【正文】 用手推動(dòng)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(shí)出現(xiàn)提示幽門梗阻 胃擴(kuò)張 食管裂孔疝 succussion test 36 第三十六頁(yè)，共五十二頁(yè)。 Friction Rub 摩擦音 ? Principle: irritated fibrinladen peritoneal surfaces grate with motion ? 機(jī)制 : 腹膜外表炎性滲出運(yùn)動(dòng)摩擦 ? Meaning: seen in localized peritonitis ? 提示 : 局限性腹膜炎 ? Technique: heard at correspond area in deep respiratory ? 方法 : 深呼吸時(shí)在相應(yīng)部位聽到 ? Clinical cause: spleen infarction, spleen and liver circumference inflammation, cholecystitis ? 病因 : 脾堵塞 脾周圍炎 肝周圍炎 膽囊炎 34 第三十四頁(yè)，共五十二頁(yè)。 Bowel Sounds Decreased 腸鳴音減弱和消失 ? 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 ? 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 31 第三十一頁(yè)，共五十二頁(yè)。 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 : 活潑和亢進(jìn) 減弱和消失 29 第二十九頁(yè)，共五十二頁(yè)。 Costovertebral Angle Tenderness 腎區(qū)叩擊痛陽(yáng)性 ? Nephritis 腎炎 ? Pyelonephritis 腎盂腎炎 ? Renal tuberculosis 腎結(jié)核 ? Calculus 腎結(jié)石 ? Perinephritis 腎周圍炎 27 第二十七頁(yè)，共五十二頁(yè)。 Percussion Pain in Gallbladder Area 膽囊區(qū)叩擊痛 ? Technique: knock the surface of gallbladder area with middle force. ? 方法 : 叩擊膽囊部位外表 ? Normal: no knock pain ? 正常 : 膽囊無(wú)叩擊痛 ? Positive: cholecystitis ? 陽(yáng)性 : 提示膽囊炎 25 第二十五頁(yè)，共五十二頁(yè)。 Difference of dullness sites between ovarian cyst and ascites 卵巢囊腫和腹水濁音區(qū)的不同 tympany tympany dullness dullness 23 第二十三頁(yè)，共五十二頁(yè)。 Common Diseases 腹水的常見病因 ? 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)腫瘤或其他部位腫瘤腹腔轉(zhuǎn)移 21 第二十一頁(yè)，共五十二頁(yè)。 Shifting Dullness due to Ascites 移動(dòng)性濁音 ? Dullness area in both side of abdomen with dorsal position 平臥位時(shí)濁音區(qū)位于腹部的兩側(cè) ? Dullness area moves to inferior when moved position 變換體位濁音區(qū)移至下方 ? Dullness movement follows position moved 濁音部位隨體位變動(dòng)而變動(dòng) 19 第十九頁(yè)，共五十二頁(yè)。 Dullness Area of Bladder or Uterus 膀胱或子宮 濁音區(qū) ? Bladder dullness area: physical signs in retention of urine, a smooth, firm, and regular swelling arising out of the pelvis which one cannot “ get below〞 and which is dull to percussion. ? 膀胱濁音區(qū) : 判斷膀胱膨脹程度 ? 恥骨上方圓形濁音區(qū) 排尿或?qū)蚝笙? ? Uterus dullness area: estimate enlarged uterus superior margin of pubis, not disappear after micturation or urethral catheterization ? 子宮濁音區(qū) : 判斷子宮增大程度 ? 恥骨上方濁音區(qū) 排尿或?qū)蚝蟛幌? 17 第十七頁(yè)，共五十二頁(yè)。 Abnormal Findings 肝濁音界異常 ? Enlarged: hepatic congestion, hepatitis, liver abscess, liver carcinoma 增大 : 肝淤血 肝炎 肝膿腫 肝癌 ? Diminished: liver cirrhosis or necrosis 縮小 : 肝硬化 肝壞死 ? Disappeared: perforation of gastrointestinal tract, abdominal surgery 消失 : 代之以鼓音 胃腸穿孔 腹部手術(shù)后 ? Upward shifting: fibrosis or atelectasis of right lung, large volume of air or gas in the gastrointestinal tract 上移 : 右肺纖維化 右肺不張 胃腸脹氣 ? downward shifting: emphysema, right side pleural effusion, hepatoptosia 下移 : 肺氣腫 右胸腔積液 肝 下垂 15 第十五頁(yè)，共五十二頁(yè)。 Percussion of Superior and Inferior border 肝上下濁音界叩診 ? Superior border: intercostal space of 5th in right midclavicular, 7th in midaxillary and 10th in sca