【正文】 功能受損 ? skin: gloom face, pigmentation, petechia, jaundice ? 皮膚 : 面色灰暗 色素沉著 出血點淤斑 黃疸 ? blood vessel: capillary dilatation, spider angioma ? 血管 : 面頸上胸部毛細血管擴張 蜘蛛痣 肝掌 ? breast: gyneastia in the male 乳房 : 男性乳房發(fā)育 ? Portal hypertension induced side branch circulation: splenomegaly, varicosity of abdomen, ascites sign ? 門脈高壓側(cè)枝循環(huán)形成 : 脾臟腫大 腹壁靜脈曲張 腹水征 44 第四十四頁，共五十二頁。 Signs of Hepatic Cirrhosis 肝硬化征象 Mental state Jaundice Fetor Hepatomegaly and gallbladder Flapping tremor (asterixis) Asscites Gastrointestinal haemorrhage Bruising Oedema Spider naevi Gynaeastia Splenomegaly Needle marks Umbilical hernia Superficial abdominal veins Palmar erythema Dupuytren’ s contracture Finger clubbing and leukonychia Testicular atrophy sparse body hair Haemorrhoids 45 第四十五頁，共五十二頁。 Ascites Sign 腹水征 ? Inspection: frog shape of abdomen in dorsal position, hypogastrium region distension with hilum hernia in stand. 視診 : 仰臥位蛙狀腹 直立位下腹膨隆臍突出 ? Palpation: fluid thrill (ascites large than 3000 ml) 觸診 : 液波震顫 (腹水量 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) 46 第四十六頁，共五十二頁。 Acute Perforated Gastric or Duodenal Ulcer 急性胃十二指腸穿孔 ? Suddenly epigastric pain, forced supine position and twin lower limbs flection 突發(fā)上腹痛 強迫仰臥位 雙下肢屈曲 ? Acute peritonitis signs, tenderness and rebound pain in epigastrium or round umbilicus quarter 急性腹膜炎征象 壓痛反跳痛位于上腹部和臍周 ? Hepatic dullness region decrease or disappear 肝濁音區(qū)縮小消失 ? shifting dullness in abdomen 腹部移動性濁音 47 第四十七頁，共五十二頁。 Physical Examination Point 急性胃腸穿孔檢體要點 ? Gas in abdominal cavity: dullness area of liver disappear ? 腹腔氣體 : 肝濁音區(qū)縮小消失 ? Liquid in abdomen: shifting dullness ? 腹腔液體 : 腹部移動性濁音 ? Inflammation in abdomen: acute peritonitis sign, serious in epigastric and umbilical region. ? 腹部炎癥反響 : 急性彌漫性腹膜炎征象 ? 壓痛反跳痛位于上腹部和臍周 ? forepart: acute ache face, pulsive supine position, lower limbs flection ? 早期 : 急性痛苦面容 冷汗 強迫仰臥位 雙下肢屈曲 ? anaphase: high fever, pulse frequency ? 后期 : 高熱 失水 精神萎靡 面色灰白 眼球凹陷 脈搏頻數(shù) 48 第四十八頁，共五十二頁。 Acute Peritonitis Signs 急性腹膜炎征象 ? Inspection: general depression in abdomen, decreased or disappeared abdominal respiration 視診 : 腹部凹陷 腹部呼吸運動減弱消失 ? Palpation: tenderness, rebound tenderness, rigid abdominal wall 觸診 : 壓痛和反跳痛 腹壁呈板狀硬 ? Percussion: shifting dullness 叩診 : 可有移動性濁音 ? Auscultation: decreased or absence of bowel sounds 聽診 : 腸鳴音減弱消失 49 第四十九頁，共五十二頁。 Intestinal Obstruction 腸梗阻 ? Symptom: abdominal pain, vomiting, no defecate and anus exhaust ? 病癥 : 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 ? Auscultation: mechanical ileus acpanied sharp bowel sound and decreased or absence of bowel sounds in paralysis ileus ? 聽診 : 機械性腸梗阻腸鳴音亢進 ? 麻痹性腸梗阻腸鳴音減弱或消失 50 第五十頁，共五十二頁。 next presentation 預(yù)告下次內(nèi)容 ? rectal and male genitals examination 肛門和男性生殖器檢查 ? spine and extremity examination 脊柱四肢檢查 51 第五十一頁，共五十二頁。 內(nèi)容總結(jié) physical examination 腹部檢查 (2) Abdominal Examination。叩診音 : 間接叩診。子宮濁音區(qū) : 判斷子宮增大程度。腹腔內(nèi)腫瘤或其他部位腫瘤腹腔轉(zhuǎn)移。消失 : 4分鐘以上聽不到 (腸蠕動消失 )。肝相對濁音區(qū)濁音減弱。 51 第五十二頁，共五十二頁。