Palpation of the sigmoid colon. Sigmoid colon - where is it located. Symptoms and signs of diseases of the sigmoid colon

Methods of physical examination of patients with diseases of the gastrointestinal tract - examination, palpation of the abdomen, percussion, auscultation.

Examination of the patient

Examination of patients with diseases of the gastrointestinal tract ( gastrointestinal tract) allows you to identify emaciation, pallor, roughness and a decrease in skin turgor in malignant tumors of the stomach and intestines. But in most patients with stomach diseases, there are no visible manifestations. When examining the oral cavity in patients with acute and chronic diseases of the stomach and intestines, a white or brown coating on the tongue is detected. In diseases accompanied by atrophy of the mucous membrane of the stomach and intestines, the mucous membrane of the tongue becomes smooth, devoid of papillae ("lacquered tongue"). These symptoms are nonspecific, but they reflect the pathology of the stomach and intestines.

Examination of the abdomen begins with the patient lying on his back. Determine the shape and size of the abdomen, the respiratory movements of the abdominal wall and the presence of peristalsis of the stomach and intestines. In healthy people, it is either somewhat retracted (in asthenics) or slightly protruded (in hypersthenics). Severe retraction occurs in patients with acute peritonitis. A significant symmetrical increase in the abdomen can be with bloating (flatulence) and accumulation of free fluid in the abdominal cavity (ascites). Obesity and ascites differ in some ways. With ascites, the skin on the abdomen is thin, shiny, without folds, the navel protrudes above the surface of the abdomen. With obesity, the skin on the abdomen is flabby, with folds, the navel is retracted. Asymmetric enlargement of the abdomen occurs with a sharp increase in the liver or spleen.

Respiratory movements of the abdominal wall are well defined when examining the abdomen. Their complete absence is pathological, which most often indicates diffuse peritonitis, but it can also be with appendicitis. Peristalsis of the stomach can be detected only with pyloric stenosis (cancerous or cicatricial), intestinal motility - with a narrowing of the intestine above the obstruction.

Palpation of the abdomen

The abdomen is a part of the body, it is the abdominal cavity, where the main internal organs are located (stomach, intestines, kidneys, adrenal glands, liver, spleen, pancreas, gallbladder). Two methods of palpation of the abdomen are used: superficial palpation And methodical deep, sliding palpation according to V.V. Obraztsov and N.D. Strazhesko:

• Superficial (approximate and comparative) palpation reveals tension in the muscles of the abdominal wall, localization of pain and an increase in any of the abdominal organs.
• Deep palpation is used to clarify the symptoms identified during superficial palpation and to detect a pathological process in one or a group of organs. When examining and palpating the abdomen, it is recommended to use schemes of the clinical topography of the abdomen.

The principle of the superficial palpation method

Palpation is carried out by slight pressure with fingers flat on the palpating hand located on the abdominal wall. The patient lies on his back on a bed with a low headboard. Arms extended along the body, all muscles should be relaxed. The doctor sits to the right of the patient, who must be warned to let him know about the occurrence and disappearance of pain. Start approximate palpation from the left inguinal region. Then the palpating hand is transferred 4-5 cm higher than the first time, and further into the epigastric and right iliac regions.

With comparative palpation, studies are carried out in symmetrical areas, starting from the left iliac region, in the following sequence: the iliac region on the left and right, the umbilical region on the left and right, the lateral abdomen on the left and right, the hypochondrium on the left and right, the epigastric region on the left and right of the white belly lines. Superficial palpation ends with a study of the white line of the abdomen (the presence of a hernia of the white line of the abdomen, divergence of the abdominal muscles).

In a healthy person, with superficial palpation of the abdomen, pain does not occur, the tension of the muscles of the abdominal wall is insignificant. Severe diffuse soreness and muscle tension over the entire surface of the abdomen indicates acute peritonitis, limited local soreness and muscle tension in this area - about an acute local process (cholecystitis - in the right hypochondrium, appendicitis - in the right iliac region, etc.). With peritonitis, a symptom of Shchetkin-Blumberg is revealed - increased pain in the abdomen with the rapid removal of the palpating hand from the abdominal wall after light pressure. When tapping on the abdominal wall with a finger, local soreness (Mendel's symptom) can be established. Accordingly, local protective tension of the abdominal wall (Glinchikov's symptom) is often found in the painful area.

Muscular protection in duodenal and pyloric ulcers is usually determined to the right of the midline in the epigastric region, with an ulcer of the lesser curvature of the stomach - in the middle part of the epigastric region, and with a cardiac ulcer - in its uppermost section at the xiphoid process. According to the indicated areas of pain and muscle protection, zones of skin hyperesthesia of Zakharyin-Ged are revealed.

Principles of deep sliding palpation

The fingers of the palpating hand, bent at the second phalangeal joint, are placed on the abdominal wall parallel to the organ being examined and, after gaining a superficial skin fold, which is necessary later for the sliding movement of the hand, carried out in the depths of the abdominal cavity along with the skin and not limited by skin tension, are immersed deeply during exhalation into the abdominal cavity. This must be done slowly without sudden movements for 2-3 breaths and exhalations, holding the reached position of the fingers after the previous exhalation. The fingers are immersed to the back wall so that their ends are located inward from the palpable organ. At the next moment, the doctor asks the patient to hold his breath while exhaling and conducts a sliding movement of the hand in a direction perpendicular to the longitudinal axis of the intestine or the edge of the stomach. When sliding, the fingers bypass the accessible surface of the organ. Determine the elasticity, mobility, soreness, the presence of seals and tuberosity on the surface of the organ.

The sequence of deep palpation: sigmoid colon, caecum, transverse colon, stomach, pylorus.

