腹部常見病變的癥狀與體征課件

1、The Abdominal Examination 董國芳 腹部常見病變的癥狀與體征 胃、十二指腸潰瘍 急性腹膜炎 肝硬化 急性闌尾炎 急性腸梗阻 腹部包塊胃、十二指腸潰瘍 癥狀 特點:節(jié)律性 周期性 季節(jié)性 慢性復(fù)發(fā)性 體征 并發(fā)癥急性腹膜炎范圍：彌漫性、局限性來源：繼發(fā)性、原發(fā)性性質(zhì)：無菌性、感染性腹膜炎三聯(lián)征壓痛反跳痛腹肌緊張門靜脈高壓的表現(xiàn)腹水側(cè)支循環(huán)的建立與開放 脾腫大 食管和胃底靜脈曲張 腹壁靜脈曲張 痔靜脈曲張AppendicitisPain usually starts periumbilically(臍周）and migrates to the RLQCoughing usu

2、ally exacerbates（加?。?pain. Time course is less than 36 hours. Any pain in RLQ is suspicious for appendicitis.急性闌尾炎麥?zhǔn)宵c壓痛與反跳痛Rovsing sign陽性Psoas sign腰大肌征陽性直腸右前壁觸痛或觸及腫塊嚴(yán)重者可及局部腹肌緊張AppendicitisMay see early voluntary guarding and then involuntary guarding Needed to also perform a rectal exam and gynecolo

3、gic exam to rule out other causesAcute CholecystitisInflammation of the gallbladder due to gallstones with associated inflammation. Patients usually have fever, RUQ tenderness and a + Murphys sign. Murphys sign: inspiratory arrest during deep palpation of the RUQ腸梗阻原因機(jī)械性動力性血管性腸梗阻臨床表現(xiàn)：痛、吐、脹、閉體征：腹部膨脹

4、腸型和蠕動波 壓痛和反跳痛 腸鳴音改變腹 部 包 塊 病因： 炎癥性腫瘤性梗阻性先天性寄生蟲性其他1.炎癥性肝炎膽囊積液闌尾膿腫回盲部結(jié)核盆腔結(jié)核腎結(jié)核2.腫瘤性肝癌膽囊癌胃癌結(jié)腸癌卵巢癌子宮肌瘤腎癌卵巢囊腫白血病浸潤脾臟3.梗阻性幽門梗阻肝淤血腸套疊尿潴留腎盂積水4.先天性多囊腎肝囊腫5.寄生蟲性肝包蟲病腸蟲癥血吸蟲病致脾腫大腹塊體檢的注意點 位置 大小 形態(tài) 質(zhì)地 壓痛 搏動 活動度正常腹部可能觸及的“包塊”腹直肌肌腹與腱劃錐體與骶骨岬乙結(jié)腸與糞塊橫結(jié)腸盲腸劍突 腹部各區(qū)常見包塊 上腹部左上腹部右上腹部腹部各區(qū)常見包塊 臍部包塊 左下腹 右下腹 下腹部Final tipsALWAYS do

5、 a rectal exam as part of the abdominal exam when possible. ALWAYS consider gynecologic or obstetric（婦產(chǎn)科） causes of abdominal pain in women (and check for pregnancy status). ALWAYS examine the groin and upper thigh to rule out inguinal and femoral hernias （腹股溝疝）as a source of pain.小 結(jié)分區(qū)檢查者和被檢查者 站位,愛傷觀念 體位,暴露范圍順序(聽診)可及與不可及可信與不可信輕重緩急 Please note the following:A normal kidney is not palpableA normal liver edge may be palpableA palpable spleen is considered enla