Abnormal findings

Generalised resistance is commonly due to anxiety in a patient unable to relax. The associated increase in muscle tone can be confirmed by the finding of a reduction in resistance to palpation during the early phase of expiration. Resistance also accompanies intra-abdominal disease, particularly when pain is present. It may be restricted to one site according to the organ affected and the extent of the peritoneal involvement, e.g. McBurney's point in appendicitis. Deep-seated inflammation not causing localised guarding may be revealed by rebound tenderness. Although the initial pressure of palpation may fail to elicit a painful response, the abrupt withdrawal may cause the sudden movement of a deeply placed, inflamed organ, resulting in pain. Generalised "board-like' rigidity implies peritonitis; the abdomen docs not move on respiration and bowel sounds are absent. Attempts to elicit olher signs such as rebound tenderness are inappropriate. It should, however, be remembered that pelvic peritonitis may be advanced before the signs are apparent abdominally and may only be revealed by rectal examination. The elasticity of the skin provides only a rough index of the degree of hydration and redundant skin folds are evidence of weight loss.

In severe constipation, faeces can be palpable in any part of the colon. Indentation of a lump by finger pressure is evidence that it is faecal. Sometimes, however, a hard, craggy lump of faeces can only be distinguished from malignancy by re-examination following defecation. Enlargement of the bladder, ovary or uterus, suspected from inspection, may be confirmed as a dome-shaped swelling rising from the pubis. An upper abdominal mass which does not move on respiration is either a fixed retroperitoneal structure (e.g. aorta or pancreas) or is attached to the abdominal wall. Masses which arc situated within the abdominal wall continue to be palpable when the muscles are contracted, for example by raising the head off the pillow. Tightening the abdominal muscles in this way identifies the intersections of the recti abdominis (Fig. 5.9). An intersection may mislead (lie beginner into believing that a tumour or the liver edge has been felt. Masses situated more deeply within the abdominal cavity are less easily palpable when the muscles are contracted. The characteristics of any mass found should be assessed systematically with respect to its si/e, position, attaeh-

Aorta

Lower pole of right kidney

Hard faecef

Rectus, abdominis and its tendinous insertions

Normal coion

Palpate Right Kidney

Fig. 5.9 Palpation of 1he abdomen, Diagrammatic representation of some findings which may be normal and are often misinterpreted.

Aorta

Lower pole of right kidney

Hard faecef

Rectus, abdominis and its tendinous insertions

Normal coion

Small nodes Distended bladder

Fig. 5.9 Palpation of 1he abdomen, Diagrammatic representation of some findings which may be normal and are often misinterpreted.

ments, surface, edge, consistency, thrills, signs of inflammation and transillumination and illustrated diagrammati-cally, as in Figure 5.10.

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Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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