J腹部检查B.ppt

1 physical examination 腹部检查腹部检查(2)Abdominal Examination palpate mass 腹部包块触诊腹部包块触诊 percussion and auscultation 腹部叩诊和听诊腹部叩诊和听诊 signs of common diseases 腹部常见疾病征象腹部常见疾病征象 2 Abdominal Masses 腹部包块腹部包块 Physical mass In abdominal wall In abdominal cavity Pathological mass swelling of organ Inflammatory masses Tumor 生理包块生理包块 腹壁包块腹壁包块 腹腔包块腹腔包块 病理包块病理包块 脏器肿大脏器肿大 炎性包块炎性包块 肿瘤肿瘤 3 Physical Masses 生理性包块生理性包块 Abdominal wall:venter musculi or tendinous intersections of musculus rectus abdominis 腹壁腹壁:腹直肌肌腹及腱划腹直肌肌腹及腱划 Abdominal cavity:lumbar centrum,sacral promontory,abdominal aorta,inferior pole of right kidney,transverse colon,sigmoid colon,cecum 腹腔腹腔:腰椎体腰椎体 骶骨岬骶骨岬 腹主腹主动脉动脉 右肾下极右肾下极 横结肠横结肠 乙状结肠乙状结肠 盲肠盲肠 4 Pathological Masses 病理性包块病理性包块 Shifting or swelling of parenchymatous organ 实质性脏器肿大实质性脏器肿大 Distension of hollow viscus 扩大的空腔脏器扩大的空腔脏器 Inflammatory masses(abscess or adhesion)炎性包块炎性包块(脓肿或粘连脓肿或粘连)Tumor or cyst 肿瘤与囊肿肿瘤与囊肿 Lymphadenectasis 淋巴结肿大淋巴结肿大 5 Characteristics of Palpation 触诊要点触诊要点 Location:relation to organs Size:diameter in long,wide and thick Contour:shape,margin and surface Texture:soft,firm and hard Tenderness:inflammation,liver swelling Pulsation:dilative and conductive Movability:shift by respiration or hand 部位部位:所在部位与该处所在部位与该处脏器多相关连脏器多相关连 大小大小:纵长纵长 横宽横宽 深厚深厚 可用实物比喻可用实物比喻 轮廓轮廓:形状形状 边缘边缘 表面表面 质地质地:柔软柔软 中等硬度中等硬度 质硬质硬 压痛压痛:炎症炎症 肝肿大肝肿大 搏动搏动:膨胀性和传导性膨胀性和传导性 移动度移动度:随呼吸移动随呼吸移动 用手推动用手推动 6 Fluid Thrill 液波震颤液波震颤 Technique:move flank wall by hand 检查方法检查方法:用手推动一侧腹壁用手推动一侧腹壁 Positive:the other hand feels liquid wave 阳性征象阳性征象:对侧手掌感到液体对侧手掌感到液体波动波动 Meaning:large volume of ascites,usually 3000ml 临床意义临床意义:大量腹水在大量腹水在34升以上以上 7 Percussion of Abdomen 腹部叩诊腹部叩诊 organs in the abdomen 脏器叩诊脏器叩诊 fluid in the abdomen 腹水叩诊腹水叩诊 8 Organs Percussion 脏器叩诊脏器叩诊 Percussion notes:indirect percussion 叩诊音叩诊音:间接叩诊间接叩诊 Tympany:hollow viscus as Traubes area,intestine 鼓音鼓音:空腔脏器空腔脏器 胃泡鼓音区胃泡鼓音区 肠腔肠腔 Dullness or flatness:parenchyma viscus as liver or spleen,enlarged bladder or uterus 叩音或实音叩音或实音:肝脏和脾脏实质脏器肝脏和脾脏实质脏器 增大的膀胱或子宫增大的膀胱或子宫 Knock pain:indirect knock impress inflammation 叩击痛叩击痛:间接叩击间接叩击 提示炎症提示炎症 Organs:liver,gallbladder,kidney 脏器脏器:肝脏肝脏 胆囊胆囊 肾脏肾脏 9 Abnormal Area of Tympany 鼓音范围异常鼓音范围异常 Enlarged area:intestinal obstruction,perforation of gastrointerstinal tract 范围增大范围增大:胃肠高度胀气胃肠高度胀气 胃肠穿孔胃肠穿孔 Reduced area:swelling of parenchymatous organ,tumor,ascites 范围缩小范围缩小:肝脾等脏器极度肿大肝脾等脏器极度肿大 腹腔肿瘤腹腔肿瘤 大量腹水大量腹水 10 Traubes Area 胃泡鼓音胃泡鼓音界界 Location:left hypochondrium 位臵位臵:左季肋部左季肋部 Upper border:left lung,diaphragm 