of the contrast agent, a picture is taken on the operating table.

The morphological state of the biliary tract is assessed - the shape, size, presence of stones (cellularity, marbling of the shadow or its absence (“silent bubble”), the presence of filling defects); length, tortuosity of the cystic duct, width of the common bile duct; the flow of contrast into the duodenum.

Ticket number 3.

1. Palpation of the gallbladder (symptom of Courvoisier).

Palpation of the gallbladder is performed in the area of ​​its projection (the point of intersection of the outer edge of the rectus abdominis muscle and the costal arch, or slightly lower if there is an increase in the liver), in the same position of the patient and according to the same rules as during palpation of the liver.

Increased gallbladder can be palpated in the form of a pear-shaped or ovoid formation, the nature of the surface of which and the consistency depend on the condition of the bladder wall and its contents.

In the case of obstruction of the common bile duct by a stone, the gallbladder relatively rarely reaches large sizes, since the long-term sluggish inflammatory process that occurs in this case limits the extensibility of its walls. They become lumpy and painful. Similar phenomena are observed with a tumor of the gallbladder or the presence of stones in it.

It is possible to feel the bladder in the form of a smooth, elastic, pear-shaped body in case of obstruction of the exit from the bladder (for example, with a stone or with empyema, with dropsy of the gallbladder, compression of the common bile duct, for example, with cancer of the pancreatic head - Courvoisier-Guerrier symptom).

Symptom Courvoisier (Courvoisier): palpation of an enlarged distended painless gallbladder in combination with obstructive jaundice caused by a tumor.

Examination of the stomach includes: questioning the patient, physical examination, examination of the functions of the stomach (laboratory, instrumental), (see), gastroscopy (see), as well as a number of special methods. To conduct x-ray studies, it is necessary to prepare the patient: a cleansing enema (see) is done in the evening on the eve of the study and at 6 o'clock. morning on the day of the study. Before the stomach, the patient should not take food, drink, medicine, and also smoke.

questioning. Find out the patient's complaints, anamnesis (see). Should be paid Special attention to a change in appetite, the presence of dyspepsia (see), pain, their localization, irradiation, time of appearance, connection with the intake and quality of food, physical and mental stress, as well as those factors that contribute to the reduction or cessation of pain (heat, medications).

Inspection. If there are complaints that suggest a stomach disease, a general examination of the patient should also be carried out, which often gives valuable data for the diagnosis of stomach disease.

Sudden weight loss may cause an assumption about the presence of gastric cancer or organic stenosis of the pylorus of the stomach. Paleness of the skin and mucous membranes is observed after heavy gastric bleeding.

With a normal abdominal wall, the stomach is not visible. Unclear contours of the stomach can sometimes be observed through the abdominal wall with a significant weight loss of the patient. With an organic narrowing or with a functional spasm of the pylorus of the stomach, pathological peristalsis of the stomach filled with food in the epigastric region can be observed.

Very quiet percussion is used to determine the lower border of the stomach. In the supine position of the patient, the lower border is located 1-3 cm above the midline.

Auscultation. Listening to sounds arising in the stomach is used when causing "splash noise". It is most easily achieved in the supine position of the patient with the help of quick and short strokes with four half-bent fingers of the right hand on the epigastric region. The left hand should fix the abdominal muscles in the area of ​​the xiphoid process. "Splashing noise" can be caused by the presence of gas and liquid in the stomach. Late "splash noise", caused a few hours after eating, indicates a violation of the evacuation function of the stomach or a sharp decrease in it. "Splash noise" to the right of the midline is detected with the expansion of the prepyloric part of the stomach (Vasilenko's symptom).

Superficial palpation allows you to determine the degree of tension of the abdominal muscles in the stomach, pain zones. The method of deep palpation (see) determines the curvature of the stomach, tumors.

By means of a special jerky palpation, we often succeed in evoking the so-called. “Splash noise is of great diagnostic value. It is formed when the stomach simultaneously contains liquid and gases (air).

When making short jerky movements with the fingers in the region of the stomach, we must try to ensure that these movements are made only with the hand without the participation of the shoulder and forearm.