Palpation of the sigmoid colon

The right hand is set parallel to the axis of the sigmoid colon in the left iliac region, a skin fold is collected in front of the finger, and then, during the exhalation of the patient, when the abdominal pressure relaxes, the fingers gradually sink into the abdominal cavity, reaching its back wall. After that, without relieving pressure, the doctor's hand slides along with the skin in a direction perpendicular to the axis of the intestine, and rolls the hand over the surface of the intestine while holding the breath. In a healthy person, the sigmoid colon is palpated in 90% of cases in the form of a smooth, dense, painless, and non-rumbling cylinder 3 cm thick. with a mesentery. With the accumulation of gases and liquid contents, rumbling is noted.

Palpation of the caecum

The hand is placed parallel to the axis of the caecum in the right iliac region and palpation is performed. The caecum is palpated in 79% of cases in the form of a cylinder, 4.5-5 cm thick, with a smooth surface; it is painless and non-displaceable. In pathology, the intestine is extremely mobile (congenital elongation of the mesentery), immobile (in the presence of adhesions), painful (with inflammation), dense, tuberous (with tumors).

Palpation of the transverse colon

Palpation is carried out with two hands, i.e., by the method of bilateral palpation. Both hands are set at the level of the umbilical line along the outer edge of the rectus abdominis muscles and palpation is performed. In healthy people, the transverse colon is palpated in 71% of cases in the form of a cylinder 5-6 cm thick, easily displaced. In pathology, the intestine is palpated dense, contracted, painful (with inflammation), bumpy and dense (with tumors), sharply rumbling, enlarged in diameter, soft, smooth (with narrowing below it).

Palpation of the stomach

Palpation of the stomach presents great difficulties, in healthy people it is possible to palpate a large curvature. Before palpating the greater curvature of the stomach, it is necessary to determine the lower border of the stomach by ausculto-percussion or by ausculto-affrication.

• Ausculto-percussion is carried out as follows: a phonendoscope is placed above the epigastric region and at the same time a quiet percussion is performed with one finger in a direction radial from the stethophonendoscope or, conversely, to the stethoscope. The border of the stomach is located on listening to a loud sound.
• Ausculto-affrication- percussion is replaced by a light intermittent sliding over the skin of the abdomen. Normally, the lower border of the stomach is determined 2-3 cm above the navel. After determining the lower border of the stomach by these methods, deep palpation is used: a hand with bent fingers is placed on the region of the lower border of the stomach along the white line of the abdomen and palpation is performed. A large curvature of the stomach is felt in the form of a "roll" located on the spine. In pathology, the descent of the lower border of the stomach, pain on palpation of the greater curvature (with inflammation, peptic ulcer), the presence of a dense formation (tumors of the stomach) are determined.

Palpation of the pylorus

Palpation of the pylorus is carried out along the bisector of the angle formed by the white line of the abdomen and the umbilical line, to the right of the white line. The right hand with slightly bent fingers is placed on the bisector of the indicated angle, the skin fold is collected in the direction of the white line and palpation is performed. The gatekeeper is palpated in the form of a cylinder, changing its consistency and shape.

Abdominal percussion

The value of percussion in the diagnosis of diseases of the stomach is small.

With it, you can determine the space of Traube (the area of ​​tympanic sound on the left in the lower part of the chest, due to the air bubble of the fundus of the stomach). It is increased with a significant increase in the content of air in the stomach (aerophagia). Percussion allows you to determine the presence of free and encysted fluid in the abdominal cavity.

When the patient is on the back, a quiet percussion is performed from the navel towards the lateral parts of the abdomen. Above the liquid, the percussion tone becomes dull. When the patient is turned on his side, the free fluid moves to the lower side, and above the upper side, the dull sound changes to tympanic. Encapsulated fluid appears with peritonitis limited by adhesions. Above it, during percussion, a dull percussion tone is determined, which does not change localization when the position changes.

Auscultation of the gastrointestinal tract

Auscultation of the gastrointestinal tract should be carried out before deep palpation, since the latter can change peristalsis. Listening is carried out with the patient lying on his back or standing at several points above the stomach, above the large and small intestines. Normally, moderate peristalsis is heard, after eating, sometimes rhythmic intestinal noises. Above the ascending part of the large intestine, rumbling can be heard normally, above the descending part - only with diarrhea.

With mechanical obstruction of the intestine, peristalsis increases, with paralytic obstruction it sharply weakens, with peritonitis it disappears. In the case of fibrinous peritonitis, during the respiratory movements of the patient, the rub of the peritoneum may be heard. Auscultation under the xiphoid process in combination with percussion (ausculto-percussion) and light short rubbing movements of the researcher's finger along the skin of the patient's abdomen along the radial lines to the stethoscope can roughly determine the lower border of the stomach.

Of the auscultatory phenomena that characterize sounds arising in the stomach, splashing noise should be noted. It is called in the supine position of the patient with the help of quick short blows with half-bent fingers of the right hand on the epigastric region. The appearance of splashing noise indicates the presence of gas and liquid in the stomach. This symptom becomes important if it is determined 6-8 hours after eating. Then, with a sufficient degree of probability, pyloroduodenal stenosis can be assumed.

Along with excessive mobility, one can encounter the opposite phenomenon - limitation of mobility or almost immobility of the sigmoid colon. This, as a rule, with the exception of rare cases of congenital short mesentery, occurs when the intestine is fixed by an inflammatory process of the outer lining of the intestine, leading to the development of adhesions between the intestine and the posterior wall of the abdominal cavity (perisigmoiditis).

In such cases, attempts to move the sigmoid colon in one direction or another are not only unsuccessful, but sometimes cause severe pain in the patient due to the tension of the adhesions.

Following mobility, attention is paid to the thickness and consistency of the palpable intestine. Sometimes the sigmoid colon is palpated in the form of a thin, dense consistency of a strand as thick as a pencil or even thinner. Often, with a similar palpation picture, the patient experiences pain during palpation. These properties are due to spasm, which, for example, can be established in spastic colitis; this is very characteristic of dysentery. It should be pointed out that sometimes during palpation the sigmoid colon can be felt either of the usual width, or of a thinner and at the same time more dense consistency. It depends on the peristaltic movements caused by repeated movements.

