July 2007

Abdominal palpation II

by Dr. Howard Loomis

I have been discussing an easy‑to‑learn‑and‑apply system of examination that I refer to as "The Second Factor" in chiropractic. The exam is designed to indicate when visceral dysfunction is the underlying cause and perpetuates musculoskeletal problems, preventing their correction and healing. We know that structure and function cannot be separated when attempting to find the cause of a patient's symptoms. Anatomy strongly influences physiology and vice versa. Of course, they are unquestionably linked neurologically.

Last month, I discussed how to relate muscle contractions associated with spinal subluxation to identifying muscle contraction in the areas supplied with innervation from the involved spinal area. It is interesting to note how often functional or visceral symptoms correlate directly with structural imbalances. The trick is to know which is the cause and which the effect.

Abdominal palpation

Examination of the abdomen is often forgotten in today's world of advanced diagnostic technology. Yet, it is very revealing when performed in a systematic and thorough manner. The following guidelines will be helpful.

***  Auscultation is relatively less important in the abdomen than in the thorax. It seldom yields meaningful information in a routine examination, but it is of extreme importance in evaluation of abdominal pain.

***  Percussion of the abdomen usually does not play an important role in the assessment of abdominal pain. It is primarily used to establish the presence of distention, tumors, fluid, and enlargement of solid viscera.

***  Therefore, palpation takes on great importance for examining the abdomen. It is rather difficult to actually palpate the abdominal organs because they are separated from the examining hand by a relatively thick, muscular wall. But this is exactly what we are searching for, i.e., muscle contraction or stress points that share the same spinal innervation as the underlying organ.

***  Remember that the only time these stress points can be found is when the organ is stressed and unable to perform its responsibilities for maintaining homeostasis. Once the stress passes, the muscle contraction disappears.

The most important point to bear in mind as we discuss abdominal palpation is distinguishing between deep pain found in the viscera, and superficial pain found in the muscular abdominal wall.

***  Myofascial trigger points in an abdominal muscle may produce referred abdominal pain and symptoms such as projectile vomiting, anorexia and nausea, intestinal colic, diarrhea, urinary bladder and sphincter spasms, and dysmenorrhea. When such visceral symptoms occur with abdominal pain and tenderness, the combination can strongly mimic acute visceral disease, especially appendicitis and cholelithiasis (Travell).

***  In addition, abdominal trigger points may be secondary to visceral disorders such as, peptic ulcer, intestinal parasites, dysentery, ulcerative colitis, diverticulosis, diverticulitis, and cholelithiasis. Abdominal trigger points may also accompany such vague complaints as burning, fullness, bloating, swelling and gas.

Topographic anatomy of the abdomen

There have been several systems devised for dividing the abdomen into topographic segments. The most commonly used divides the anterior surface of the abdomen is divided into 4 quadrants by two intersecting lines, one extending vertically from the xiphoid to the symphysis pubis and the other extending horizontally across the abdomen to the level of the umbilicus. This divides the abdomen into four quadrants: right upper, right lower, left upper, and left lower quadrants.

Generally speaking, the following correlations can be made between contractions found in the superficial musculature of the abdomen and in the paraspinal musculature: esophagus, T5‑T6; stomach, T7‑T9; gallbladder, T8‑T9; pancreas, T5‑T9; duodenum, T9‑T11; ascending colon, lower thoracic; descending colon, upper lumbar; sigmoid colon, lower lumbar; rectum, S2‑S4.

Next month, I will examine each of these areas individually.

(Dr. Loomis can be reached by mail at 6421 Enterprise Lane, Madison,WI 53719 or by phone at 800‑662‑2630. Visit his website at http://www.loomisenzymes.com.)