Palpation na baƙin ciki: wani algorithm da fasaha

Saifa - unpaired Gabar da aka located a gefen hagu na ciki. A gaban jiki sashi ne m zuwa ciki, da kuma mayar da - da koda, adrenal da hanji.

A tsarin da baƙin ciki

A abun da ke ciki a tsare baƙin ciki serous murfin kuma mai zaman kansa kwantena, da karshen kafa ta hade da connective nama, tsoka da kuma na roba zaruruwa.

A kwantena wuce a cikin kwarangwal na jiki, raba da ɓangaren litattafan almara (da parenchyma) a cikin raba "tsibiran" tare da trabecular. A ɓangaren litattafan almara (ganuwar da arterioles) ana shirya zagaye ko m nodules na lymphoid nama (lymphoid follicles). A zuciya na ɓangaren litattafan almara ne da reticular masana'anta wanda aka cika da wani iri-iri na sel: ja jini Kwayoyin (kagaggun rubabben), leukocytes da lymphocytes.

Gabar aiki

• The baƙin ciki ne da hannu a cikin lymphopoiesis (watau tushen lymphocytes).
• An zabi a hematopoietic da kuma rigakafi da ayyuka da kwayoyin.
• Halakar shaye na platelets da kuma ja da maikacin jini.
• Shaida na jini.
• A farkon matakai na embryogenesis aiki a matsayin mai hematopoietic sashin jiki.

Wannan shi ne, jiki ya yi aikin da dama da muhimmanci ayyuka, sabili da haka domin sanin munanan a farkon matakai na binciken dole farko aiwatar da palpation kuma feat. Irfan na baƙin ciki.

The domin na palpation na ciki gabobin

Bayan tattara gunaguni, likita tarihi da kuma janar jarrabawa, likita yawanci farawa jiki da hanyoyin da binciken, wanda sun hada da palpation kuma feat. Irfan.

rarrabe:

• Surface palpation a wadda gano soreness sãɓãwar launukansa filin ƙarfin lantarki na ciki tsokoki, da busa, da kuma da dama hatimi samuwar (hernia, marurai, nodes). Kawo shi da m matsa lamba rabin-lankwasa yatsunsu, fara daga hagu iliac yankin counterclockwise.
• Deep palpation da za'ayi a cikin wadannan jerin: makafi , ileum (karshen bangare), ciwon (hawa da sauka sassan), mai gangara ciwon hanji, ciki, hanta, pancreas, saifa, kodan, yana da za'ayi amfani da zurfin shigar azzakari cikin farji yatsu likita a kogon ciki.

A cikin hali na tuhuma da splenic cututtuka (ko ta karuwa saboda cutar hanta) rike feat. Irfan dole, a palpation da hanta da saifa.

Janar dokoki palpation

Palpation (palpation) na baƙin ciki - daya daga cikin mafi m hanyoyin da jiki bincike, gudanar da wani likita. A cikin hali na wani kadan karuwa a cikin jiki, a lokacin da baƙin ciki ba sauki bincike, a tabbatar da likita ya bada shawarar nassi na duban dan tayi tabbatar / shanyewa zargin Pathology a wani yaro ko balagagge.

haƙuri da matsayi:

• Supine (a cikin wannan matsayi da aka gudanar palpation da hanta da saifa).
• Kwance a kan gefen dama. A hannun dama shi ne a karkashin kaina, da kuma hagu ya kamata a lankwashe à a gwiwar hannu, da kuma aza a kan kirji (wannan dabara ake kira palpation na baƙin ciki daga Sali). Bugu da ƙari, haƙuri da shugaban ya kamata a dan kadan tilted zuwa kirji, dama kafar madaidaiciya da kuma hagu kafar ya kamata a lankwashe à a da kwantangwalo da gwiwa gidajen abinci.

Palpation na baƙin ciki: algorithm

1. Hannunsa na hagu likita dole ne a sa saboda haka shi ya ta'allaka ne a gefen hagu daga cikin kirji na magana, da tazara tsakanin 7th kuma 10th haƙarƙari daidai da axillary Lines, da kuma samar da wani kadan matsa lamba. Lokacin da yatsun hannun dama dole ne a rabin-lankwasa da kuma located a kan bar costal baka haka cewa tsakiyar yatsa dab da 10th haƙarƙari.
2. Lokacin da haƙuri numfasawa a, cikin fata da aka canja zuwa ƙasa ta samar da wata Musulunci na fata.
3. Bayan exhalation likita ta hannu ratsa cikin ciki (ciki).
4. A haƙuri a request daga likita daukan mai zurfi numfashi, yayin da a ƙarƙashin rinjayar da baƙin ciki diaphragm motsa saukar. A cikin hali na kara yatsunsu likita zai haɗu ta ƙananan iyakacin duniya. Irin wannan mataki dole ne a maimaita sau da yawa.

fassarar sakamakon

Karkashin al'ada yanayi (a cikin m mutane), da baƙin ciki ba palpable. Ban ne asthenics (mafi yawa mata). Tausa baƙin ciki a wasu lokuta na iya zama a tsallake diaphragm (pneumothorax, pleurisy) da kuma splenomegaly, wato, da karuwa a jiki size. A irin wannan yanayin ne mafi kowa a cikin wadannan jihohi:

• Cututtuka na jini.
• Kullum hanta pathologies (splenomegaly cikin wancan akwai ãyã daga portal hauhawar jini ko hepatolienal ciwo).
• M kuma na kullum cututtuka matakai (endocarditis kamuwa da cuta, zazzabin cizon sauro, typhoid zazzabi, sepsis).
• Cututtuka na connective nama.
• Infarctions ko abscesses na baƙin ciki.