Thicker than normal, the sigmoid colon occurs primarily when it is filled with feces and gases. If the contents of the intestine are liquid and at the same time there is an accumulation of gases, then rumbling or splashing is felt on palpation of the intestine. Splashing on palpation is one of the objective symptoms of the band, but it should be remembered that it also happens in patients who, shortly before palpation, were injected with liquid through the rectum, for example, a cleansing enema, etc.

If stool masses stagnate in the sigmoid colon for a long time, then as a result of partial absorption of the liquid by the intestinal wall, they harden significantly and give the palpable intestine a significant density. In some cases, such dense fecal masses appear to be heterogeneous and form, as it were, calculi - the so-called fecal stones (scybala). On palpation of the sigma containing fecal stones, the intestine is palpated hard and bumpy-beaded. The same intestine is found in the tuberculous process, severe ulcerative colitis, or, finally, in a neoplasm. It is not difficult to distinguish these relatively innocent fecal stones from a neoplasm or process in tuberculosis by probing the intestine a second time after a previously made cleansing enema.

Thickening of the intestine may also be the result of the development of the pericolytic process. Then, if the process has not yet stabilized, the sigmoid colon is outlined indistinctly in the form of a wider motionless cylinder of pasty consistency, painful on palpation; in addition, an infiltrate is palpable in the left iliac region.

Finally, with intestinal atony in general, and in particular with atony of the sigmoid colon, the latter is palpable in the form of a wide soft ribbon with a transverse diameter of up to 2-3 fingers. A particularly significant expansion of the palpable intestine occurs when it is damaged by a neoplastic process, tuberculosis, or with intestinal polyposis. Naturally, in these cases, the consistency of the probed segment also changes.
The severe pain felt by the patient during palpation is in most cases due to the inflammatory process in the intestine itself and especially in its serous membrane. First of all, significant pain occurs in dysentery, ulcerative colitis, advanced proctosigmoiditis. Sometimes this soreness can be caused by an inflammatory process of the peritoneum in the circumference of the intestine, the starting point of which in women is the genital area.

According to the methodology of the school of V.P. Exemplary palpation of the large intestine begins with the sigmoid colon, which is more accessible for research and almost always palpable, according to F.O. Gausman - in 91% of cases. Only severe obesity or
bloating, powerful abdominal press, ascites do not allow to probe this intestine. The length of the intestine is about 40 cm (15-67 cm). In cases of congenital anomaly, it can be 2-3 times longer. Palpation is available segment of the intestine for 20-25 cm - its initial and middle part. The final part of the sigma, passing into the rectum, cannot be palpated.
When palpation of the sigmoid colon, it is necessary to evaluate its properties such as:

• localization;
• thickness;
• length;
• consistency;
• surface character,
• peristalsis;
• movable ib (movable ib),
• murmur, splash,
• soreness.

Rice. 404. Palpation of the sigmoid colon.
A. Scheme of the topography of the sigmoid colon. The oval indicates the part of the intestine to be palpated. The dotted line connects the anterior superior part of the ilium with the umbilicus, it crosses the sigma approximately in the middle of B. The position of the doctor's hand during palpation The fingers are placed in the middle of the distance between the navel and the anterior superior iliac spine. First, the middle part of the intestine is palpated.
The normal sigmoid colon is palpated in the left iliac region in the form of an elastic cylinder with a diameter

1. 2.5 cm (thickness of the patient's thumb), moderately firm, with an even smooth surface, not rumbling, with displacement
2. 5 cm (up to a maximum of 8 cm). With a short mesentery, the intestine can be almost motionless. Normally, peristalsis of the sigmoid colon is not felt, palpation of the intestine is painless.

Rice. 406. The third variant of palpation of the sigmoid colon (method of oblique palpation with the edge of the palm).

breathing deep to the back wall, then a sliding movement is made outward. The rib of the brush rolls over the intestine, getting an idea of ​​​​its condition.
If during palpation of the sigma there is a pronounced reflex tension of the abdominal wall in the study area, then it is necessary to use the "damp" technique - with the left palm, moderately press on the abdominal wall in the region of the right iliac fossa.
It should be noted once again that the thickness and consistency of the sigma may change during palpation.
Pathological signs revealed during palpation may be the following:
The large sigmoid colon with a diameter of up to 5-7 cm is observed with a decrease in its tone due to impaired innervation, chronic inflammation, prolonged overflow and stagnation due to impaired rectal patency (spasm, hemorrhoids, anal fissure, tumor). A certain role in increasing the thickness of the sigmoid colon is played by thickening of its wall with hypertrophy of the intestinal muscle, inflammatory infiltration of its wall, tumor development, and polyposis. A wide and elongated sigmoid colon (megadolichosigma) can be both a congenital condition and when a mechanical obstruction occurs in the rectum.

A thin sigma in the form of a pencil indicates the absence of fecal masses in it when it is completely cleansed after diarrhea, an enema, and also in the presence of spasm. This also happens with disorders of innervation, chronic inflammation.
The increased density of the sigmoid colon is caused by spastic contraction of its muscle, its hypertrophy in chronic inflammation, in cases of narrowing of the rectum, germination of the wall by a tumor, and even accumulation of dense fecal masses.
The sigma becomes very soft with its shioyupi or atony due to a violation of innervation, it is palpable in the form of a lenga 2-3 fingers wide.
The sieve intestine acquires a bumpy surface with spastic constipation, the formation of fecal stones in the intestine or a tumor of its syupka, with the development of fibrous adhesions around! intestines (jerisi! moiditis). The tuberous intestine often becomes very dense. The accumulation of fecal stones in the intestine makes it clear
Strengthened, felt peristalsis in the form of an alternate increase and decrease in dense! and intestines is observed in acute sigmoiditis, in violation of the patency of the rectum.
An increase in the mobility of the sigmoid colon is due to lengthening of the mesentery (a variant of a congenital anomaly) and prolonged constipation.
Complete immobility of the sigmoid colon is possible with a congenital short mesentery, with perisigmoiditis, with sigmoid cancer with germination into the surrounding tissues.
Soreness on palpation is noted in neurotic individuals, in the presence of an inflammatory process of the intestine and its mesentery.
Rumbling and splashing during palpation occur in conditions of accumulation of gases and liquid contents in the intestine. This happens with inflammation due to the exudation of inflammatory fluid, as well as with damage to the small intestine (enteritis) with accelerated evacuation of liquid contents.
In cases of detection of such pathological signs as thickening of the intestine, focal thickening, tuberosity, palpation should be repeated after bowel cleansing, after stool, but better after an enema, which will allow to differentiate constipation, intestinal obstruction from organic pathology of the intestine.

