Can you palpate your colon

Unlike other masses, its contents can often be indented, especially in constipation. Rarely, a colonic tumour can be felt, particularly in the caecum, where masses may grow to a large size before causing symptoms.

Get help. GPnotebook no longer supports Internet Explorer. To ensure the site functions as intended, please upgrade your browser. Terminal learning objective: Given a simulated patient with simulated symptoms, the student will be able to recognize potential problems and properly perform the needed exam.

Enabling learning objective: Identify different bowel sounds. Identify different types of hernias. Identify different organs and their position in the abdominal cavity. Identify the different symptoms of an acute abdomen. All rights reserved. The Abdominal Exam. Supine position. Arms across chest, not above head. Ask patient where pain is, and examine last. If the patient is ticklish or frightened, initially use the patients hand under yours as you palpate.

When patient calms then use your hands to palpate. Is there an area that is bulging or moving? Skin: Strai stretch marks : a streak or line, may be red, white, or purple. Dark pink-purple strai of Cushing disease. Venous: dilation - seen in hepatic cirrhosis or inferior vena cava obstruction.

Color: areas of discoloration or rashes. Umbilicus: contour, location, inflammation, hernia. Contour of abdomen Flat, rounded, protuberant or scaphoid. Bulging flanks - seen in ascites. Local bulges - pregnancy or distended bladder. Symmetrical - asymmetry with enlarged organs or masses.

Visible organs or masses - lower abdominal masses of ovarian or uterine tumor. Peristalsis: increased peristaltic waves of intestinal obstruction. Due to congenital defect or weakness in the wall of the vessel. Abdominal - hernia through the abdominal wall. Umbilical - bulging defect at umbilicus. Incisional - defect in abdomen muscles after surgical incision. Must palpate the size of the defect. Diastasis recti - not a true hernia, a separation or the two rectus abdominus muscles.

No clinical significance. Epigastric - small, midline protrusion through a defect in the linea alba located between the xiphoid process and umbilicus. Auscultation of the Abdomen Bowel sounds use diaphragm of stethoscope Bowel sounds are widely transmitted throughout the abdomen.

Listening in one spot is usually sufficient. Normal sounds are due to peristaltic activity. Normal sounds consist of clicks and gurgles. Hypoactive bowel sounds are less than sounds a minute. Borborygmus - is the medical term for stomach growling.

This is due to prolonged episodes of hyperperistalsis. This is normal. Abnormal bowel sounds: caused by a number of illnesses. This maneuver allows the examiner to feel anterior liver surface as it slips under the finger pads.

Make a note of the consistency of the liver surface. For bimanual liver palpation, place the left hand posteriorly at the level of the two lower ribs and gently press upward to elevate the liver into a more accessible position. Ask the patient to take a deep breath and perform palpation with the right hand as demonstrated previously. Sometimes, the liver is not palpable by these standard techniques and therefore a different maneuver like "hooking" can prove to be helpful.

To perform this technique, place your flexed fingers over the edge of costal margin. Ask the patient to take a deep breath and try to feel the liver edge as you press downward and upward, towards the patient's head. Next, perform spleen palpation. A normal size spleen is rarely palpable. However, if the spleen is significantly enlarged, it displaces the stomach and expands downward below the rib cage and medially across the abdomen, and might be felt as low as at the left lower quadrant.

In order to detect enlarged spleen, request the patient to take a deep breath and starting in left lower quadrant, move your fingers slightly up with each inspiration and expiration. Palpate pressing down and towards the patient's head and then releasing, in the same motion as for palpating of the lower edge of the liver.

If the spleen is not felt, repeat the exam with patient lying on their right side. Some examiners use the bimanual spleen palpation technique, during which the palpation is performed with the right hand, while the left the hand is placed behind the left rib cage, and is pressed on the ribs and soft tissues upwards.

Lastly, palpate to detect enlarged kidneys. Ask the patient to take a deep breath, keep your left hand positioned at the costophrenic angle and palpate with your right hand pressing forward. Attempt to capture the kidney between your hands, or at least feel it with your upper hand.

If you feel the kidney on inspiration, ask the patient to exhale deeply and hold their breath for a moment. You might feel the kidney moving back to its expiratory position. Repeat the maneuver on the left side. At the end of the exam, thank the patient for their cooperation. In this presentation, we reviewed the types of palpation techniques useful in evaluation of various abdominal structures.

This part of physical diagnosis is especially informative when evaluating a patient presenting abdominal pain, as it provides insight into localization, cause, and severity of the problem. As always, thanks for watching! Subscription Required. Please recommend JoVE to your librarian. Abdominal palpation is the final and an important part of the abdominal exam.

One must remember to start with the superficial palpation and follow with the deep palpation, systematically going through all the abdominal regions. As in the other sections of the abdominal examination, the patient should be comfortably positioned and relaxed. Patient breathing can and should be used to the examiner's advantage so that the deeper structures are more accessible by palpation on deep expiration. A very common mistake is to overlook significant organomegaly by starting the liver and spleen palpation too high in the abdomen.

Abdominal palpation can provide a significant amount of information for a clinician. A few potential findings are:. Evaluation of the abdominal region by palpation allows for follow-up on the findings obtained during the previous stages of the physical examination, and for the clinician to integrate and interpret the information, which will determine the subsequent diagnostic steps.

The correlation between the abnormal physical signs at different stages of physical examination increases a likelihood of identifying pathology such as organomegaly. It is also extremely important not to miss the physical signs of catastrophic events, such as peritonitis causing rebound tenderness, or an abdominal organ perforation causing severe tenderness and guarding.

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Previous Video Next Video. Overview Procedure Applications and Summary Transcript. Overview Source: Alexander Goldfarb, MD, Assistant Professor of Medicine, Beth Israel Deaconess Medical Center, MA Abdominal palpation, if performed correctly, allows for examination of the large and relatively superficial organs; for a skilled examiner, it allows for assessment of the smaller and deeper structures as well. Log in or Start trial to access full content.

Light palpation Light palpation allows for determination of the areas of tenderness and abdominal wall resistance due to rigidity involuntary muscle spasm or guarding voluntary contraction of the abdominal wall musculature.

Make sure that the patient is positioned correctly, and explain the procedure. Ask the patient to indicate the area of pain or tenderness, and examine this area last to avoid generalized abdominal resistance due to apprehension.

Examine the painful areas gently, and don't try to re-elicit the pain. To improve the abdominal relaxation, you might need to have the patient change position or lie with the knees bent.

Using your dominant hand, keep your fingers together and press to a depth of approximately 1 cm using the pads flat surfaces of your fingers with a gentle circular motion. Examine all of the abdominal regions, moving in a clockwise direction.

Slightly lift your hand as you move to a different spot, and avoid sudden jabs. If the patient is ticklish, ask place the patient's hand under yours, and then slip your hand underneath the patient's hand after a few moments. Note the presence of irregularities of the abdominal wall, superficial organs or masses, and crepitus crunching feeling during palpation produced by gas or fluid within subcutaneous tissues.

Deep palpation While the superficial palpation provides information about potential areas of tenderness, superficial structures, and the abdominal wall, deep palpation permits inspection of the internal organs and delineation of the intra-abdominal masses. Start with the quadrant opposite to the one where the pain is located.