医学专题-J腹部检查B

physicalexamination

腹部(fùbù)检查(2)

AbdominalExaminationpalpatemass

腹部(fùbù)包块触诊percussionandauscultation

腹部叩诊和听诊signsofcommondiseases

腹部常见疾病征象第一页，共五十二页。编辑课件AbdominalMasses

腹部(fùbù)包块PhysicalmassInabdominalwallInabdominalcavityPathologicalmassswellingoforganInflammatorymassesTumor生理(shēnglǐ)包块腹壁包块腹腔包块病理包块脏器肿大炎性包块肿瘤第二页，共五十二页。编辑课件PhysicalMasses

生理性包块Abdominalwall:ventermusculiortendinousintersectionsofmusculusrectusabdominis腹壁:腹直肌肌腹及腱划Abdominalcavity:lumbarcentrum,sacralpromontory,abdominalaorta,inferiorpoleofrightkidney,transversecolon,sigmoidcolon,cecum腹腔:腰椎体骶骨岬腹主动脉(dòngmài)右肾下极横结肠乙状结肠盲肠第三页，共五十二页。编辑课件PathologicalMasses

病理性包块Shiftingorswellingofparenchymatousorgan实质性脏器肿大Distensionofhollowviscus扩大的空腔脏器Inflammatorymasses(abscessoradhesion)炎性包块(脓肿或粘连(zhānlián))Tumororcyst肿瘤与囊肿Lymphadenectasis淋巴结肿大第四页，共五十二页。编辑课件CharacteristicsofPalpation

触诊(chùzhěn)要点Location:relationtoorgansSize:diameterinlong,wideandthickContour:shape,marginandsurfaceTexture:soft,firmandhardTenderness:inflammation,liverswellingPulsation:dilativeandconductiveMovability:shiftbyrespirationorhand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:形状边缘表面质地: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(hūxī)移动用手推动第五页，共五十二页。编辑课件FluidThrill

液波震颤(zhènchàn)Technique:moveflankwallbyhand

检查方法:用手推动一侧腹壁Positive:theotherhandfeelsliquidwave

阳性征象:对侧手掌感到液体波动Meaning:large

volumeofascites,usually>3000ml临床意义:大量腹水(fùshuǐ)在3~4升以上第六页，共五十二页。编辑课件PercussionofAbdomen

腹部(fùbù)叩诊

organsintheabdomen

脏器叩诊(kòuzhěn)fluidintheabdomen

腹水叩诊第七页，共五十二页。编辑课件OrgansPercussion

脏器(zānɡqì)叩诊Percussionnotes:indirectpercussion叩诊音:间接叩诊Tympany:hollowviscusasTraube’sarea,intestine鼓音:空腔脏器胃泡鼓音区肠腔Dullnessorflatness:parenchymaviscusasliverorspleen,enlargedbladderoruterus叩音或实音:肝脏(gānzàng)和脾脏实质脏器增大的膀胱或子宫Knockpain:indirectknockimpressinflammation

叩击痛:间接叩击提示炎症Organs:liver,gallbladder,kidney脏器:肝脏胆囊肾脏第八页，共五十二页。编辑课件AbnormalAreaofTympany

鼓音范围(fànwéi)异常Enlargedarea:intestinalobstruction,perforationofgastrointerstinaltract范围增大:胃肠高度胀气胃肠穿孔Reducedarea:swellingofparenchymatousorgan,tumor,ascites范围缩小:肝脾等脏器极度(jídù)肿大腹腔肿瘤大量腹水第九页，共五十二页。编辑课件Traube’sArea

胃泡鼓音界Location:lefthypochondrium

位置:左季肋部

Upperborder:leftlung,diaphragm

上界:左肺下缘膈

Lowerborder:Rib下界:肋弓Rightborder:liver右界:肝脏(gānzàng)Leftborder:spleen左界:脾脏第十页，共五十二页。编辑课件Traube’sArea

Abnormal

胃泡鼓音范围(fànwéi)异常Pathology:contentvariationofstomachandcompressionofneighbororgan机制:胃内含气量变化邻近器官(qìguān)扩大压迫Enlarged:gastricdilatation,pylorusobstruction扩大:见于胃扩张幽门梗阻Reduced:swellingsofliverorspleen,leftpleuraleffusion,pericardialeffusion缩小:见于肝脾肿大左侧胸腔积液心包积液第十一页，共五十二页。编辑课件DullnessAreaofLiver