Examination of the caecum
Inspection. When examining the right iliac region, the location of the caecum in a healthy person, no deviations are noted, it is symmetrical to the left iliac region, does not bulge, does not sink, visible peristalsis is not noticeable.
In pathological conditions of the caecum, swelling is possible at the site of its localization or closer to the navel, which is especially characteristic of intestinal obstruction. In such cases, the intestine acquires a sausage shape and is located not in a typical place, but closer to the navel.
Peristalsis of the caecum, even with its overflow and swelling, is difficult to see, it is felt only by palpation.
Percussion is normal over the caecum is always audible tympanitis. With its sharp swelling, tympanitis becomes high, with overflow with fecal masses, if it is affected by a tumor, a dull-tympanic sound will be detected.
Palpation of the caecum
Palpation of the caecum is carried out in two positions of the patient - in the usual position on the back and in the position on the left side. The doctor resorts to research on the left side when it becomes necessary to clarify the displacement of the caecum, the localization of pain on palpation, to differentiate the pathological condition of the caecum and neighboring organs.
When palpation of the caecum, as well as the sigmoid colon, it is necessary to evaluate its properties such as:

• localization;
• thickness (width);
• consistency;
• the nature of the surface;
• mobility (displacement);
• peristalsis;
• rumbling, splashing;
• soreness.

lindr 2-3 cm thick (rarely 4-5 cm), painless, slightly rumbling, with a smooth surface, with displacement up to

1. 2.5 cm, with a small pear-shaped blind expansion downwards (actually the caecum). The lower end of the caecum in men is usually 1 cm above the line connecting the upper anterior spines, in women - at its level. In some cases, a higher location of the caecum is possible with its displacement upward by 5-8 cm. Such a gut can only be palpated with the help of the so-called bimanual palpation. The left hand of the doctor, placed across the body from the back at the edge of the ilium, will serve as a solid base, to which the intestine will be pressed when probing. The actions of the palpating hand are similar to normal palpation, the installation of the fingers should be progressive above the zone of normal location of the intestine.

A wide caecum (5-7 cm) can be with a decrease in its tone, as well as with its overflow with feces due to a violation of the evacuation capacity of the large intestine or the occurrence of obstruction below the intestine.
A narrow, thin and compacted caecum as thick as a pencil and even thinner is palpable during prolonged starvation of the patient, with diarrhea, after taking laxatives. This condition of the intestine is due to spasm.
A dense caecum, but not wide and not crowded, occurs with its tuberculous defeat, often it also acquires tuberosity. The intestine becomes dense, enlarged in volume with the accumulation of dense fecal masses, with the formation of fecal stones. Such a gut is more often tuberous.
The hilly surface of the caecum is determined by its neoplasms, the accumulation of fecal stones in it, with tuberculous lesions of the intestine (tuberculous typhlitis).
Displacement of the caecum is due to elongation of the mesentery and insufficient fixation to the posterior wall. Intestinal dislocation or lack of mobility occurs due to the development of the adhesive process (perigifli!), which is always combined with the appearance of pain in the Nazi position on the left side (displacement of the intestine due to gravity and tension of the adhesions ), as well as the occurrence of pain during palpation of the intestine in the same position
Increased peristalsis of the caecum is defined as alternating compaction and relaxation under the palpating fingers. It happens when there is a narrowing below the caecum (scars, swelling, compression, obstruction).
Loud rumbling, splashing on palpation indicates the presence of gas and liquid contents in the caecum, which happens with inflammation of the small intestine - enteritis, when liquid chyme and inflammatory exudate enter the caecum. Rumbling and splashing in the caecum is noted in typhoid fever.
Mild soreness of the caecum during palpation is possible and normal, pronounced and significant - characteristic of inflammation of the inner lining of the intestine and inflammation of the peritoneum covering the kizhu. However, pain during palpation of the iliac region may be due to the involvement of neighboring organs in the process, such as the appendix, ureter, ovary in women, jejunum and ascending intestine.

Examination of the transverse, ascending and descending colon
The transverse meningeal intestine, its length is 25-30 cm, it is more often located in the umbilical region and has the shape of a garland. The ascending part of the colon has a length of up to 12 cm, it is located in the right lateral region of the abdomen. The descending part of the colon has a length of about 10 cm, its localization is the left lateral region of the abdomen.
Examination of the abdomen. When examining the areas of location of these parts of the colon in a healthy person, there are no noticeable bulges, retractions or peristalsis. Their appearance in any case indicates a pathology, the causes of which were mentioned in the description of studies of the sigmoid and caecum.
Among the methods of physical examination of these parts of the colon, palpation is of the greatest importance, although its possibilities are limited due to their special location in the abdominal cavity.
Palpation is carried out sequentially:

• transverse colon;
• ascending colon;
• descending part of the colon.

