【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(yè)，共五十二頁(yè)。,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(wú)叩擊痛 Abnormal: the knock pain in liver area indicates hepatitis and liver abscess 叩擊痛陽(yáng)性: 見(jiàn)于肝炎 肝膿腫,第二十四頁(yè)，共五十二頁(yè)。,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(wú)叩擊痛 Positive: cholecystitis 陽(yáng)性: 提示膽囊炎,第二十五頁(yè)，共五十二頁(yè)。,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(wú)扣擊痛,第二十六頁(yè)，共五十二頁(yè)。,27,Costovertebral Angle Tenderness 腎區(qū)叩擊(k242。u jī)痛陽(yáng)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?chē)?第二十七頁(yè)，共五十二頁(yè)。,28,Auscultation of Abdomen 腹部(f249。 b249。)聽(tīng)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(yè)，共五十二頁(yè)。,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?；蛎芭菀?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(yè)，共五十二頁(yè)。,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(yè)，共五十二頁(yè)。,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(tīng)不到(腸蠕動(dòng)消失) 急性腹膜炎 麻痹性腸梗阻,第三十一頁(yè)，共五十二頁(yè)。,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(yè)，共五十二頁(yè)。,33,Common Cause 血管(xu232。guǎn)雜音常見(jiàn)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(jiàn)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(mén)靜脈高壓(gāoyā)腹壁靜脈曲張,第三十三頁(yè)，共五十二頁(yè)。,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