肝脏(gānzàng)浊音界Method:percussionalongthelinesofrightmidclavicular,midaxillaryandscapularline方法:沿右锁骨中线右腋中线右肩胛(jiānjiǎ)线叩诊Superiorborder:relativedullnessmarginbetweenliverandlung,it’sfromresonancetodullness,correspondtotopofliver.,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Inferiorborder:fromabdomentympanyuptoliverdullnessmargin肝下界:由腹部向上叩鼓音变浊音第十二页，共五十二页。编辑课件Percussionof

SuperiorandInferiorborder

肝上下(shàngxià)浊音界叩诊Superiorborder:intercostalspaceof5thinrightmidclavicular,7thinmidaxillaryand10thinscapularline

肝上界:右锁骨中线第5肋间右腋中线第7肋间右肩胛(jiānjiǎ)线第10肋间Inferiorborder:costalmargininrightmidclavicularline10thriblevelinrightmidaxillaryline肝下界:右锁骨中线右季肋下缘右腋中线相当于第10肋骨水平第十三页，共五十二页。编辑课件AreaofLiver

肝界范围(fànwéi)Superiorborder:1~2inter-costalspaceshigherthaninferiorlungborder

肝上界:肺下界的上1~2肋间Inferiorborder:1~2cmhigherthandetectedbypalpation

肝下界:

较触及的肝界高1~2厘米Liverspaninrightmidclavicularline:9~11cm肝上下径(右锁骨中线(zhōngxiàn)):肝上下界间的距离约9~11厘米第十四页，共五十二页。编辑课件AbnormalFindings

肝浊音(zhuóyīn)界异常Enlarged:hepaticcongestion,hepatitis,liverabscess,livercarcinoma增大:肝淤血肝炎肝脓肿肝癌(ɡānái)Diminished:livercirrhosisornecrosis缩小:肝硬化肝坏死Disappeared:perforationofgastrointestinaltract,abdominalsurgery消失:代之以鼓音胃肠穿孔腹部手术后Upwardshifting:fibrosisoratelectasisofrightlung,largevolumeofairorgasinthegastrointestinaltract上移:右肺纤维化右肺不张胃肠胀气downwardshifting:emphysema,rightsidepleuraleffusion,hepatoptosia

下移:肺气肿右胸腔积液肝下垂第十五页，共五十二页。编辑课件DullnessAreaofSpleen

脾脏(pízàng)浊音界Normalspace正常状况Location:9th~11thICSalongsideleftmidaxillaryline

位置:左腋中线9~11肋间Diameter:superio-inferior4~7cmtheanteriorbordernotexceedanterioraxillaryline

范围:上下径4~7厘米(límǐ)前界不超过腋前线Abnormalfindings叩诊异常Enlarged:splenomegaly

范围增大:脾肿大Diminished:toomuchgasinsurroundingorgans

范围缩小:胃扩张或肠胀气第十六页，共五十二页。编辑课件DullnessAreaofBladder

orUterus

膀胱(pángguāng)或子宫浊音区Bladderdullnessarea:physicalsignsinretentionofurine,asmooth,firm,andregularswellingarisingoutofthepelviswhichonecannot“getbelow”andwhichisdulltopercussion.膀胱浊音区:判断膀胱膨胀程度(chéngdù)耻骨上方圆形浊音区排尿或导尿后消失Uterusdullnessarea:estimateenlargeduterussuperiormarginofpubis,notdisappearaftermicturationorurethralcatheterization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第十七页，共五十二页。编辑课件PercussionofAscites

腹水(fùshuǐ)叩诊Shiftingdullness:移动性浊音freefluidcausesair-containingguttofloatuptothemostsuperiorposition

液体流动使含气脏器位于(wèiyú)最高位置volumeofascitesusuallyexceeds1000mlifdetectable

腹水量在1000ml以上Puddlesign:水坑征freefluidinthemostinferiorpositioninelbow-kneeposture肘膝位腹水位于最低位awaytodetectsmallamountsoffluid

用于发现少量腹水第十八页，共五十二页。编辑课件ShiftingDullnessduetoAscites

移动性浊音(zhuóyīn)Dullnessareainbothsideofabdomenwithdorsalposition平卧位时浊音区位于腹部的两侧Dullnessareamovestoinferiorwhenmovedposition变换(biànhuàn)体位浊音区移至下方Dullnessmovementfollowspositionmoved浊音部位随体位变动而变动第十九页，共五十二页。编辑课件PuddleSignduetoAscites

水坑(shuǐkēnɡ)征Inelbow-kneeposture肘膝位Percussiondullnessinumbilicalregion脐部叩诊呈浊音(zhuóyīn)Dullnessdisappearwhenpositionmoved变换体位浊音区消失第二十页，共五十二页。编辑课件CommonDiseases

