物理診斷學課件 3-Physical Examination 201508

2023/5/17北京醫(yī)院孫鐵英1PhysicalExamination

基本檢查方法北京醫(yī)院呼吸與危重癥醫(yī)學科國家呼吸疾病臨床研究中心孫鐵英2023/5/17北京醫(yī)院孫鐵英2Whatisphysicalexamination?Itisafundamentalexaminingmethod,itisproceededbythesenseorganssuchaseyes,ears,noseandhandsorsimpletools–stethoscopeandplexor.2023/5/17北京醫(yī)院孫鐵英3Thebasicmethodsofphysicalexaminationinspection視診palpation觸診percussion叩診auscultation聽診olfactoryexamination嗅診2023/5/17北京醫(yī)院孫鐵英4Inspection

2023/5/17北京醫(yī)院孫鐵英5InspectionIncludesageneralviewofthepatient’s1.mentalstatus意識狀態(tài)

2.development發(fā)育3.nutrition營養(yǎng)

4.posture體位5.bodymovement姿勢6.gait步態(tài)7.facialexpression表情8.complexion面容2023/5/17北京醫(yī)院孫鐵英6無力型（瘦長型）超力型（矮胖型）正力型（勻稱型）2023/5/17北京醫(yī)院孫鐵英7pallorexophthalmusCyanosis(lips)moonfacespiderangiomabarrelchestGastrictypeAbdomenalrespiratorymovementanemiaHyperthyroidismmitralfacecushingsyndromelivercirrhosispulmonaryemphysemapylorusobstructionNormal，men，childrenInspection

2023/5/17北京醫(yī)院孫鐵英8palpation2023/5/17北京醫(yī)院孫鐵英9PalpationMainlyusedinabdominalexamination

mass:

1.location部位2.size大小

3.contour邊緣4.consistency質(zhì)地/邊界

5.mobility活動度6.tenderness壓痛

7.pulsation波動感2023/5/17北京醫(yī)院孫鐵英10Palpation2023/5/17北京醫(yī)院孫鐵英11ThemethodsofpalpationLightpalpation淺部觸診法DeepPalpation深部觸診法deepslippingpalpation深部滑行觸診bimanualpalpation雙手觸診法deeppresspalpation深壓觸診法ballottement沖擊觸診法Themethodsofpalpationlightpalpation淺部觸診法

abdominalmuscletensity

abdominaltenderness

2023/5/17北京醫(yī)院孫鐵英122023/5/17北京醫(yī)院孫鐵英13DeepPalpationDeepPalpation

deepslippingpalpation---deepmassbimanualpalpation---liver,spleen,kidney3.deeppresspalpation---tendernesspoint2023/5/17北京醫(yī)院孫鐵英14bimanualpalpationliverandspleen2023/5/17北京醫(yī)院孫鐵英15DeeppresspalpationtendernesspointCholecysticpoint:Murphy’ssignAcutecholecystitistendernesspoint2023/5/17北京醫(yī)院孫鐵英16

Cholecysticpoint:Murphy’ssignAppendixpoint:McBurneypoint

acuteappendicitisReboundtenderness：acuteperitonitisBallottement：沖擊

liverenlargement,

splenomegalywithmassiveascitesDeepPalpation2023/5/17北京醫(yī)院孫鐵英17Notice:Patientinsupineposition仰臥位Askpatientflexhisthighsandknees放松、屈膝Tellpatientrelaxhisabdomenalmuscles腹部放松Doctorstandsattherightsideofpatient站右側(cè)Warmhand,useyourpalmaraspectoffinger,examininggentlyandlightly,fromsuperficialtodeep.手腦并用2023/5/17北京醫(yī)院孫鐵英18Percussionlungs---margin界heart---sizeandshape大小、形狀liver---uppermargin上界Ascites腹水---shiftingdullness移動濁音2023/5/17北京醫(yī)院孫鐵英19PercussionmethodsTherearetwomethodsthatmaybeusedforpercussion

1

Indirectpercussion

2

Directpercussion

2023/5/17北京醫(yī)院孫鐵英20Indirectpercussion2023/5/17北京醫(yī)院孫鐵英212023/5/17北京醫(yī)院孫鐵英22DirectpercussionThismethodcanbedonebystrikingchestwiththepalmaraspectofrighthandorthetipsofallofthefingersheldfirmlytogether,mainlyusedtoexaminemassivefluidinthoraciccavity.2023/5/17北京醫(yī)院孫鐵英23DirectPercussion2023/5/17北京醫(yī)院孫鐵英24

Resonance清音

Dullness濁音

Tympany鼓音

Flatness實音

Hyperresonanc過清音

PercussionSounds2023/5/17北京醫(yī)院孫鐵英25Auscultation

therearetwomethodsofauscultation:

directauscultationwiththeear;

indirectauscultationwiththestethoscope.2023/5/17北京醫(yī)院孫鐵英262023/5/17北京醫(yī)院孫鐵英27bythesetwomethodswecanlistentothesounds

producedfrom

heartlungsandabdomenorthe

bloodvesselnote2023/5/17北京醫(yī)院孫鐵英28

Twoprincipaltypeofstethoscope

thebell鐘型聽診器

ismoresuitabletolistentothelowpitchedrumblesuchasthemurmurofmitralstenosis

2023/5/17北京醫(yī)院孫鐵英29Twoprincipaltypeofstethoscopethediaphragm膜性聽診器

ismoresuitabletolistentothehighpitchedtones

themurmurofaorticregurgitation,breathsoundandbowelsond2023/5/17北京醫(yī)院孫鐵英30OlfactoryexaminationSmellingtoidentifytheunusualodorwhichproducedfrompatientsuchastheodorofsweat汗sputumpusfluid膿vomitus嘔吐物Stool便Urinebreath2023/5/17北京醫(yī)院孫鐵英31嗅診酸性汗液：風濕熱、水楊酸、阿司匹林狐臭味：腋臭患者惡臭痰液：支氣管擴張、肺膿腫（厭氧菌感染）惡臭膿液：氣性壞疽糞便嘔吐物：長期劇烈嘔吐、腸梗阻爛蘋果味嘔吐物：胃壞疽腐敗性臭味糞便：消化不良、胰腺功能不良2023/5/17北