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1、.,1,physical examination腹部检查 (1)Abdominal Examination,landmarks and regions 体表标志和分区 inspection 视诊 palpation 触诊,.,2,Landmarks and Regions体表标志与分区,abdominal landmarks 腹部体表标志 abdominal regions 腹部分区,.,3,Surface Landmarks on Interior体表标志 (前面),xiphoid process of sternum 剑突,anterosuperior iliac spine 髂前上棘,s
2、uperior margin of os pubis 耻骨联合,costal margin 肋弓下缘,midline 腹中线,umbilicus 脐,pubic ligament 腹股沟韧带,.,4,Surface Landmarks on Posterior 体表标志 (后面),Costovertebral angle 肋脊角 Vertebrocostal point 肋脊点 Costolumbar point 肋腰点 Spinous process 脊柱棘突,.,5,The Four Abdominal Quadrants腹部四分区,two imaginary perpendicular
3、lines 二条水平和垂直交叉线 four quadrants: 分四区 right upper 右上腹部 left upper 左上腹部 right lower 右下腹部 left lower 左下腹部,.,6,The Nine Abdominal Areas腹部九分区,Epigastric 上腹部 Umbilical region 脐部 Supra-pubic region 下腹部 Right hypochondrium 右上腹部 Left hypochondrium 左上腹部 Right flank region 右腰部 Left flank region 左腰部 Right ingui
4、nal 右下腹部 Left inguinal 左下腹部,.,7,Inspection of Abdomen腹部视诊,abdominal contour and movement 腹部外形和运动 abdominal wall inspection 腹壁视诊,.,8,Notice Proceeding注意事项,Patient in dorsal position 取仰卧位 Exposure whole abdomen 暴露全腹 Doctor stand in right side 立于右侧 Observe from above to below 自上而下观察,.,9,Abdominal Conto
5、ur腹部外形,Normal: flat to rounded Abnormal: abdominal distention abdominal depression,正常: 平坦 低平或饱满 异常: 腹部膨隆 腹部凹陷,Flat 平坦,Scaphoid 舟状,Rounded 饱满,Protuberant 膨隆,.,10,Distension腹部膨隆,Abdominal wall disorders 腹壁改变 Tumor: appeared clearly in force 肿物: 腹部用力时肿物明显 Incrassation: hilum depressed such as obesity 增
6、厚: 脐部凹陷 如肥胖 Abdominal cavity increase 腹腔增大 Full distension: normal pregnancy and abnormal 全腹膨隆: 正常妊娠和异常 Local distension 局部膨隆 Measure surround of abdomen 测量腹围 Around the abdomen through hilum by soft ruler 仰卧位用软尺绕脐一周,.,11,Common Causes of Distension常见膨隆原因,Fat 肥胖 Fluid 腹水 Feces 粪块 Fetus 妊娠 Flatus 胃肠胀
7、气 Fibroids 子宫平滑肌瘤 Fatal tumor 恶性肿瘤 .Remember:5F,Protruded umbilicus,ascites,ovarian cyst,.,12,Contour: Protuberant Abdomen全腹膨隆,Ascites: frog shape of abdomen, accompanied hilum hernia. 腹水: 蛙状腹 常伴脐疝 causes: hepatocirrhosis, serious heart failure, pericarditis, renal disease syndrome, peirtoneum cance
8、r. 病因: 肝硬化 严重心衰 缩窄性心包炎 肾病综合征 腹膜癌 Gases distention of the intestines: sphericity of abdomen 肠胀气: 球形腹 causes: ileus, intestinal paralysis. 病因: 肠梗阻 肠麻痹 Organomegaly: enormous ovary cyst and teratoma. 肿瘤: 巨大卵巢囊肿 畸胎瘤,.,13,Local Distension局部膨隆,Weakness of abdominal wall: hernia 腹壁薄弱: 疝 types: exomphalocel