腹水(fùshuǐ)的常见病因Hepatocirrhosis肝硬化Tuberculousperitonitis结核性腹膜炎Cardiacdysfunction心功能不全Nephropathysyndrome肾病综合征Primaryormetastasistumor

inabdominalcavity腹腔内肿瘤或其他部位(bùwèi)肿瘤腹腔转移第二十一页，共五十二页。编辑课件CompareAscitesandOvarianCyst

腹水(fùshuǐ)和卵巢囊肿的鉴别Signs征象Ascites腹水Ovariancyst卵巢囊肿

Dorsalposition仰卧位

Umbilicus脐Percussionsound叩诊音

Shiftingdullness移动性浊音Rulerpressingtest尺压试验

Sidedistension侧腹膨隆Extrude突出Middletympanysidedullness中部鼓音两侧浊音Positive阳性Nojumpiness无跳动

Middledistension中腹膨隆Flat平坦Middledullnesssidetympany中部浊音两侧鼓音Negative阴性Rhythmjumpiness有节奏跳动第二十二页，共五十二页。编辑课件Differenceofdullnesssitesbetweenovariancyst

and

ascites

卵巢囊肿和腹水(fùshuǐ)浊音区的不同tympanytympanydullnessdullness第二十三页，共五十二页。编辑课件PercussionPaininLiverArea

肝区叩击(kòujī)痛Technique:putleftpalminliverarea,righthandwithboxingknocktheleftbackofhandwithmiddleforce.方法:将左手掌平放于肝区右手握拳用中等强度(qiángdù)力量向左手背叩击Normal:nopainsfeelinginliverarea.正常:肝区无叩击痛Abnormal:

theknockpaininliverareaindicateshepatitisandliverabscess叩击痛阳性:见于肝炎肝脓肿第二十四页，共五十二页。编辑课件PercussionPaininGallbladderArea

胆囊(dǎnnáng)区叩击痛Technique:knockthesurfaceofgallbladderareawithmiddleforce.方法:叩击胆囊部位(bùwèi)表面Normal:noknockpain正常:胆囊无叩击痛Positive:cholecystitis阳性:提示胆囊炎第二十五页，共五十二页。编辑课件PercussionPaininKidneyArea

肾区叩击(kòujī)痛Technique:sitorsidelie,方法:坐位或侧卧位putleftpalmincostovertebralangle

area,righthandwithboxingknocktheleftbackofhandwithmiddleforce.

用左手掌平放肋脊角及邻近区域右手握空拳以中等强度(qiángdù)力量向左手背扣击Normal:noknockpain正常:肾区无扣击痛第二十六页，共五十二页。编辑课件CostovertebralAngleTenderness

肾区叩击(kòujī)痛阳性Nephritis肾炎(shènyán)Pyelonephritis肾盂肾炎Renaltuberculosis肾结核Calculus肾结石Perinephritis肾周围炎第二十七页，共五十二页。编辑课件AuscultationofAbdomen

腹部(fùbù)听诊

bowelsounds肠鸣音

vascularsounds血管(xuèguǎn)杂音

frictionrub摩擦音scratchsound搔弹音

splashingsound振水音第二十八页，共五十二页。编辑课件BowelSounds

肠鸣音Principle:peristalticactivityemitsvariousgurglingandbubblingsoundsasairandfluidinterfaceschangewithcontractionwaves.borborygmus:loudprolongedgurgles.定义:肠蠕动肠管气液体流动产生咕噜或冒泡音Normal:4~5/min正常:每分钟4~5

次Abnormal:increased,decreasedandabsence.

异常(yìcháng):活跃和亢进减弱和消失第二十九页，共五十二页。编辑课件BowelSoundsIncreased

肠鸣音活跃(huóyuè)和亢进Increased:>10/min:hypermotilestatessuchasacutegastroenteritis,bloodinthesmallbowel活跃:>10次/分(肠蠕动增强)急性肠炎胃肠道大出血服泻药(xièyào)饥饿High-pitchedtinkling:intestinalfluidandairunderpressure,asinearlyobstruction亢进:>10次/分(响亮高亢甚至金属音)机械性肠梗阻第三十页，共五十二页。编辑课件BowelSoundsDecreased

肠鸣音减弱(jiǎnruò)和消失Decreased:postlaparotomy,electrolyteimbalance,senileconstipation减弱:1次/3~5分(肠蠕动减弱) 腹膜炎低血钾老年性便秘(biànmì)

Absence:acuteperitonitis,paralyticileus

onemustlistenforatleastafull3minutesbeforepronouncingthatperistalsishasceased消失:4分钟以上听不到(肠蠕动消失)急性腹膜炎麻痹性肠梗阻第三十一页，共五十二页。编辑课件VascularSounds

