J腹部检查B.pptx

physical examination腹部检查(2)Abdominal Examination,palpate mass 腹部包块触诊 percussion and auscultation 腹部叩诊和听诊 signs of common diseases 腹部常见疾病征象,1,第一页，共五十二页。,Abdominal Masses腹部包块,Physical massIn abdominal wallIn abdominal cavityPathological massswelling of organ Inflammatory massesTumor,生理包块腹壁包块腹腔包块病理包块脏器肿大炎性包块肿瘤,2,第二页，共五十二页。,Physical Masses生理性包块,Abdominal wall:venter musculi or tendinous intersections of musculus rectus abdominis 腹壁: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:腰椎体 骶骨岬 腹主动脉 右肾下极 横结肠 乙状结肠 盲肠,3,第三页，共五十二页。,Pathological Masses病理性包块,Shifting or swelling of parenchymatous organ 实质性脏器肿大Distension of hollow viscus 扩大的空腔脏器Inflammatory masses(abscess or adhesion)炎性包块(脓肿或粘连)Tumor or cyst 肿瘤与囊肿Lymphadenectasis 淋巴结肿大,4,第四页，共五十二页。,Characteristics of Palpation 触诊要点,Location:relation to organsSize:diameter in long,wide and thickContour:shape,margin and surfaceTexture:soft,firm and hardTenderness:inflammation,liver swelling Pulsation:dilative and conductive Movability:shift by respiration or hand,部位:所在部位与该处脏器多相关连大小:纵长 横宽 深厚 可用实物比喻轮廓:形状 边缘 外表质地:柔软 中等硬度 质硬压痛:炎症 肝肿大搏动:膨胀性和传导性移动度:随呼吸移动 用手推动,5,第五页，共五十二页。,Fluid Thrill液波震颤,Technique:move flank wall by hand 检查方法:用手推动一侧腹壁Positive:the other hand feels liquid wave 阳性征象:对侧手掌感到液体波动Meaning:large volume of ascites,usually 3000ml 临床意义:大量腹水在34升以上,6,第六页，共五十二页。,Percussion of Abdomen 腹部叩诊,organs in the abdomen 脏器叩诊 fluid in the abdomen 腹水叩诊,7,第七页，共五十二页。,Organs Percussion脏器叩诊,Percussion notes:indirect percussion 叩诊音:间接叩诊Tympany:hollow viscus as Traubes area,intestine 鼓音:空腔脏器 胃泡鼓音区 肠腔Dullness or flatness:parenchyma viscus as liver or spleen,enlarged bladder or uterus 叩音或实音:肝脏和脾脏实质脏器 增大的膀胱或子宫Knock pain:indirect knock impress inflammation 叩击痛:间接叩击 提示炎症Organs:liver,gallbladder,kidney 脏器:肝脏 胆囊 肾脏,8,第八页，共五十二页。,Abnormal Area of Tympany鼓音范围异常,Enlarged area:intestinal obstruction,perforation of gastrointerstinal tract 范围增大:胃肠高度胀气 胃肠穿孔Reduced area:swelling of parenchymatous organ,tumor,ascites 范围缩小:肝脾等脏器极度肿大 腹腔肿瘤 大量腹水,9,第九页，共五十二页。,Traubes Area胃泡鼓音界,Location:left hypochondrium 位置:左季肋部 Upper border:left lung,diaphragm 上界:左肺下缘 膈 Lower border:Rib 下界:肋弓Right border:liver 右界:肝脏Left border:spleen 左界:脾脏,10,第十页，共五十二页。,Traubes Area Abnormal胃泡鼓音范围异常,Pathology:content variation of stomach and compression of neighbor organ 机制:胃内含气量变化 邻近器官扩大压迫Enlarged:gastric dilatation,pylorus obstruction 扩大:见于胃扩张 幽门梗阻Reduced:swellings of liver or spleen,left pleural effusion,pericardial effusion 缩小:见于肝脾肿大 左侧胸腔积液 心包积液,11,第十一页，共五十二页。,Dullness Area of Liver肝脏浊音界,Method:percussion along the lines of right midclavicular,midaxillary and scapular line 方法:沿右锁骨中线 右腋中线 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:由肺区向下叩出肝与肺清音变浊音的 相对浊音界 相当于被肺遮盖的肝顶部Inferior border:from abdomen tympany up to liver dullness margin 肝下界:由腹部向上叩 鼓音变浊音,12,第十二页，共五十二页。,Percussion of Superior and Inferior border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:右锁骨中线第 5 肋间 右腋中线第 7 肋间 右肩胛线第10肋间Inferior border:costal margin in right midclavicular line 10th rib level in right midaxillary line 肝下界:右锁骨中线右季肋下缘 右腋中线相当于第10肋骨水平,13,第十三页，共五十二页。,Area of Liver肝界范围,Superior border:12 inter-costal spaces higher than inferior lung border 肝上界:肺下界的上12肋间Inferior border:12 cm higher than detected by palpation 肝下界:较触及的肝界高12厘米Liver span in right midclavicular line:911 cm 肝上下径(右锁骨中线):肝上下界间的距离约 911厘米,14,第十四页，共五十二页。,Abnormal Findings肝浊音界异常,Enlarged:hepatic congestion,hepatitis,liver abscess,liver carcinoma 增大:肝淤血 肝炎 肝脓肿 肝癌Diminished:liver cirrhosis or necrosis 缩小:肝硬化 肝坏死 Disappeared:perforation of gastrointestinal tract,abdominal surgery 消失:代之以鼓音 胃肠穿孔 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:右肺纤维化 右肺不张 胃肠胀气downward shifting:emphysema,right side pleural effusion,hepatoptosia 下移:肺气肿 右胸腔积液 肝下垂,15,第十五页，共五十二页。,Dullness Area of Spleen脾脏浊音界,Normal space 正常状况Location:9th11th ICS alongside left midaxillary line 位置:左腋中线911肋间Diameter:superio-inferior 47 cm the anterior border not exceed anterior axillary line 范围:上下径47厘米 前界不超过腋前线Abnormal findings 叩诊异常Enlarged:splenomegaly 范围增大:脾肿大Diminished:too much gas in surrounding organs 范围缩小:胃扩张或肠胀气,16,第十六页，共五十二页。,Dullness Area of Bladder or Uterus 膀胱或子宫浊音区,Bladder dullness area:physical signs in retention of urine,a smooth,firm,and regular swelling arising out of the pelvis which one cannot“get below and which is dull to percussion.膀胱浊音区:判断膀胱膨胀程度 耻骨上方圆形浊音区 排尿或导尿后消失Uterus dullness area:estimate enlarged uterus superior margin of pubis,not disappear after micturation or urethral catheterization 子宫浊音区:判断子宫增大程度 耻骨上方浊音区 排尿或导尿后不消失,17,第十七页，共五十二页。,Percussion of Ascites腹水叩诊,Shifting dullness:移动性浊音free fluid causes air-containing gut to float up to the most superior position 液体流动使含气脏器位于最高位置volume of ascites usually exceeds 1000ml if detec