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1、消化系统诊断学部分的PPT整理: 使用说明：1、略去了 PPT中的图片，但是文字部分全部保留。顺序同PPT。2、橙色与红色标注的文字基本与PPT上一致，具体到个别字句会冇出入。3、中文系本人参照大绿书手工翻译，个别地方在内容上稍作了补充，仅供参考。Abdominal Examination:1. Sequenee： inspection, auscultation, percussion, and palpation望、听、叩、触原因：(1) convenient to perform the auscultation after the auscultation of the heart.便
2、于在心脏听诊后进行腹部听诊(2) avoid the negative impacts of palpations on auscultation of bowel sounds ( alteration of peristalsis)避免触诊对听肠鸣音的影响(改变了肠蠕动)2 Anatomic Landmarks：解剖标志(1) xiphoid (ensiform) process(剑状突起)of sternum(胸骨)(2) costal margin 肋弓缘(3 ) umbilicus 脐(4) anterior superior iliac spine 酩B了上棘(5) inguina
3、l ligament 腹股沟韧带(6) superior margin of os pubis lib肾一上缘(7) anterior midline/midabdominal line 腹中线(8) lateral border of rectus muscles 腹直肌外缘(9) symphysis pubis (耻骨联合)3、Zones of abdomen： 4 quadrants,9sectionsThe anterior surface of the abdomen is divided into four quadrants by two intersecting lines前腹
4、面经两条相交线分为四个区(1) one extendi ng vertically from the xiphoid, through the umbilicus, to the symphysis pubis 一条由剑突垂直向下经过脐，到达耻骨联合(2) the other extending horizontally across the abdomen at the level of the umbilicus.另一条在脐处水平横贯腹部所以分为了 4个区：Right upper quadrant 右上腹部Left upper quadrant 左上腹部Right lower quadra
5、nt 右下腹部Left lower quadrant 左卜腹部Two imaginary, parallel, horizontal lines 两条互相平行的假想水平线(1) across the lowest border of the costal margin 经过两侧肋弓下缘的连线(2) across the anterior superior iliac spine 经过两侧骼前上棘的连线Two imaginary, parallel, vertical lines两条互相平行的假想垂直线(1) across the middle point of linking line for
6、med by left anterior superior iliac and midabdominal line经过左骼前上棘至腹中线连线的中点(.2) across the middle point of linking line formed by right anterior superior iliac and midabdominal line经过右骼前上楝至腹小线连线的中点所以分为了 9 sections：Right hypochondrial region 右季肋部Left hypochondrial region 左季肋部Right lumber region 右腰部Left
7、 lumber region 左腰部Right iliac region 右骼部Left iliac region 左骼部Epigastric region 上腹部Umbilical region 脐部Hypogastric region 下腹部4. Questi on : What are the disti net ben efits and disadva ntages in Fourquadra nt and Nin e-sectio n methods?四区法和九区法的明显优缺点？Four-quadra nt:(1) simple, practical 简单实用rough, impr
8、ecise粗糙不精确(tenderness of epigastric region)(上腹部压痛)Nine-sectio n(1) elaborates more clearly and more exactly 更清晰精确inconvenient不方便(3) limited scope of left or right hypochondrial region, left or right iliac region左、右季肋部，左、右酩部范围局限5. Inspection: General preparation 望诊的一般准备(1) urinate completely: bladder
9、 is empty 膀胱排空(2) relax abdomi nal muscles: lie o n back with a pillow un der head a nd kn ees bent 放松腹部 肌肉：低枕仰卧位，双腿屈曲(3) expose abdomen completely: from xiphoid process to pubis 充分暴露腹部： 上至剑突， 下至耻骨联合(4) breasts should be covered: female 遮盖乳房:女性6. Inspection: major contents 望诊的主要内容 abdominal contour
10、腹部外形4 respiratory movements 呼吸运动 abdominal veins 腹壁静脉亠 gastral or intestinal pattern(胃型或肠型) peristalsis(端动波) abdominal rash (皮疹),hernia(疝),striae(纹),etc.7. Inspection: Abdominal Contour 视诊M whether the abdomen is symmetrical 腹部是否対称 whether it is bulged or retracted 是否膨隆或凹陷 whether it is indicative o
11、f ascites or enclosed mass(包块)是否提示有腹水或包块 Normal:(1) abdominal flatness(腹部平坦):V abdomen at the same level or lower as between costal margin and symphysis pubis前腹面处于肋弓缘与耻骨联合平面，或略微凹陷V ask the patient to sit, the lower part of umbilicus can become more or less protruded or bulged要求病人处位，脐以下部位可稍膨出(2) abdo
12、minal fullness(腹部饱满):V very fat or a child, the abdomen is a little bit round 肥胖者或小儿(尤其餐后)腹部外形 饱满或膨隆V The level of the abdomen higher than that of the surface between costal margin and symphysis pubis前腹面超过肋弓缘至耻骨联合平面(3) abdominal lowness(腹部低平):V very thin or slender, the level of the abdomen lower th
13、an that of the surface between costal margin and symphysis pubis (- little subcutaneous fat)消瘦者前腹血低于肋弓缘至耻骨联合平血(山皮下脂肪少导致) abdominal flatness, fullness, and lowness (normal cases)V abdomen obviously protruded or bulged, or exceed!ngly retracted or depressed (abnormal and usually pathologic)腹部明显膨隆或过分凹陷
14、(异常,通常为病理)8. Pathologic conditions 病理情况：abdominal protuberance (bulge)腹部膨隆I. Overall/generalized abdominal protuberance/bulge 全腹膨隆V abdominal wall can be lax in supine position 仰卧位时腹壁松弛- fluid can deposit at both lateral sides (the contour just like a frog belly)液体下沉于腹腔两侧(外形如蛙腹)V lies on one side or sits 狈1J卧或坐位一 the lower part of abdominal wall will be bulged ( in Iong-term ascites, the appearanee of the umbilicus is protruded or everted (umbilical hernia)在长期腹水中，脐外形凸出或外翻(脐疝)V (obesity) the umbilicus is usually deeply inverted (肥胖)脐通常下凹Apical belly 尖腹-pe