血管(xuèguǎn)杂音Principle:Turbulentflowinadilated,constricted,ortortuousvessel.机制:血管扩张或狭窄产生湍流(tuānliú)Arterymurmur:ejectordraughtinsystolicwithhighpitchandstrongsound.动脉杂音:收缩期喷射性或吹风样音调高音响强Venousmurmur:continuousmurmurwithlowpitchandebbsound.静脉杂音:连续性嗡鸣音调低音响弱第三十二页，共五十二页。编辑课件CommonCause

血管(xuèguǎn)杂音常见病因Artery动脉性Epigastrium:abdominalaortastrictureoraneurism上腹部:腹主动脉狭窄或腹主动脉瘤Umbilicalorintheflanks:renalarterystricture脐周或侧腹部:肾动脉狭窄Righthypochondrium:hepaticarterystrictureusuallycompressedbypancreasorleftlivercancer.右季肋部:肝动脉狭窄常见于胰腺癌肝左叶癌Venous静脉性Recanalizedumbilicalvein:portalhypertensionaccompaniedvaricosityinabdominalwall

脐周:门静脉高压(gāoyā)腹壁静脉曲张第三十三页，共五十二页。编辑课件FrictionRub

摩擦音Principle:irritatedfibrin-ladenperitonealsurfacesgratewithmotion机制:腹膜表面(biǎomiàn)炎性渗出运动摩擦Meaning:seeninlocalizedperitonitis

提示:局限性腹膜炎Technique:heardatcorrespondareaindeeprespiratory

方法:深呼吸时在相应部位听到Clinicalcause:spleeninfarction,spleenandlivercircumferenceinflammation,cholecystitis

病因:脾梗塞脾周围炎肝周围炎胆囊炎第三十四页，共五十二页。编辑课件ScratchSound

搔弹音Mechanism:soundwaveconductivediversityindiffermediummadenoisealteration.Aidsinstaticborderdefinition机制:声波在不同介质中传导的差异致声响改变有助于确定实质脏器或液体边界Technique:putthestethoscopeincentralandthehandscratchtoit,whensoundsuddenlyincreasedindicatetheborder.方法:听诊器置于中央手边搔弹边向听诊器移动声响突然增强为其边界Meaning:confirminferiorborderoftheliverandascites(<120ml)意义:确定肝脏下界和小量腹水(fùshuǐ)范围scratchtest第三十五页，共五十二页。编辑课件SplashingSound

振水音Mechanism:causedbyincreasedairandfluidinthestomach,splashsoundproducewhenairandfluidsuccussed.

机制:胃内气体和液体增加气体与液体受冲击振动产生声音(shēngyīn)Technique:heardsplashsoundfromstethoscopeinepigastricandwhenthehandmovingstomach方法:听诊器置于上腹部

用手推动上腹部可听到振水声Meaning:whenlimosisappearedclewpyloricobstruction,gastricdilatationorlargehiatushernia意义:

空腹时出现提示幽门梗阻

胃扩张食管裂孔疝succussiontest第三十六页，共五十二页。编辑课件CommonDiseaseofAbdomen

腹部(fùbù)常见疾病

conditionscausingliverchanges

肝脏改变常见原因(yuányīn)

ascites腹水征

peritonitis腹膜炎

acutegastricorduodenal

perforation急性胃十二指肠穿孔第三十七页，共五十二页。编辑课件ConditionsCausingLiverChanges

肝脏改变(gǎibiàn)常见原因Primaryhepaticcarcinomaandmetastases原发性肝癌(ɡānái)或转移癌Rightheartfailure

右心功能不全Overinflatedlungs肺气肿Diffuseinfiltration弥漫性肝肿大Cirrhosisofliver

肝硬化第三十八页，共五十二页。编辑课件Primaryhepaticcarcinomaandmetastases

原发性肝癌(ɡānái)和转移癌Tendernessinepigastriumandwasting

上腹部压痛和消瘦Largehardirregularlivereasilypalpableperabdomen

上腹部可触及大而硬的肝脏Highrightdiaphragmwithdullnesstopercussionanddiminishedbreathsoundsoverlowerchest