The position of the patient and the doctor during palpation of the POC is normal. Palpation of the intestine is carried out either with both hands simultaneously bilaterally, or with one hand - first on one side of the midline, then on the other (Fig. 408).
Both hands with half-bent fingers are placed on the anterior abdominal wall so that the terminal phalanges are along the long axis of the intestine 1-2 cm below the found border of the stomach on both sides of the midline. More often it is 2-3 cm above the navel. If the lower limit of the greater curvature is not known, then it must be determined and marked on the skin.
With strongly developed rectus abdominis muscles, an attempt to examine the POC under them does not give results, it is better to use the fingers of both



A

IN

Rice. 408. Palpation of the transverse colon.
A. Scheme of the topography of the transverse colon. Pay attention to the position of the garland of the intestine, its relationship with the greater curvature of the stomach, the position of the hepatic and splenic curvature of the intestine B. Palpation of the intestine with both hands at the same time. B. Palpation with one hand.

hands immediately set at the outer edges of the rectus muscles at the same level and conduct a study.
The fingers of both hands for 2-3 respiratory cycles on exhalation carefully sink deep into the abdomen up to the back wall, and then on the next exhalation a calm sliding downward movement is made. POC is palpable in 60-70% of cases and is perceived as an easily displaced cylinder located behind a thick layer of muscles and omentum. Usually, the intestine is determined at the level of the navel in men and 1-3 cm below the navel in women, which is 2-3 cm below the greater curvature of the stomach. Localization of the intestine is very individual and variable. The diameter of the cylinder is 2-3 cm, its surface is smooth, elastic, palpation is painless, the intestine is easily displaced, does not rumble when palpated
Overflowing with fecal masses, the intestine becomes dense, sometimes its density is uneven, bumpy. After a cleansing enema, the density and tuberosity of such an intestine disappears. An empty intestine, especially after diarrhea and an enema, is palpated in the form of a thin dense cord, and in the presence of inflammation it is painful.
To increase the contact of the fingers with the intestine during palpation, they should be slightly spaced. After examining the POC at the midline, the doctor's hands move laterally on each side along the POC to the hypochondrium up to the splenic angle on the left and the hepatic angle on the right by about 6-10 cm in each direction, but taking into account bowel deflection.
If, after 2-3 multiple palpation, the POC is not palpable, then its search is necessary, starting from the xiphoid process up to the pubic joint. The POC may lie horizontally and resemble the letter P with ascending and descending divisions, but may have a significant deflection and resemble the Latin letter U.
Sometimes a large curvature of the stomach can be mistaken for POC, their differences are as follows:

1. A large curvature is perceived as a fold from which the fingers slide off. POK during palpation bends around with fingers from above and below.
2. Large curvature is palpable only on the left, POC - on both sides of the navel.
3. The most reliable principle is the simultaneous probing of both the greater curvature and the POC.

The hepatic curvature of the ROC can be confused with the right kidney and gallbladder. The difference lies in the fact that the kidney lies deeper, has a denser consistency, less displacement, and does not rumble. The difference from the gallbladder is a more lateral and superficial location of the intestine, a tympanic sound above it, often changing properties of the intestine during palpation due to the evacuation of the contents from it.
On palpation of the splenic curvature, the doctor's left hand is pushed under the patient to the left lumbar region, located at the same level as on the right. The right hand is set at the edge of the costal arch parallel to the rectus abdominis muscle. Further actions are similar to those performed in the study of hepatic curvature. You can palpate with your left hand, and put your right hand under your back (Fig. 409).
Normally, the splenic curvature is not palpable due to its deep location (approximately at the level of the IX-X rib along the axillary line) and its more rigid fixation with the help of a diaphragm! intestinal ligament. If it is palpable, then this is already a sign of pathology.
Palpation of the ascending colon (Fig. 410).
The intestine is located in the right flank of the abdomen, there is no dense surface behind it, so its palpation is carried out bimanually. The left hand of the doctor with closed fingers lays


Rice. 410. Bimanual palpation of the ascending colon A. Scheme of the transverse section of the abdomen at the level of the umbilicus and palpation of the ascending colon. The function of a hard surface, to which the palpable intestine is pressed, is performed by the doctor’s left hand B. The position of the doctor’s hands during palpation

on the right lumbar region so that the fingertips rest against the edge of the long muscles of the back, creating rigidity for the palpating right hand. The right hand is placed above the right flank parallel to the left hand, the fingers of the right hand should rest against the outer edge of the rectus muscle. Taking into account the patient's breathing, the doctor's right hand is immersed in the flank of the abdomen, the left hand should also be displaced as much as possible in the direction of the right hand. On exhalation 2-3, the right hand, having reached the back wall, makes a sliding movement outward.
Palpation of the descending colon is also performed bimanually (Fig. 411). The doctor's left hand is pushed under the patient to the left lumbar region at the same level as on the right, the right hand is superimposed on the left flank parallel to the left hand so that the fingertips are at the outer edge of the left flank and lie parallel to the long axis of the intestine. After they dive deep to the back wall, taking into account the breath of the Nazi, the fingers make a sliding movement towards the spine
There is another, somewhat modified method of palpation of the descending colon. The left hand of the doctor is installed as in the previous method, and the right hand lies with the fingers not outward, but medially, touching the edge of the rectus muscles or retreating from them by 2 cm. After immersion in the abdominal cavity, the fingers slide to the outer edge of the left flank
It is difficult to palpate the ascending and descending colon. This is possible only in persons with a weak abdominal wall and thin. The intestine is perceived as a mobile, tender, soft, painless, non-rumbling (although not always) strand up to 1.5-2 cm in diameter.
Rice. 411. Bimanual palpation of the descending colon.

