Inspection, palpation and percussion

Examination of a patient begins with a General diagnostic methods of examination, palpation, percussion, examination of the urine.
Examination of the kidneys begins with inspection. When viewed from front wall of the abdomen is sometimes a protrusion in the field hypochondrium due to increased kidney (hydronephrosis, tumor, etc.,). With large tumors, kidney subcutaneous veins of the relevant part of the abdomen sometimes expanded. When paranemia observed sometimes swelling in the corresponding half of the lumbar region.
During the inspection you can see above the pubic area or in the lower part of the belly bulging pear shaped related to overcrowded bladder with urinary retention.
The examination can also detect congenital anomaly of the urethra - the hypospadias - absence of the lower wall of the urethra.
If epispadias outer hole channel opens on the back surface of a member, the front wall of the urethra is missing.
The outer opening of the urethra to examine urination. In acute inflammation of the urethra outer hole appears to be swollen, hyperemic, pus. External examination reveals the presence of phimosis or paraphimosis, inflammatory changes of the foreskin and head, tumors, ulcers of the penis or prepucialna bags, limfangoita, parauretral moves.
Hyperemia, swelling of the skin of the scrotum are observed in acute epididymitis, orchitis; bluish coloration or purulent fistula - tuberculosis testicle or epididymis. When the accumulation of fluid in the membranes of the egg (hydrocele, it does), for tumors, hummah testicles when hematomas scrotum corresponding half of its increased in size.
Palpation of the kidneys produce bimanual in the patient on the back, on the side and standing. The patient relaxes the muscles of the abdomen, breathe evenly and deeply.
In the study of the right kidney left hand is placed under the lumbar region of the patient palm up, between the spine and XII edge, and the right hand is on the front wall of the abdomen below the costal region. During exhalation bring the fingers of both hands fingers lying on top of the right hand is carried out on the opportunity to delve into the quadrant, and the left hand gently push the front area of the kidneys. Healthy kidneys usually't be felt. I lean people, especially women, sometimes manage to grasp the bottom edge of the right kidney, located lower than the left. The left kidney is examined in the same way, but under the lumbar region down the right hand and the left put on the front abdominal wall. Palpation of the kidney on the side is particularly indicated in patients with significantly developed subcutaneous layer of the anterior abdominal wall. The patient lies on the right side in the study of the left and on the left side in the study of the right kidney. On the research side leg slightly bent at the knee and hip joints. The position of the hands of the doctor is the same as in the study on the back. When examining the patient in the standing position for relaxing the abdominal muscles he leans slightly forward.
Pain caused by lumbar this area in the corner between the XII edge and the outer margin of the long muscles of the back (the symptom of Pasternatskogo)indicate kidney disease or renal pelvis.
When Pioneros, the omission or kidney tumors, hydronephrosis often able to feel the kidney, to determine its surface (smooth, rough), consistency, mobility, running. The ballot is revealed as follows: the patient lies on his back; his hand connected to the lumbar region, produce short shocks, which passed the second hand on the anterior abdominal wall apparently through the kidney.
Through the side of the vault of the vagina in women and through the rectum in men is sometimes possible to probe the stone in kolapushina Department of the ureter or thickening last tuberculosis.
* Palpation of the prostate gland and seminal vesicles is made through the rectum into the patient on the right side with the belly by feet or on your back with their legs bent at the knee and hip joints of the lower limbs or in Bozeman or bent vertical position of the patient. In the rectum enter the index finger of the right hand with pre put on him by napalechniki (or in the glove), smeared with petroleum jelly or vaseline oil. During feeling through the front wall of the colon determine the size of cancer, its texture, surface, tenderness, state median groove and surrounding tissue. Normal consistency prostate elastic, smooth surface of the border and the median groove are defined clearly.
Palpation of the urethra in men make on the lower surface of the penis. In norm the urethra seems soft, without any seals and thickening. The presence of swelling testifies to inflammatory process in glands of the urethra or Scarring its walls. Palpation of the urethra in women produce through the front wall of the vagina.
In the cavernous bodies of the penis can be detected in seals for inflammation (overnite) or plastic induration them (see the relevant sections).
Palpation of the scrotum is made with both hands with the patient lying and standing. Note separately palpation changes testis, epididymis, and the constituent parts of the spermatic cord. Palpation you can install the absence of one or both testicles in the scrotum (due cryptorchidism or castration), underdevelopment or atrophy.
Tuberous infiltrate in the field of the epididymis, celabrate thickening VAS duct find in tuberculous inflammation of the epididymis.
Percussion renal region from the side of the abdominal wall helps to differentiate the tumor from tumors of abdominal cavity organs. The kidneys are located in the lower abdomen behind the intestine, which percussion gives timpani, and when the tumor from the abdominal cavity organs (liver, gall bladder, ovarian, colon), the dull sound. Only with very large tumors, kidney or hydronephrosis intestine may be offset in the medial side, and then over the tumor percutere determined dullness.
At a delay of urine over crowded bladder is determined by the dullness of percussion sound, sometimes spreading to the navel and above.