右膈抬高右下肺呼吸音减低(jiǎndī)Clinicalsignsmaystimulatepleuraleffusionatrightbaseposterior

晚期可伴有右肺底胸腔积液第三十九页，共五十二页。编辑课件RightHeartFailure

右心功能不全Tenderenlargedliver

肝脏增大压痛Rightdiaphragmnotnecessarilyelevated

右膈不一定抬高Distendedcervicalveinandhepatojuglarrefluxpositive

颈静脉怒张肝颈静脉回流征阳性(yángxìng)Othersignsofrightheartfailuresuchaspendulousedema

低垂部位水肿等其它右心功能不全征象Systolicpulsationofliveriftricuspidincompetencepresent

三尖瓣关闭不全时有肝脏收缩期搏动第四十页，共五十二页。编辑课件Emphysema

肺气肿

Liveredgesoftandpalpableperabdomen

肋缘下触及质软的肝下缘Chesthyper-resonantwithlevelsofliver

肝上界水平(shuǐpíng)叩呈过清音Dullnessdepressed

肝相对浊音区浊音减弱Accompaniedbarrelchest

伴有桶状胸第四十一页，共五十二页。编辑课件DiffuseInfiltrationoftheLiver

弥漫性肝浸润(jìnrùn)Generalizedfirmregularenlargedliver

肝脏肿大变硬形态正常Spleenmayalsobepalpable

脾脏可同时触及Causedbyamyloidorsarcoidosis

可由淀粉样变或肉芽肿疾病(jíbìng)引起Biliaryductdisordersmayaccompanyenlargedgallbladderandjaundice

胆道病变可伴有胆囊增大和黄疸第四十二页，共五十二页。编辑课件CirrhosisofLiver

肝硬化Smalllivertopercussionbutahardedgemaybepalpableunderthexiphoid

剑突下触及边钝质硬缩小的肝脏Spleenpalpable

脾脏肋缘下可触及Varicosityandascites脐周静脉曲张(jìngmài-qūzhāng)和腹水征palmarerythema,spiderangiomaandGynaecomastia

肝掌蜘蛛痣男性乳房发育Gastrointestinalhaemorrhage消化道出血第四十三页，共五十二页。编辑课件PhysicalExaminationPoint

肝硬化失代偿(dàichánɡ)期检体要点Liverchange:sizereduced,hardquality,sharpmargin肝脏改变:肝脏缩小质硬边锐表面细颗粒状Liverfunctiondamage肝功能受损

skin:gloomface,pigmentation,petechia,jaundice皮肤:面色灰暗色素沉着出血点淤斑黄疸

bloodvessel:capillarydilatation,spiderangioma血管:面颈上胸部毛细血管扩张蜘蛛痣肝掌

breast:gynecomastiainthemale乳房:男性乳房发育Portalhypertensioninducedsidebranchcirculation:splenomegaly,varicosityofabdomen,ascitessign

门脉高压侧枝循环(xúnhuán)形成:脾脏肿大腹壁静脉曲张腹水征第四十四页，共五十二页。编辑课件SignsofHepaticCirrhosis

肝硬化征象(zhēngxiàng)MentalstateJaundiceFetorHepatomegalyandgallbladderFlappingtremor(asterixis)AsscitesGastrointestinalhaemorrhageBruisingOedemaSpidernaeviGynaecomastiaSplenomegalyNeedlemarksUmbilicalherniaSuperficialabdominalveinsPalmarerythemaDupuytren’scontractureFingerclubbingandleukonychiaTesticularatrophysparsebodyhairHaemorrhoids第四十五页，共五十二页。编辑课件AscitesSign

腹水(fùshuǐ)征Inspection:frogshapeofabdomenindorsalposition,hypogastriumregiondistensionwithhilumherniainstand.视诊:仰卧位蛙状腹直立位下腹膨隆脐突出Palpation:fluidthrill(asciteslargethan3000ml)触诊:液波震颤(腹水量(shuǐliànɡ)>3000ml)Percussion:shiftingdullness(asciteslargethan1000ml),puddlesign(smallamountsoffluid)叩诊:移动性浊音(腹水量>1000ml)水坑征(少量腹水)Auscultation:umbilicusscratchsound

inelbow-kneeposture(ascites>120ml)听诊:脐部搔弹音(腹水量>120ml)第四十六页，共五十二页。编辑课件AcutePerforatedGastricorDuodenalUlcer

急性胃十二指肠(shíèrzhǐcháng)穿孔Suddenlyepigastricpain,forcedsupinepositionandtwinlowerlimbsflection

突发上腹痛

强迫仰卧位双下肢屈曲(qūqǔ)Acuteperitonitissigns,tendernessandreboundpaininepigastriumorroundumbilicusquarter

急性腹膜炎征象

压痛反跳痛位于上腹部和脐周Hepaticdullnessregiondecreaseordisappear

肝浊音区缩小消失

shiftingdullnessinabdomen

腹部移动性浊音第四十七页，共五十二页。编辑课件PhysicalExamina