10.1消化系统临诊.ppt

消化诊断学 血管杂音 Vascular murmur 中腹部的收缩期血管杂音 腹主动脉瘤,可触及搏动的包块还可听到收缩期杂音 腹主动脉狭窄时, 在腹部也可听到收缩期血管杂音，搏动减弱,下肢血压低于上肢,严重者触不到足背动脉搏动 左右上腹部收缩期血管杂音 肾动脉的狭窄 下腹两侧收缩期杂音 髂动脉狭窄 左叶肝癌压迫肝动脉或腹主动脉--在包块部位吹风样血管杂音. 在脐的附近，或在胸骨剑突下部--连续的静脉嗡鸣声，无收缩期和舒张期杂音的节奏，压迫脾脏此音可加强，见于肝硬化伴有门静脉高压病人 摩擦音 friction sound 脾梗塞、脾周围炎、肝周围炎、胆囊炎累及局部腹膜时，与深呼吸时在各相应部位可听到摩擦音，触诊可有摩擦感。 搔刮试验scratch test 用于肝下缘触诊不清楚时，以协助定界。 用于腹壁较厚或不能满意地配合触诊患者。也用于鉴别右上腹肿物是否为肿大的肝脏。 肝上界： 右锁中线：第5肋间 右腋中线：第7肋间 右肩胛线：第10肋间 肝下界 右季肋下缘 右腋中线上第10肋骨 六、膀胱叩诊Percussion of bladder 在耻骨联合上方进行，从上向下，由鼓音转为浊音 腹水时耻骨上叩诊也可有浊音区，但浊音区的弧形上缘凹向脐部，而胀大膀胱浊音区的弧形上缘凸向脐部 七、肾脏叩诊 Percussion of kidney 脊肋角叩痛：主要用于肾脏病变 肾区叩击痛：肾炎、肾盂肾炎、肾结石、肾结核及肾周围炎时， * * Diagnostics of Digestive System Diseases 消化内科 Gastroenterology Department 腹 部 听 诊 Abdominal Auscultation 1. Intestinal sound Gurgling sound produced by bowel movement with fluid and gas passing by; 4-5 times per min. normally and features judged by experiences; Active intestinal sound Over 10 times per min.: acute gastroenteritis, GI bleeding, etc. 肠鸣音亢进 (hyperactive intestinal sound) 如次数多且肠鸣音响亮、高亢甚至呈叮当声或金属音，称肠鸣音亢进，见于机械性肠梗阻。 肠鸣音减弱 (hypoactive intestinal sound) 肠鸣音明显少于正常，或许数分钟才听到一次，称肠鸣音减弱，见于老年性便秘、腹膜炎、电解质紊乱（低血钾）及胃肠动力低下等。 肠鸣音消失 (vanished intestinal sound) 持续听诊3～5分钟未听到肠鸣音称为肠鸣音消失，见于急性腹膜炎或麻痹性肠梗阻。 腹 部 叩诊 Abdominal percussion  一、腹部叩诊音Percussion sound Normally: tympanic sound， Dullness: places where solid organs are located. Greatly enlarged liver, spleen, tumors, ascites, area of tympanic sound becomes smaller. Dullness develops. Gastrointestinal gas distension or perforation: Area of tympanic sound becomes bigger. It appears in the place where it should not normally. 二. Percussion of liver Upper limit of liver: Along mid-clavicular line, mid axillary line and right scapular line; Resonance shifts to dullness: upper limit of liver (relative dullness of liver)-肝相对浊音界 1-2 ribs downwards: dullness shifts to solidness: absolute dullness of liver (lower limit of lung) Lower limit of liver: Percussion is done from t