In pathological conditions, changes in the physical properties of the colon sections will be similar to those described in the sections of the study of the sigmoid and caecum.
Examination of the appendix - appendix
The study of the appendix presents difficulties due to deep localization and great variability of its location relative to the caecum.
When examining the right iliac region, the location of the appendix, normally no features are detected, both iliac regions are symmetrical, actively participate in the act of breathing.
In pathology, in most cases, examination of this area is also not very informative. But with an inflammatory lesion of the appendix with suppuration, in addition to the pronounced signs of a general reaction of the body, a lagging of the right iliac region in breathing, local bloating is revealed. With the development of diffuse peritonitis, there is swelling of the entire abdomen, its complete non-participation in the act of breathing, and the board-like appearance of the abdominal wall.
Percussion with disease of the appendix is ​​determined by local or widespread severe tympanitis and local pain over the location of the appendix. Auscultatory at the initial stages of the disease, no deviations are detected, only with the development of diffuse peritonitis, formidable symptoms appear - the disappearance of peristalsis and the noise of peritoneal friction.
The leading method for diagnosing appendix disease at all stages of the development of the pathological process is palpation.
Palpation of the appendix
The results of palpation depend on the localization of the appendix and the presence of a pathological process in it.
Most often, the appendix lies deep in the right iliac fossa, but it can be much higher or lower, sometimes reaching the small pelvis. It is important to note that no matter what position the appendix occupies, the place of its confluence with the caecum remains constant: on the medial-posterior surface of the caecum, 2.5-3.5 cm below the confluence of the ileum (TOIC). The length of the appendix is ​​8-15 cm, the diameter is 5-6 mm.
There are 4 options for the position of the appendix:

1. Descending, the appendix is ​​located downward from the caecum,

1. Lateral, the appendix is ​​located outward from the caecum.

1. Medial, the appendix is ​​located medially from the caecum. Occurs in 17-20% of cases.
2. Ascending, the end of the appendix runs up and back from the caecum (retrocecal position). Occurs in 13% of cases. Based on this, it was found that normally the appendix can

• pain on palpation, as a symptom of inflammation;
• palpation of a thickened and compacted appendix;
• pear-shaped appendix due to accumulation inside it

• the presence of an infiltrate due to the spread of inflammation from the appendix to the surrounding tissues.

• lying on your back with

• lying on the left side with legs pulled up to the stomach;
• knee-elbow position.

• the state of the sphincters;
• condition of the mucous membrane;
• condition of the wall of the rectum;
• condition of the fiber surrounding the rectum;
• position and condition of the pelvic organs adjacent to the front.

We said that S. Romanum it is palpable in the form of a smooth, dense, mobile, finger-thick, non-rumbling and painless cylinder, but under various pathological conditions it can become bumpy, painful, rumbling, immobile and change its main features in other respects as well. Let us consider in detail how each of its properties can change, and what diagnostic value this has.

Thickness is primarily change depending on the degree of fat deposition in appendicis epiploecis; the better nourished the subject is, the wider S. Romanum appears to be when touched; in the same way, addition and height affect its thickness - in large, strong people, it is wider than in small, weak builds. On the other hand, the condition of its walls and the degree of filling with gases and fecal masses affect the palpatory thickness of S. Romani.

With normal walls intestine it seems the narrower the greater the muscle tone, and vice versa; in the same way, inflammatory infiltration of the intestinal wall, with sigmoiditis, the development of a newly formed tissue, as, for example, with diffuse cancer, polyposis or papilomatosis, contributes to the thickening of the cylinder, and with diffuse polyposis, sometimes you have to feel a completely empty intestine 3-4 fingers wide.

Likewise, the more crowded S.R.. fecal masses - whether they are semi-liquid with gases or dense, it seems thicker on palpation, sometimes 2-3 fingers thick; on the contrary, after defecation, it sometimes subsides. shrinking to the thickness of the little finger; that is why, in the same subject at different times, we find on palpation S. R. of different thickness. S. Romanum, we said, smooth; however, when overflowing with solid fecal masses - Scyballa - it appears clearly; in the same way, a deep ulcerative process, for example, in severe dysentery or tuberculous ulcers, a developing neoplasm or a dense, fibrinous exudate deposited around it, makes it bumpy, uneven.

It is moderately dense and sharp peristaltes. But with spasm in hysterics, with acute inflammation, for example, with dysentery, its density increases significantly, and in these cases it appears in the form of a dense rope. It also happens at the moment of peristalsis with hypertrophy of its muscles, in the case of stenosis of the intestines below the curvature. On the contrary, the overflow of S. R. with gases and liquid contents reduces its consistency, and in these cases the intestine is palpated in the form of an air sausage with flaccid thin walls.

Concerning peristalsis and the associated change in consistency and density, then, in the case of an increase and increase in peristalsis, one always has to think either about inflammatory irritation, or about the nervous state of the intestine (increased tone of n. pelvici), or about the existence of some kind of obstacle below S. R. B In this regard, the appearance of isolated S. R. peristalsis is often one of the first signs of a developing neoplasm in the area often inaccessible to palpation of the partis praerectalis or in the upper sections of the rectum itself.

On the contrary, the complete absence peristaltic contractions in S. R, during prolonged palpation it is often observed in the atonic form of constipation.
Probing S.R., as said, painless. However, in nervous subjects, a completely normal S. R. may be painful - this is due to the proximity of sympathetic ganglia, which can be irritated by probing; in other cases, in women, pain on palpation is due to the inflammatory condition of the appendages. Of course, the inflammatory process in the intestine itself (Sygmoiditis catharrhalis, ulcerosa) or in the peritoneum covering the intestine immediately causes severe pain, for example, in acute severe dysentery, the patient does not allow the intestine to be probed.

When palpating the abdomen, the intestines are palpated from below as a rigid tube (namely, only the sigmoid intestine), this is constant, does not go away at all. The sigmoid colon is as hard as a tube. I think you understand.

The stool is most often not formed, it is mushy, not liquid, it is lumpy, creamy, with wateriness. There is no pain. But like for a long time there were pains in the bottom of a stomach or belly. I go to the toilet as if not with ease, the feces seem to be difficult to go.

I also have neurosis, phobic anxiety disorder, hypochondria.

From the tests I passed the coprogram - excellent, the general blood test - excellent, the biochemistry blood test (alt, ast, bilirubin, protein, urea, creatinine, amylase) - everything is fine, I also passed the oncomarkers REA, AFP, CA everything is fine. Passed FGDS - gastroduodenitis, and did an ultrasound of the abdominal cavity - diffuse changes in the pancreatic perenchyma, bending of the bile duct, signs of intrahepatic cholestasis.