The “surface splash noise” obtained in this way is of greater diagnostic value than the “deep splash noise”. The latter can be induced in almost everyone, if only there is a sufficient amount of liquid in the stomach and if one resorts to vigorous jerky movements with one or both hands.

The appearance of surface splashing noise is due to the lethargy of the stomach wall and the lethargy of the abdominal integuments; a favorable moment in this case should be considered a low-standing stomach.

Each of these factors separately is able to cause splashing noise, but there is undoubtedly a causal relationship between them. With relaxed abdominal integuments, the stomach loses one of its supports and is not able to offer sufficient resistance to the weight of its contents; it becomes atonic and gradually descends. If, however, we find a superficial splashing noise with normal abdominal integuments, then we have to attribute it to the lethargy of the walls of the stomach alone, i.e., due to its hypo- or atony.

The sound of splashing becomes of great importance when it is possible to cause it not immediately after eating, but after such a period of time when the stomach is usually already empty. This can happen only when his motor ability is lowered, that is, when it is insufficient. But especially great importance we give the splash noise obtained on an empty stomach. If we exclude hypersecretion, which is relatively rarely the cause of the described phenomenon, then only one conclusion remains, namely, that in this case we are dealing with severe deficiency (stenosis pylori) and the associated stagnation of food masses.

Finally, we also use splash noise to define the boundaries of the stomach. Since splash noise can only be obtained under certain conditions (sluggish abdominal walls, lethargy of the gastric walls and prolapse of the stomach), then the use of this method is limited to certain cases suitable for this purpose.

Much more often it is possible to cause the “splash noise from impact” described by V.P. Obraztsov with the help of percussion palpation. the ends of these fingers were strictly in the same horizontal plane, we make vertical blows on the wall of the abdomen, while trying to reach the surface of the liquid in the stomach.

By pressing with the left hand on the lower part of the sternum or the upper part of the epigastric region, we right hand we produce the jerky movements described above and cause splashing noise; we repeat these movements from top to bottom until the splashing noise disappears; the place where the splash ceases to be audible corresponds approximately to the great curvature. We can just as well go in the direction from the bottom up, and then the place where the splash appears will correspond to a large curvature.

On the same subject

Medicine is a separate and very important area of ​​human activity, which is aimed at studying various processes in the human body, treating and preventing various diseases. Medicine explores both old and new diseases, developing all new methods of treatment, medicines and procedures.

It has always occupied the highest place in human life, since ancient times. The only difference is that the ancient physicians were based either on personal little knowledge or on their own intuition in the treatment of diseases, and modern physicians are based on achievements and new inventions.

Although many discoveries have already been made over the centuries-old history of medicine, methods of treating diseases that were previously considered incurable have been found, everything is developing - new methods of treatment are being found, diseases are progressing and so on ad infinitum. No matter how many new medicines mankind discovers, no matter how many ways to treat the same disease come up, no one can guarantee that in a few years we will not see the same disease, but in a completely different, new form. Therefore, humanity will always have something to strive for and activities that can be more and more improved.

Medicine helps people recover from everyday illnesses, helps in the prevention of various infections, but it also cannot be omnipotent. There are still quite a lot of different unknown diseases, inaccurate diagnoses, wrong approaches to curing the disease. Medicine cannot provide 100% reliable protection and assistance to people. But it's not just about underexplored diseases. Recently there have been many alternative methods recovery, the terms correction of the chakras, restoration of energy balance, are no longer surprising. Such a human ability as clairvoyance can also be used to diagnose, predict the course of development of certain diseases, complications.

In the stomach, auscultated in the supine position with short quick strokes of the fingers on the epigastric region; indicates the presence of gas and liquid in the stomach, for example. with hypersecretion of the stomach or with a delay in the evacuation of its contents.

Big medical dictionary . 2000 .

