Percussion and Palpation - Major Abdominal Examination Skills

The arrangement of the abdominal examination changes with age and the cooperation of the children. Usually all four types of assessments (examination, auscultation, percussion and palpation) are performed at different times. For example, a medical practitioner may give voice to bowel sounds following the assessment of heart and lung sounds at the beginning of the examination when the child is calm. The percussion usually follows the pulmonary percussion, and palpation can be done towards the end of the examination when the child is relaxed and trusting the medical practitioner.

For descriptive purposes, the abdominal cavity is divided into four squares or quadrant by drawing a vertical midline from the sternum to the genital symphysis and a horizontal line across the abdomen through the umbilicus. This method of division actually involves the pelvic cavity. Each section is defined as follows: upper right quadrant (RUQ), right quadrant (RLQ), left quadrant (LUQ), lower left quadrant (LLQ).

Percussion
Abdominal percussion is performed in the same way as lung and heart percussion. Usually, ignorance or boredom is heard on the right at low cost margins due to the location of the Heart. Tympany is usually heard in the abdomen on the left and usually in the abdomen. Extraordinary tympanic sounds, such as loud drums, usually breathe. However, it can also describe pathoilogic conditions such as low intestinal obstruction or paralytic ileus. Lac tympany may occur when the stomach is full after eating, but in other cases, it may indicate the presence of fluid or dense mass.

Palpation
Two types of palpation are performed, superficial and deep. In superficial palpation, a light doctor puts his hands on the skin and senses each quadrant, recording any tenderness, muscle tone, and superficial lesions, such as cysts. Shallow palate is often considered "ticklish" by children. That may interfere with their effectiveness, Nurses can avoid this problem by having their child "help" them by putting up with statements such as, "I try to taste what's available for lunch". Advising children to stop laughing only attracts attention and reduces cooperation. Positioning the child in a compressed position with the legs flexing at the hip and knee helps to relax the abdominal muscles.

Aging everywhere in the stomach during superficial palpation is always observed. There are two types of abdominal pain:
1. Visceral, arising from the viscera or internal organs such as the intestine, and
2. Somatic, arising from the wall or lining of the abdominal cavity such as the peritoneum.

Visceral pain is usually tedious, poorly socialized, and difficult for the patient to describe. Somatic pain is usually acute, illustrated and easy to describe. When assessing abdominal pain, it is important to remember that the child will often respond with an "all-or-nothing" reaction - whether there is no pain or major pain. Therefore, all aspects of the examination should be carefully considered when deciding on such an appendix.

A special phenomenon called softening of the rebound, or the Blumberg sign, can be done if the child complains of abdominal pain. It is done by pressing firmly on the abdomen distal to the soft spot. When the pressure is released, the child feels pain in the area of ​​tenderness. This reaction can only be detected when the visceral peritoneum or diseased organ is inflamed, such as in the appendix.

Deep palpation is used for thinning organs and large blood vessels and for detecting mass and tenderness not found during superficial palpation. If the child complains of abdominal pain, the abdominal area is released. Usually, the middle palpation of the epigastrium causes pain like pressure exerted on the aorta, but this should not be confused with deep or somatic tenderness.

The doctor relaxes the abdominal organ by pressing it with his free hand, which is placed behind the child. Palpation begins in the lower quadrant and moves upward. In this way, the enlarged liver or spleen will not be missed. Except for enlarging the liver, identification of other successful organs, such as the spleen, kidneys, and parts of the colon, requires a great deal of practice with proper supervision.

The lower end of the heart can sometimes be felt in infants and young children as a mass of 1 to 2cm (1/2 inch) below the right margin of costume (distance sometimes measured in fingerbreadths). If the liver feels 3cm (1/4 inch) or 2 fingerbreadths below the costume margin, it is considered enlarged and this finding is referred to a doctor. Usually the heart goes down during inspiration when the diaphragm moves downwards. This downward shift should not be considered a sign of hepatomegaly. In older children, the heart is often unimaginable, although its lower advantages can be attributed to percussing dullness on the costume margin.

The spleen is felt by feeling it between the hands placed behind it and the prominent quadrant on the left. The spleen is much smaller than the liver and is located behind the abdominal fundus. The tip of the spleen is usually felt during inspiration as it descends into the abdominal cavity. They can sometimes extend 1 to 2 cm below the left costume margin of infants and children. The spleen can easily grow more than 2cm below the correct costume margin and is always reported for further medical investigation.

Other anatomical structures that can sometimes be felt in children include the cecum, and the sigmoid colon. Cecum is a soft mass and gas is filled at the bottom right of the quadrant. The sigmoid colon is left as a sausage-shaped mass that moves freely over the pelvis hip in the lower left quadrant and is usually soft.

Although many of these structures are not routinely felt, one must be aware of their relative location and features so as not to blame them for abnormal people. The lower quadrant is most common because with left colon inflammation fills with impurities and gas until the ileocecal valve is reached. Cecum becomes swollen, causing pain, which may be related to appendicitis.

Special investigation method
Laboratory examination
1. Regular blood examination
2. Urine test (bile pigment, ketonuria)
3. Biochemical analysis (total bilirubin, bilirubin, conjugate, conjugate, protein, cholesterol, AlAt, AsAt, amylase, trypsin and lipase)
4. Biochemical analysis of Urine for diastases.

Disruption
1. Cholistasis Syndrome increases bilirubin and cholesterol levels equally and conjugated).
2. Cytolysis Syndrome (Increased levels of AsAt, AlAt, LDG)
3. Pancreatic dysfunction syndrome (increased levels of amylase, trypsin, lipase)
4. Polymerization chains for hepatitis A, B, C viruses
5. Fecal examination of intestinal parasites (ascarides, systemic lamblia, enterobiosis)
6. Copogram
• Non-contagious muscle fibers
• Steatorrhea
• Lientery
• Bacteria in the gut

Method of instrumental examination
1. Esophagogastroduodenoscpy
2. Ultrasound investigation
3. Intragastric pH-metry
4. Colonoscopy
5. Procto (sigmoido) scopy
6. Studies of artificial contrast in the gastrointestinal system
7. Laparoscopy
8. Irrigoscopy and irrigography

Normal laboratory value of blood biochemical analysis
Glucose 3.33-5.55 mmol / L
Bilirubin total 8.5-2.0 mcmol / L
Not withheld 2/3 of the total
Conjugate 1/3 of the total volume
Total protein 60.0-80.0g / L
ALT 0.1-0.75 mcmol / g / L
AST 0.1-0.45 mcmol / g / L
Amylase 16-32 dye unit / L

A number of gastrointestinal disorders are caused by impaired motor function. Some diseases, like Hirschsprung, produce signs of obstruction that are commonly classified as obstructive disorders.

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