【正文】 ch is dull to percussion. 膀胱濁音區(qū): 判斷膀胱膨脹程度(ch233。yīn),Dullness area in both side of abdomen with dorsal position 平臥位時濁音區(qū)位于腹部的兩側(cè) Dullness area moves to inferior when moved position 變換(bi224。i)腫瘤腹腔轉(zhuǎn)移,第二十一頁，共五十二頁。)力量向左手背叩擊 Normal: no pains feeling in liver area. 正常: 肝區(qū)無叩擊痛 Abnormal: the knock pain in liver area indicates hepatitis and liver abscess 叩擊痛陽性: 見于肝炎 肝膿腫,第二十四頁，共五十二頁。)力量 向左手背扣擊 Normal: no knock pain 正常: 腎區(qū)無扣擊痛,第二十六頁，共五十二頁。guǎn)雜音 friction rub 摩擦音 scratch sound 搔彈音 splashing sound 振水音,第二十八頁，共五十二頁。o) 饑餓 Highpitched tinkling:intestinal fluid and air under pressure, as in early obstruction 亢進(jìn): 10次/分(響亮高亢甚至金屬音) 機(jī)械性腸梗阻,第三十頁，共五十二頁。,33,Common Cause 血管(xu232。 b249。,40,Right Heart Failure 右心功能不全,Tender enlarged liver 肝臟增大壓痛 Right diaphragm not necessarily elevated 右膈不一定抬高 Distended cervical vein and hepatojuglar reflux positive 頸靜脈怒張 肝頸靜脈回流征陽性(y225。b236。nhu225。 232。,50,Intestinal Obstruction 腸梗阻,Symptom: abdominal pain, vomiting, no defecate and anus exhaust 癥狀: 腹痛 嘔吐 無排便和肛門排氣 Inspection: full distension, intestine form and peristaltic wave 視診: 腹部膨隆 腸型 可見腸蠕動波 Palpation: rigid abdominal wall, tenderness and rebound pain 觸診: 腹肌緊張 壓痛及反跳痛 Percussion: tympany region increased 叩診: 鼓音范圍增大(zēnɡ d224。ng)總結(jié),physical examination 腹部檢查 (2) Abdominal Examination。51,第五十二頁，共五十二頁。,內(nèi)容(n232。x236。nɡ)3000ml) Percussion: shifting dullness (ascites large than 1000 ml), puddle sign (small amounts of fluid) 叩診: 移動性濁音 (腹水量1000ml) 水坑征 (少量腹水) Auscultation: umbilicus scratch sound in elbowknee posture (ascites 120ml) 聽診: 臍部搔彈音 (腹水量120ml),第四十六頁，共五十二頁。i ch225。nr249。,39,Primary hepatic carcinoma and metastases 原發(fā)性肝癌(ɡān 225。,36,Splashing Sound 振水音,Mechanism: caused by increased air and fluid in the stomach, splash sound produce when air and fluid succussed. 機(jī)制: 胃內(nèi)氣體和液體增加 氣體與液體受沖擊振動產(chǎn)生聲音(shēngyīn) Technique: heard splash sound from stethoscope in epigastric and when the hand moving stomach 方法: 聽診器置于上腹部 用手推動上腹部可聽到振水聲 Meaning: when limosis appeared clew pyloric obstruction, gastric dilatation or large hiatus hernia 意義: 空腹時出現(xiàn)提示幽門梗阻 胃擴(kuò)張 食管裂孔疝,succussion test,第三十六頁，共五十二頁。guǎn)雜音,Principle: Turbulent flow in a dilated, constricted, or tortuous vessel. 機(jī)制: 血管擴(kuò)張或狹窄產(chǎn)生湍流(tuānli)和亢進(jìn),Increased: 10/min: hypermotile states such as acute gastroenteritis, blood in the small bowel 活躍: 10次/分(腸蠕動增強(qiáng)) 急性腸炎 胃腸道大出血 服瀉藥(xi232。 b249。u jī)痛,Technique: sit or side lie, 方法: 坐位或側(cè)臥位 put left palm in costovertebral angle area, right hand with boxing knock the left back of hand with middle force. 用左手掌平放肋脊角及鄰近區(qū)域 右手握空拳以中等強(qiáng)度(qi225。u jī)痛,Technique: put left palm in liver area, right hand with boxing knock the left back of hand with middle force. 方法: 將左手掌平放于肝區(qū) 右手握拳用中等強(qiáng)度(qi225。shuǐ)的常見病因,Hepatocirrhosis 肝硬化 Tuberculous peritonitis 結(jié)核性腹膜炎 Cardiac dysfunction 心功能不全 Nephropathy syndrome 腎病綜合征 Primary or metastasis tumor in abdominal cavity 腹腔內(nèi)腫瘤或其他部位(b249。)最高位置 volume of ascites usually exceeds 1000ml if detectable 腹水量在1000ml以上 Puddle sign: 水坑征 free fluid in the most inferior position in elbowknee posture 肘膝位腹水位于最低位 a way to detect small amounts of fluid 用于發(fā)現(xiàn)少量腹水,第十八頁，共五十二頁。 mǐ) 前界不超過腋前線 Abnormal findings 叩診異常 Enlarged: splenomegaly 范圍增大: 脾腫大 Diminished: too much gas in surrounding organs 范圍縮小: 胃擴(kuò)張或腸脹氣,第十六頁，共五十二頁。i),Superior border: 1~2 intercostal spaces higher than inferior lung border 肝上界: 肺下界的上1~2肋間 Inferior bord