Painful abdominal points

1. Gastroepato
2. Gastroenterology
3. Painful abdominal points
4. Surgical abdominal pain
5. Flatulence, meteorism and aerophagia
6. 'The patient with abdominal distension
7. How to visit a patient

Notes by dr Claudio Italiano

Painful points originating from the liver and biliary tract are:
  -the colecistic point: it is located immediately below the costal arch, at the meeting point between the X coast and the outer edge of the rectum of the abdomen. This point is extremely painful in acute cholecystitis, much less so in chronic cholecystitis, gallbladder lithiasis and gallbladder dyskinesias. Sometimes the gallbladder pain arises only during the deep inhalation, which is then abruptly interrupted (sign of Murphy or of the inspiratory arrest). Sometimes the patient can feel the pain as well as in the palpation site, in correspondence of the left flank (by reflex spasm of the left colonic angle, at the level of the sperm of Payr); in some cases the pain can be appreciated only here, lacking that at the gallbladder level.
 

Link correlati al tema:
- Pain in the upper right
abdominal quadrant
-Left inferior abdomen pain

The choledocho-pancreatic area of ​​Chauffard-Rivet is located between the xifo-umbilical and the bisector of the angle formed on the right between it and the transverse umbilical; it is therefore a triangular area that extends vertically for about 5-6 cm from the navel and corresponds to the projection of the first portion of the duodenum, the head of the pancreas and the common bile duct. Palpation should be performed by pressing with your fingers perpendicular to the abdominal wall. The tenderness is aroused in cases of duodenal ulcer, choledochal calcosis, acute inflammation of the pancreas.
Other painful points include the following:
- epigastric point: immediately below the ensiform apophysis;
- Binet point: at the front end of the IX right bank;
- right frenico point: between the two ends of the right sternocleidomastoidus, at the base of the neck;
- Schmidt point on the edge of the right hand sewing;
- Scapular or Budd point: at the lower corner of the right shoulder blade;
- the vertebral points of Boas: a few centimeters to the right of the spinous apophysis of the dorsal IX-X-XI-XII;
- Campanacci point: posteriorly, in the paravertebral area, below the last right-hand side.

Appendicular points

In the acute and chronic inflammation of the appendix painfulness arises at the lower right quadrant of the abdomen, where various points can be identified (in relation to the topographic variability of the appendix and especially in relation to the different length and direction of the bowel); the most important are:
- point by Mc Burney: halfway through the spinal-umbilical line, which corresponds to the lymphatic ganglia of the ileo-cecal angle and therefore can also be present in blind man's affections);
- the point of Morris, on the umbilical spino, 4 cm from the navel;
- Munro's point; at the crossing of the parasternal with the spindlehelical;
- Lanz point: at the union of the lateral third with the middle third of the bisiliaca;
- Clado's point: on the same line, in the right paramedian office;
- Aazon sign: compressing epigastric pain in the appendicular area;
- sign of Bastedo: blowing air in the colon appears pain in the right iliac fossa;

Bihind

- Campanacci point: in the dorsal region, at the last right intercostal space, between posterior posterior axillary and angular of the scapula (in the retrocecal appendicitis).
- Jalaguier's point: it is in the middle of the line that joins the upper anterior iliac spine with the pubic spine, if the appendix is ​​retrocecal. It should be remembered that in relation to the frequent ectopies of the appendix the objective observations can undergo some modifications: so, in case of a long appendix that medially pushes, the tenderness is located on the right median or paramedian line; in the subhepatic appendicitis the pain is felt in the right hypochondriac site, where it also localizes the painfulness to the pressure, thus simulating a cholecystitis. In the retrocecal appendicitis pain is felt in the lumbar region and in the same seat, above the iliac crest, pain is felt. In the case of pelvic appendicitis urinary disorders (pollakiuria, dysuria) or rectal or female sexual sphere can occur; objectively it causes diffuse suprapubic pain and the rectal exploration allows to arouse very intense pain at the Douglas retrovescical breach. In the case of situs viscerum inversus, diagnostic difficulties may arise, in relation to the abnormal location of the pain (to the left iliac fossa, instead of the right one). In the old often the painful symptomatology is attenuated and so too in the child; in this the pain symptomatology can be mainly periumbilical and the defense contracture may not arise. In acute appendicitis the already mentioned sign of Blumberg or parietal peritoneum rebound pain can be found) and the sign of Rovsing: the pressure exerted upwards in the descending colon accentuates the pain in the right iliac fossa, due to the abrupt distention of the blind due to the displacement of the colon gas. It should be noted that pain in the right iliac fossa, as well as appendicitis, may be caused by right adnexal inflammation, from extra-uterine pregnancy with threat of rupture in the peritoneum, from Crohn's terminal ileitis. In the case of acute appendicitis, the localized peritoneal reaction can lead to the formation in the right iliac fossa of a platelet (a very painful, very painful flogomatous mass which can slowly regress or evolve towards the abscess).

Pancreas pain

We have already talked about the choledocho-pancreatic area; here we recall the pancreatic point of Dejardins: it is placed at 5-6 cm on the bisector of the angle between xifo-umbilical and umbilical transverse; corresponds to the outlet of the Wirsung canal in the duodenum. During acute pancreatitis, the pain is localized in the epimesogastric site and radiates outwards behind the bar. A painful point can be found posteriorly in the left paravertebral site, at the height of D11-D12, at the cost-vertebral angle.

Renal and ureteral points

In diseases. painful of the kidney is successful in the maneuver of the Jordan: the percussion with the ulnar margin of the hand cut at the renal lodge (just below the costal arch) evokes living pain. In the case of kidney bacterium affections or renal capsule distension (for kidney stones, acute glomerulonephritis, pyelonephritis, perirenal abscess, ptosis with hydronephrosis, etc.), renal pain points can be found posteriorly:
- cost-vertebral point: at the corner between the XII rib and the outer margin of the lumbar spine;
- muscle cost point: at the angle between the XII rib and the outer margin of the lumbar muscles; it differs from myositic tenderness because in this case the pain is aroused by the pressure also on the remaining part of the muscle.
The pain in these points is more easily visible when the patient is in a supine position. Another renal pain point is found at the free end of the XI ipsilateral rib (costal point).
Anterior ureteral pain points can be found:
- anterior subcostal point: just under the rib arch along the prolonged parasternal line; corresponds to the renal pelvis) Another area of ​​choice for pain of the renal pelvis is found on the side, immediately below the rib arch, along the anterior axillary (lateral sub-focal point);
- upper or paraumbilical urethral point of Bazin: on the umbilical umbilical to 5 cm from the navel;
- average ureteral point at the intersection of the upper anterior bispinoilaca line with the vertical line raised from the point of joining the middle third with the two thirds external of the Poupart arch;
- suprapubic ureteral point above the pubic tubercle;
- lower ureteral point, which corresponds to the outlet of the ureter in the bladder. It is researched in man with rectal exploration, outside the seminal vesicles and in the woman with full bladder vaginal exploration, at the lateral arch.
Speaking of pains in the lower abdomen, remember how bladder pain can be evoked by palpation in the suprapubic site; the distended bladder can be palpated like a roundish suprapubic swelling, which disappears after urination.

Painful points of the uterus and ovary

The pain that originates from the body of the uterus is located anteriorly above the pubis, in the medial site and posteriorly in the lumbosacral.
The pain of adnexal origin is localized in the iliac fossa, in the middle of a line that goes from the anterior superior iliac spine to the pubic tubercle (spino-pubic line).