10.1消化系统临诊PPT.ppt

;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。 ;血管杂音 Vascular murmur;摩擦音 friction sound;搔刮试验scratch test;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 the lower part of the belly. But not very easy, so usually it is determined by palpation. ;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 ;Enlarged liver dullness: liver cancer, liver abscess, hepatitis, liver congestion, and poly-cysts of liver; Smaller liver dullness: acute liver necrosis, liver cirrhosis, etc. Disappeared liver dullness: tympanic sound, perforation Shift upward: pulmonary fibrosis, pulmonary atelectasis, pneumoperitoneum, etc. Shift downward: pulmonary emphysema, right pneumothorax, Percussion pain over the liver region: hepatitis and liver abscess; Percussion pain over gall bladder region: cholecystitis