I can’t do a colonoscopy because of the main diagnosis of neurosis.

What could it possibly be? Very worried. Thanks in advance for your replies.

After receiving the answer, do not forget to rate ("rate the answer"). I am grateful to everyone who found it possible and necessary to rate the answer!

God bless you never have a reason to go to the doctor! And if you have to, then do not delay.

Psychotherapy. Teaching sanogenic thinking. Osteopathy. Homeopathy. Reflexology. Sale of devices for home treatment - Tuning fork, DeVita-RITM, DeVita-AP.DeVita-Cosmo. DeVita Energy. Functional food. Weight correction. Postcard "Longevity". Razumrud -2. Detensor therapy.

Yours sincerely, General Director of the Research and Production Institute of Public Relations “Health Image”

Other options (congenital anomaly, oncology) are excluded by your description of the disease.

Yes, srk can be like that. Yes, such a long spasm. And not only in the sigmoid colon. In other departments it is simply impossible to probe.

Treatment of inflammation of the sigmoid colon, its symptoms and diagnosis

The intestinal canal is divided into several sections, each of which perform its specific function. The digestive system is responsible not only for the digestion of food, but also for immune function. One of the important sites is the sigmoid colon. What is it and why is it needed? Let's figure it out.

Reasons for the development of pathological processes

In appearance, the sigmoid colon resembles the Latin letter sigma. The length of the sigmoid colon is about sixty centimeters. Its main function is to digest food, absorb water and saturate the body with it. Also, the formation of fecal masses occurs in it.

Where is the sigmoid colon located? This site is located on the left side in the retroperitoneal space. In the female half of the population, it is located directly behind the uterine cavity. In men, the sigmoid colon is located behind the bladder.

This type of intestinal tract is considered one of the largest. The unusual shape allows you to hold moving food, so that it is digested and formed into feces. From the sigmoid colon, the mass passes into the rectum, from where it exits.

Often in practice there is a disease such as sigmoiditis. It is characterized by the development of an inflammatory process, which occurs due to stagnation of feces and the ingress of an infectious agent as a result of injury to the mucous membrane.

The causes of the development of the disease in the sigmoid colon are:

• violation of blood flow in the pelvic organs;
• dilation of venous vessels;
• diseases of the rectum in the form of fissures in the anus, proctitis, paraproctitis, Crohn's disease;
• colibacillary type infections, dysentery, dysbacteriosis in the intestinal canal;
• malnutrition, lack of vitamins and minerals, lack of foods that are rich in fiber;
• sedentary lifestyle;
• persistent constipation;
• deterioration of digestive peristalsis;
• diseases of the digestive system in the form of duodenitis, cholecystitis, enzyme deficiency;
• pathological processes in the prostate gland;
• chronic diseases in women;
• increased pressure on the intestine during the period of bearing a baby;
• surgical interventions on the abdominal cavity;
• injury to the abdomen.

If a person has encountered at least one of the above reasons, then it is worth visiting a doctor for a consultation and further examination. The sooner an ailment is detected, the easier and faster it will be cured.

Types of sigmoiditis

The inflammatory process in the sigmoid intestine can have an acute and chronic course.

The acute process is characterized by vivid symptoms. It develops against the background of injury or ingestion of infectious agents.

The chronic course proceeds sluggishly. Most often characterized by a disorder of the intestinal canal and dysbacteriosis.

Often, sigmoiditis is divided according to the nature of the damage. These include:

• catarrhal form. This type of disease is the easiest. The inflammatory process affects only the surface layer of the epithelium;
• erosive form. Often observed as a result of untreated catarrhal sigmoiditis. With such a pathology, erosions form on the mucous membrane. When food is digested, bleeding occurs;
• ulcerative form. This type of disease is considered the most severe. It is characterized by the formation of ulcers on the mucous membrane. Moreover, their number can be several, and also have different depths and localization. Often manifested due to ineffective treatment of erosive sigmoiditis.

Usually patients ignore the catarrhal type of sigmoiditis, since symptoms do not always occur. It is much harder to cure the ulcerative form.

Symptoms of the disease

Symptoms and treatment depend on the course and form of the disease. The sooner the patient detects unpleasant signs and turns to a specialist, the more the treatment process will pass without complications.

Symptoms of sigmoiditis are manifested in the following:

• painful sensations. Pain in the sigmoid colon is intense, and localized on the left side;
• development of spasms. Can give to the left leg and lumbar region;
• bloating;
• liquefied stools of a frequent nature. Feces have an unpleasant odor. There may be blood or purulent impurities;
• signs of intoxication in the form of blanching of the skin, weakness;
• nausea and vomiting.

These signs characterize the disease in the acute period.

If the sigmoid colon has been damaged for a long time, and the disease has acquired a chronic course, then the disease will manifest itself:

• in alternating diarrhea and constipation;
• in a feeling of fullness in the abdomen;
• in painful sensations that occur during the emptying of the intestinal canal.

Inflammation of the sigmoid colon of this type leads to a deterioration in the digestion and absorption of food. If the disease is not treated for a long time, then the person loses weight, lacks nutrients. The long presence of feces in the sigmoid region can lead to the development of allergic reactions. Chronic sigmoiditis is characterized by periodic exacerbations and remissions.

Methods for diagnosing the sigmoid colon

Inflammation of the sigmoid colon is quite difficult to diagnose. Often sigmoiditis is confused with another disease in the form of acute appendicitis. If the sigmoid colon begins to hurt, then it is urgent to consult a specialist.

He will listen to the patient's complaints and palpate the abdomen. An experienced doctor will immediately be able to determine the location of the inflammatory process and prescribe an appropriate examination.

To identify inflammation of the sigmoid colon, you need:

• donate blood for analysis;
• pass feces;
• conduct an x-ray;
• perform an irrigoscopy using a contrast agent;
• perform a sigmoidoscopy.