See what "splash noise" is in other dictionaries:

See Hippocratic splash noise... Big Medical Dictionary

HIPPOCRATES SPLASH NOISE- HIPPOCRATES SPLASHING NOISE, a phenomenon described by Hippocrates, is observed in cases of the simultaneous presence of liquid and gas in the pleural cavity or in another, relatively large cavity in the chest. In such cases, sometimes already at a distance from b ... ... Big Medical Encyclopedia

- (succussio Hippocratis; Hippocrates) splashing noise in the chest, heard with a quick change of position or concussion chest; observed with the simultaneous presence of fluid and gas in the pleural cavity ... Big Medical Dictionary

- (succusio Hippocratis) So-called. the noise that forms in the cavity of the pleural sac when fluid and air accumulate in the latter, which usually occurs when the lung tissue is ruptured for whatever reason, and when air passes from ... ... Encyclopedic Dictionary F.A. Brockhaus and I.A. Efron

I random combination of sounds of different strength and frequency; may have adverse effects on the body. Sh.'s source is any process that causes a local change in pressure or mechanical vibrations in solid, liquid and ... ... Medical Encyclopedia

I splash, you splash; incl. present splashing; dep. splashing and splashing; nesov. 1. Being in motion, hitting against something, make noise, splash (about water, liquid). The jet runs and splashes, And, basking in the sun, shines. Tyutchev, What are you bending over the waters. ... ... Small Academic Dictionary

Splashing noise in a colon overflowing with liquid and gas occurs in 50% of cases. It is determined by jerky movements of the surgeon's fingers with overflowing liquid and gases of the intestinal loop and wears name s-m Sklyarova.

6. Sonorous intestinal noises with a sonorous metallic tint, determined during auscultation, are a sign of pneumatosis and overstretching of the contents of the small intestine. It is called a symptom of a falling drop or Kivuli.

7. Balloon-like swelling of the rectal ampulla with a decrease in the tone of the external sphincter, characteristic of low obstructive intestinal obstruction - a symptom of the Obukhov hospital.

8. A complex of manifestations of OKN, including:

Visible asymmetry of the abdomen

Palpation of the intestinal bulge

visible to the eye peristalsis

High tympanitis heard on percussion

is called Val's symptom.

2 group. Character general disorders with OKN is determined their main causes are endotoxicosis and metabolic disorders. Change usually starts with a disruption. s-s-s functions(tachycardia, later microcirculatory disorders and, as a result, pallor, cyanosis). Violations respiratory system- shortness of breath, shallow breathing. They can lead to the development of a shock lung, which exacerbates respiratory hypoxia. Neuropsychiatric disorders - lethargy, disorientation, in some cases, inadequate excitement, euphoria. Against the background of progressive toxic cerebral edema, a coma may occur. The increase in endotoxicosis leads to a decrease in diuresis, the accumulation of underoxidized products in the body, and functional decompensation of the liver.

OKN has 3 stages of development.

1st - the initial stage, depending on the form of obstruction, it can last from 2 to 12 hours (the "ileus cry" phase).

2nd - intermediate stage, which is based on a violation of intra-wall hemocirculation, is characterized by the development of endotoxicosis, is manifested by a violation of hemodynamics and lasts from 12 to 36 hours.

3rd, late, occurs after 36 hours, is extremely severe, aggravated by the addition of peritonitis.

Suspicion of the presence of AIO in a patient is an absolute indication for hospitalization of a patient in a hospital.

After collecting an anamnesis and examining the patient, the patient is plain radiography abdominal organs. With OKN, Kloiber's bowls are determined on an overview radiograph - horizontal levels of liquid with gas above them and small intestinal arches with transverse striation due to edematous folds of Kerckring (circular folds).

If the diagnosis of OKN is difficult, it is prescribed control of the passage of barium through the intestinal tube according to Schwartz. In parallel, therapeutic measures are carried out aimed at eliminating the dynamic component of obstruction, including the appointment of anticholinergic, anticholinesterase and ganglionic blocking agents. They can be supplemented by conduction (perirenal, sacrospinal) or epidural blockade.

Enterography- insertion of a probe into the duodenum, removal of intestinal contents and introduction under pressure of 500.0-2000.0 ml. barium suspension and dynamic X-ray monitoring of its progress for 20-90 minutes. With this technique, the contrast mass quickly moves through the intestine and after 30-40 minutes. appears in the caecum.