In the clinical practice of any medical institution, the primary skills by which a doctor assesses the patient's condition and determines a preliminary diagnosis are a general questioning and examination, as well as detailed concerning each body system, auscultation of the heart and lungs, palpation and percussion. Especially it concerns the doctor of a reception dormitory, for which there is very little time allocated for each patient, and if he does it urgently, then in a matter of minutes. So often just a positive symptom of Shchetkin-Blumberg allows you to diagnose the patient signs of peritonitis and urgently transfer it to the surgical department. In the technique of palpation distinguish between superficial and deep, which directly assess the condition of internal organs. This technique is used mainly with suspicions of diseases of the gastrointestinal tract and the genitourinary system, since the abdominal region is most suitable for conducting such a non-invasive, but often painful, study.
Some methods of palpation
For example, one of the main techniques is the symptom of Shchetkin-Blumberg, Kera, Murphy, Schoffar, Mayo-Robson, as well as some diaphragmatic projections projecting into the place of attachment of the sternocleidomastoid muscle to the clavicle. These methods reveal soreness at certain points, which is manifested in certain diseases. So, often there is a positive symptom of Shchetkin-Blumberg with appendicitis, spillage peritonitis, perforation of hollow organs; Kera and Murphy - with inflammatory diseases of the gallbladder and its pathways. And soreness in the points of Shoffar and Mayo-Robson (projection of the head and tail of the pancreas) indicates an acute phase of pancreatitis. However, the most important of them is probably the Shchetkin-Blumberg symptom, since its positive variant is indicative of irritation of peritoneal interoreceptors, which means internal hemorrhage or spreading of this inflammatory process from the abdominal cavity to this basic serous membrane. And this condition in any case is urgent.
Symptom of irritation of peritoneum
To correctly check the symptom of Shchetkin-Blumberg in a patient, it is necessary to give the hand a semi-bent position in the interphalangeal joints (as if holding a small ball in his hand) and attach three working fingers (index, middle and anonymous) to the abdominal region. Then ask the patient to take a deep breath (at this time you need to collect the skin fold and pull it down), exhale (deepen the fingers 3-4 cm) and pull them off sharply. A positive symptom of Schetkina-Blumberg is considered, if at the last act the soreness in this place is sharply increased. It can also be negative and questionable. Most often, this check is done if the patient enters the emergency room or polyclinic with a syndrome of an acute abdomen and complains of prolonged progressive pain. Most often, the symptom of Schetkina-Blumberg is positive for spillage of peritonitis and appendicitis. In this case, the patient is urgently transferred to surgery, so that experts have already specified the cause of the manifestation of this symptom.