【文章內(nèi)容簡(jiǎn)介】 tween ovarian cyst and ascites 卵巢囊腫和腹水(f249。shuǐ)濁音區(qū)的不同,tympany,tympany,dullness,dullness,第二十三頁，共五十二頁。,24,Percussion Pain in Liver Area 肝區(qū)叩擊(k242。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。ngd249。)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。,25,Percussion Pain in Gallbladder Area 膽囊(dǎnn225。ng)區(qū)叩擊痛,Technique: knock the surface of gallbladder area with middle force. 方法: 叩擊膽囊部位(b249。w232。i)表面 Normal: no knock pain 正常: 膽囊無叩擊痛 Positive: cholecystitis 陽性: 提示膽囊炎,第二十五頁，共五十二頁。,26,Percussion Pain in Kidney Area 腎區(qū)叩擊(k242。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。ngd249。)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。,27,Costovertebral Angle Tenderness 腎區(qū)叩擊(k242。u jī)痛陽性,Nephritis 腎炎(sh232。n y225。n) Pyelonephritis 腎盂腎炎 Renal tuberculosis 腎結(jié)核 Calculus 腎結(jié)石 Perinephritis 腎周圍炎,第二十七頁，共五十二頁。,28,Auscultation of Abdomen 腹部(f249。 b249。)聽診,bowel sounds 腸鳴音 vascular sounds 血管(xu232。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。,29,Bowel Sounds 腸鳴音,Principle: peristaltic activity emits various gurgling and bubbling sounds as air and fluid interfaces change with contraction waves. borborygmus: loud prolonged gurgles. 定義: 腸蠕動(dòng)腸管氣液體流動(dòng)產(chǎn)生咕嚕或冒泡音 Normal: 4~5/min 正常: 每分鐘 4~5 次 Abnormal: increased, decreased and absence. 異常(y236。ch225。ng): 活躍和亢進(jìn) 減弱和消失,第二十九頁，共五十二頁。,30,Bowel Sounds Increased 腸鳴音活躍(hu243。yu232。)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(dòng)增強(qiáng)) 急性腸炎 胃腸道大出血 服瀉藥(xi232。y224。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。,31,Bowel Sounds Decreased 腸鳴音減弱(jiǎnru242。)和消失,Decreased: postlaparotomy, electrolyte imbalance, senile constipation 減弱: 1次/3~5分 (腸蠕動(dòng)減弱) 腹膜炎 低血鉀 老年性便秘(bi224。n m236。) Absence: acute peritonitis, paralytic ileus one must listen for at least a full 3 minutes before pronouncing that peristalsis has ceased 消失: 4分鐘以上聽不到(腸蠕動(dòng)消失) 急性腹膜炎 麻痹性腸梗阻,第三十一頁，共五十二頁。,32,Vascular Sounds 血管(xu232。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) Artery murmur: eject or draught in systolic with high pitch and strong sound. 動(dòng)脈雜音: 收縮期噴射性或吹風(fēng)樣 音調(diào)高音響強(qiáng) Venous murmur: continuous murmur with low pitch and ebb sound. 靜脈雜音: 連續(xù)性嗡鳴 音調(diào)低 音響弱,第三十二頁，共五十二頁。,33,Common Cause 血管(xu232。guǎn)雜音常見病因,Artery 動(dòng)脈性 Epigastrium: abdominal aorta stricture or aneurism 上腹部: 腹主動(dòng)脈狹窄或腹主動(dòng)脈瘤 Umbilical or in the flanks: renal artery stricture 臍周或側(cè)腹部: 腎動(dòng)脈狹窄 Right hypochondrium: hepatic artery stricture usually compressed by pancreas or left liver cancer. 右季肋部: 肝動(dòng)脈狹窄 常見于胰腺癌 肝左葉癌 Venous 靜脈性 Recanalized umbilical vein: portal hypertension accompanied varicosity in abdominal wall 臍周: 門靜脈高壓(gāoyā)腹壁靜脈曲張,第三十三頁，共五十二頁。,34,Friction Rub 摩擦音,Principle: irritated fibrinladen peritoneal surfaces grate with motion 機(jī)制: 腹膜表面(biǎomi224。n)炎性滲出運(yùn)動(dòng)摩擦 Meaning: seen in localized peritonitis 提示: 局限性腹膜炎 Technique: heard at corre