9、e, femoral or inguinal hernia 类型: 脐疝 股疝 腹股沟疝 Ventro-cavity occupation: organ disorders 腹腔占位: 脏器病变 diseases: organomegaly, tumor, inflammation mass, gastrointestinal pneumotamatosis ect. 疾病: 脏器肿大 肿瘤 炎性包块 胃肠胀气等,.,14,Local Distension and Disorders 局部膨隆与疾病 (1),Right hypochondrium: hepatomegaly, cholecys
10、t fluid accumulation, colon tumor under liver 右上腹部: 肝肿大 胆囊积液 结肠肝曲肿瘤 Epigastric: left lobe of liver enlarged, gastric cancer, gastric dilation; inflammation, tumor and cyst of pancreas 上腹部: 肝左叶肿大 胃癌 胃扩张 胰腺炎症 肿瘤 囊肿 Left hypochondrium: spleen intumesce, gigantic colon, colon tumor under spleen 左上腹部: 脾肿
11、大 巨结肠 结肠脾曲肿瘤 Side flank region: kidney intumesce, hydronephrosis, vastness adrenal gland tumor 侧腹部: 肾肿大 肾盂积水 巨大肾上腺肿瘤,.,15,Local Distension and Disorders局部膨隆与疾病 (2),Umbilical region: hilum hernia, inflammation mass 脐部: 脐疝 炎性包块 Right inguinal: ileo-colic tuberculosis and tumor, crohn disease, appendix
12、 abscess 右下腹部: 回盲部结核 肿瘤 克隆病 阑尾脓肿 Left inguinal: descending or sigmoid colon tumor or feces 左下腹部: 降结肠或乙状结肠肿瘤 粪块 Supra-pubic region: pregnancy, myoma of uterus, bladder enlarged, ovary tumor 下腹部: 妊娠 子宫肌瘤 膀胱胀大 卵巢肿瘤,.,16,Contour: Depression Abdomen腹部凹陷,Regional depression: surgical scar 局部凹陷: 腹部手术瘢痕收缩 G
13、eneral: scaphoid abdomen 全腹凹陷: 舟状腹 Cachexia: late duration of chronic deplete disease, malignant tumor, nervous anorexia 恶病质: 慢性消耗性疾病晚期 恶性肿瘤 神经性厌食 Early acute diffuse peritonitis: abdominal muscle spasmodic contraction 早期急性弥漫性腹膜炎: 腹肌痉挛性收缩,.,17,Normal Respiratory Movement正常呼吸运动,Male and Children: Abd
14、ominal respiratory movement 男性及小儿: 以腹式呼吸为主 Female: Chest respiratory movement 女性: 以胸式呼吸为主,.,18,Abnormal Respiratory Movements异常呼吸运动,Decreased: inflammational pain, volume expansion 呼吸减弱: 炎性疼痛 腹腔容积增加 disorders: acute peritonitis, enteroparalysis, ascites, mass 疾病: 急性腹膜炎 肠麻痹 腹水 肿物 Increased: chest and
15、 lung diseases 呼吸增强: 胸肺疾病 disorders: rib fracture, Pleural effusion 疾病: 肋骨骨折 胸腔积液,.,19,GI Form & Peristaltic Wave胃肠型和蠕动波,Mechanism: weakness of abdominal wall or dilatation of stomach and intestine 机制: 腹壁薄弱或胃肠扩张 Gastric and intestinal form: stomach and intestine shapes appears in abdominal wall 胃肠型:
16、 胃肠在腹壁上显出轮廓 Peristaltic wave: gastric and intestinal waves appears in abdominal wall 蠕动波: 腹壁可见起伏胃肠波型,.,20,Gastric Form & Peristaltic Wave胃型和蠕动波,Gastric form in epigastric region 上腹壁显出胃饱满隆起轮廓 Gastric Peristaltic wave in epigastric region 上腹壁可见胃蠕动增强起伏的蠕动波型 Positive wave: wave moved from left to right 正蠕动波: 自左肋缘下向右推进的蠕动波 Athwart wave: from right to left by vomiting 逆蠕动波: 自右向左的蠕动波见于剧烈呕吐时 Cause: pyloric obstru