During the diagnosis, it is necessary to determine the cause of the manifestation of the disease. If the diagnosis is erroneous, then the sigmoid colon will not be able to fully carry out its functions.

Features of the treatment of the sigmoid colon

Treatment of sigmoiditis is considered a difficult and rather lengthy process. It requires the patient to comply with all the recommendations of the doctor. The treatment process is based on diet and medication.

Nutrition for sigmoiditis

If the intestines are affected, the sigmoid colon will not be able to fully digest food and absorb water. As a result, the feces will stagnate or come out with undigested pieces of food.

In acute cases, food should be sparing. It means eliminating irritating foods from the diet.

Treatment of sigmoiditis with a diet excludes the consumption of foods that are rich in carbohydrates and fats. This process leads to inhibition of digestion and the development of fermentation.

From the diet are completely excluded:

• fresh pastries and bread;
• fatty, fried foods;
• meat and sausages;
• soups and cereals with milk;
• strong meat broths;
• fish and canned food;
• caffeinated and alcoholic drinks;
• marinades, spices, seasonings, smoked meats.

For seven days, the menu should consist of vegetable broth and cereals. As a drink, you can use green tea, infusions of berries, decoctions of wild rose. Also in the diet should include baked apples.

Gradually, the menu can be expanded. But the emphasis should be on preventing congestion in the sigmoid colon and the appearance of constipation.

Medical therapy

If the sigmoid colon is affected, the location of the pain sensation will be on the left side. An unpleasant feeling may occur during or after eating, when emptying the intestinal canal.

To get rid of this, the patient is prescribed treatment, which includes:

• painkillers and antispasmodics;
• antibacterial medicines in the form of Doxycycline, Tetracycline, Phthalazole;
• means of an adsorbing nature in the form of Smecta or Neo-smectin;
• enveloping and astringent type medicines. These include:
• Almagel;
• drugs with anti-inflammatory properties.

Treatment of sigmoiditis also involves the restoration of intestinal microflora. For this, the patient is prescribed probiotics in the form of Acipol, Bifidumbacterin. The duration of treatment therapy is from seven to fourteen days.

Alternative methods of treatment of inflammation of the sigmoid colon

You can restore the work of the digestive organ with the help of folk remedies. They are used as adjunctive therapy to reduce inflammation and stop diarrhea.

There are several effective recipes.

In equal proportions, herbs are taken in the form of sage, mint, St. John's wort. Herbal collection is poured with a cup of boiled water and infused for thirty to forty minutes. Then it is filtered.

The finished product should be taken up to three times a day, one hundred milligrams, thirty minutes before eating.

When the first signs appear, you should immediately consult a specialist.

The information on the site is provided for reference purposes only. Do not self-medicate. At the first sign of disease, consult a doctor.

Sigmoid colon is hard

Along with excessive mobility, one can encounter the opposite phenomenon - limitation of mobility or almost immobility of the sigmoid colon. This, as a rule, with the exception of rare cases of congenital short mesentery, occurs when the intestine is fixed by an inflammatory process of the outer lining of the intestine, leading to the development of adhesions between the intestine and the posterior wall of the abdominal cavity (perisigmoiditis).

In such cases, attempts to move the sigmoid colon in one direction or another are not only unsuccessful, but sometimes cause severe pain in the patient due to the tension of the adhesions.

Following mobility, attention is paid to the thickness and consistency of the palpable intestine. Sometimes the sigmoid colon is palpated in the form of a thin, dense consistency of a strand as thick as a pencil or even thinner. Often, with a similar palpation picture, the patient experiences pain during palpation. These properties are due to spasm, which, for example, can be established in spastic colitis; this is very characteristic of dysentery. It should be pointed out that sometimes during palpation the sigmoid colon can be felt either of the usual width, or of a thinner and at the same time more dense consistency. It depends on the peristaltic movements caused by repeated movements.

Thicker than normal, the sigmoid colon occurs primarily when it is filled with feces and gases. If the contents of the intestine are liquid and at the same time there is an accumulation of gases, then rumbling or splashing is felt on palpation of the intestine. Splashing on palpation is one of the objective symptoms of the band, but it should be remembered that it also happens in patients who, shortly before palpation, were injected with liquid through the rectum, for example, a cleansing enema, etc.

If stool masses stagnate in the sigmoid colon for a long time, then as a result of partial absorption of the liquid by the intestinal wall, they harden significantly and give the palpable intestine a significant density. In some cases, such dense fecal masses appear to be heterogeneous and form, as it were, calculi - the so-called fecal stones (scybala). On palpation of the sigma containing fecal stones, the intestine is palpated hard and bumpy-beaded. The same intestine is found in the tuberculous process, severe ulcerative colitis, or, finally, in a neoplasm. It is not difficult to distinguish these relatively innocent fecal stones from a neoplasm or process in tuberculosis by probing the intestine a second time after a previously made cleansing enema.

Thickening of the intestine may also be the result of the development of the pericolytic process. Then, if the process has not yet stabilized, the sigmoid colon is outlined indistinctly in the form of a wider motionless cylinder of pasty consistency, painful on palpation; in addition, an infiltrate is palpable in the left iliac region.

Finally, with intestinal atony in general, and in particular with atony of the sigmoid colon, the latter is palpable in the form of a wide soft ribbon with a transverse diameter of up to 2-3 fingers. A particularly significant expansion of the palpable intestine occurs when it is damaged by a neoplastic process, tuberculosis, or with intestinal polyposis. Naturally, in these cases, the consistency of the probed segment also changes.

The severe pain felt by the patient during palpation is in most cases due to the inflammatory process in the intestine itself and especially in its serous membrane. First of all, significant pain occurs in dysentery, ulcerative colitis, advanced proctosigmoiditis. Sometimes this soreness can be caused by an inflammatory process of the peritoneum in the circumference of the intestine, the starting point of which in women is the genital area.

Interesting medical articles.