上界上界:左肺下缘左肺下缘 膈膈 Lower border:Rib 下界下界:肋弓肋弓 Right border:liver 右界右界:肝脏肝脏 Left border:spleen 左界左界:脾脏脾脏 11 Traubes Area Abnormal 胃泡鼓音范围异常胃泡鼓音范围异常 Pathology:content variation of stomach and compression of neighbor organ 机制机制:胃内含气量变化胃内含气量变化 邻近器官扩大压迫邻近器官扩大压迫 Enlarged:gastric dilatation,pylorus obstruction 扩大扩大:见于胃扩张见于胃扩张 幽门梗阻幽门梗阻 Reduced:swellings of liver or spleen,left pleural effusion,pericardial effusion 缩小缩小:见于肝脾肿大见于肝脾肿大 左侧胸腔积液左侧胸腔积液 心包积液心包积液 12 Dullness Area of Liver 肝脏浊音界肝脏浊音界 Method:percussion along the lines of right midclavicular,midaxillary and scapular line 方法方法:沿右锁骨中线沿右锁骨中线 右腋中线右腋中线 右肩胛线叩诊右肩胛线叩诊 Superior border:relative dullness margin between liver and lung,its from resonance to dullness,correspond to top of liver.,肝上界肝上界:由肺区向下叩出肝与肺清音变浊音的由肺区向下叩出肝与肺清音变浊音的 相对浊音界相对浊音界 相当于被肺遮盖的肝顶部相当于被肺遮盖的肝顶部 Inferior border:from abdomen tympany up to liver dullness margin 肝下界肝下界:由腹部向上叩由腹部向上叩 鼓音变浊音鼓音变浊音 13 Percussion of Superior and Inferior border 肝上下浊音界叩诊肝上下浊音界叩诊 Superior border:intercostal space of 5th in right midclavicular,7th in midaxillary and 10th in scapular line 肝上界肝上界:右锁骨中线第右锁骨中线第 5 肋间肋间 右腋中线第右腋中线第 7 肋间肋间 右肩胛线第右肩胛线第10肋间肋间 Inferior border:costal margin in right midclavicular line 10th rib level in right midaxillary line 肝下界肝下界:右锁骨中线右季肋下缘右锁骨中线右季肋下缘 右腋中线相当于第右腋中线相当于第10肋骨水平肋骨水平 14 Area of Liver 肝界范围肝界范围 Superior border:12 inter-costal spaces higher than inferior lung border 肝上界肝上界:肺下界的上肺下界的上12肋间肋间 Inferior border:12 cm higher than detected by palpation 肝下界肝下界:较触及的肝界高较触及的肝界高12厘米厘米 Liver span in right midclavicular line:911 cm 肝上下径肝上下径(右锁骨中线右锁骨中线):):肝上下界肝上下界间的距离约间的距离约 911厘米厘米 15 Abnormal Findings 肝浊音界异常肝浊音界异常 Enlarged:hepatic congestion,hepatitis,liver abscess,liver carcinoma 增大增大:肝淤血肝淤血 肝炎肝炎 肝脓肿肝脓肿 肝癌肝癌 Diminished:liver cirrhosis or necrosis 缩小缩小:肝硬化肝硬化 肝坏死肝坏死 Disappeared:perforation of gastrointestinal tract,abdominal surgery 消失消失:代之以鼓音代之以鼓音 胃肠穿孔胃肠穿孔 腹部手术后腹部手术后 Upward shifting:fibrosis or atelectasis of right lung,large volume of air or gas in the gastrointestinal tract 上移上移:右肺纤维化右肺纤维化 右肺不张右肺不张 胃肠胀气胃肠胀气 downward shifting:emphysema,right side pleural effusion,hepatoptosia 下移下移:肺气肿肺气肿 右胸腔积液右胸腔积液 肝肝下垂下垂 16 Dullness Area of Spleen 脾脏浊音界脾脏浊音界 Normal space 正常状况正常状况 Location:9th11th ICS alongside left midaxillary line 位臵位臵:左腋中线左腋中线911肋间肋间 Diameter:superio-inferior 47 cm the anterior border not exceed anterior axillary line 范围范围:上下径上下径47厘米厘米 前界不超过腋前线前界不超过腋前线 Abnormal findings 叩诊异常叩诊异常 Enlarged:splenomegaly 范围增大范围增大:脾肿大脾肿大 Diminished:too much gas in surrounding organs 范围缩小范围缩小:胃扩张