Mafi sau da yawa, ko da palpation m kara girman baƙin ciki. Ban ne sashin jiki infarcts, m tensile capsules episplenitis. A cikin wadannan lokuta, da baƙin ciki zama musamman m (watau, m on palpation).

A cirrhosis na hanta da kuma sauran kullum cututtuka na baƙin ciki gefen wani m, m guda matakai - taushi.

Daidaito ne yawanci m, a m cututtuka, na kullum cututtuka da kuma hanta cirrhosis zama m.

Haka magnification palpated jiki sashi na iya zama karami ko ya fi girma darajar, da kuma yadda baƙin ciki spun daga gefuna iya nuna gaskiya har ya fi girma jiki. Saboda haka, mun gwada da kananan karuwa nuna wani fitarwa jiki gefen costal baka a 2-7 cm, wanda aka lura a cikin m cututtuka (typhoid, meningitis, sepsis, lobar ciwon huhu, da sauransu) ko kullum cututtuka (cututtukan zuciya, cirrhosis, erythremia, cutar sankarar bargo, anemia) da kuma na unknown etiology da ya auku fiye da sau da yawa a cikin matasa (yiwu a hereditary syphilis, rickets)

Haka yawa palpable baƙin ciki baki (idan karuwa) shi ne zai yiwu su kusantar da karshe game da sayen magani tsari. Wannan ne, da ya fi tsayi da kumburi ba a cikin jiki, da denser da wuya fiye da ta parenchyma, daga wanda ya bi da cewa mafi taushi da kuma m fiye da a kullum baƙin ciki baki a m tafiyar matakai.

Lokacin da jiki ne ma manyan, a lokacin da ƙananan baki aka bayyana a cikin pelvic rami, za su gudanar da palpation na baƙin ciki ne mai sauqi qwarai da kuma ba ya bukatar musamman da dabarun.

A cikin hali na splenomegaly sakamakon splenic marurai da palpation (more daidai, ta Margo crenatus) an ƙaddara ta a Burr (1 zuwa 4). Irin wannan bincike alamar nuna gaban amyloidosis, sankarar bargo (na kullum myelogenous ko psevdoleykemii), zazzabin cizon sauro, cysts da endothelium.

Wannan shi ne, a lokacin da baƙin ciki palpation likita ne iya tantance yanayin da surface, don gane fibrin shaida (kamar lokacin da perisplenitah), daban-daban protrusions (cewa shi ne, misali, abscesses, zub da jini da kuma serous cysts, echinococcosis) da kuma sanin da yawa daga cikin nama. A abscesses sau da yawa samu da kuma canji. Duk abin da aka ƙaddara da palpation bayanai ne musamman m ga ganewar asali mafi cututtuka na baƙin ciki, da kuma definition cuta, wanda zai iya haifar da splenomegaly.

A al'ada baƙin ciki ne located in bar subcostal yankin, ta tsawon axis ta'allaka tare da goma haƙarƙari. Authority yana da wani m (wake) siffar.

Baƙin ciki a yara

The girma na baƙin ciki ne al'ada, dangane da shekaru:

• Neonates: nisa - to 38 millimeters a tsawon - har zuwa 40 millimeters.
• 1-3 shekaru: tsawon - har zuwa 68 millimeters, nisa - har zuwa 50 millimeters.
• 7 shekaru: tsawon - 80 mm, nisa - har zuwa 55 millimeters.
• 8-12 shekaru: nisa - har zuwa 60 millimeters a tsawon - har zuwa 90 millimeters.
• Shekaru 15: nisa - har zuwa 60 mm, da kuma tsawon - 100-120 mm.

Ya kamata a tuna cewa palpation na baƙin ciki a yara, kazalika da manya, ya zama m, a Bugu da kari, da baƙin ciki ne al'ada a wani yaro da aka ba m. The sama masu girma dabam ne ba makawa, cewa shi ne, kananan sabawa a cikin shugabanci na ragewa / kara jiki lallai ba ne su a matsayin pathological girma.

saifa feat. Irfan

Wannan hanya da ake amfani da su kimanta da girma (iyakoki) na jiki.

Haƙuri aka sanya a cikin dama polubokovoe matsayi da hannuwa sanya a kan kansa, tare da ƙafafunsa kawai tankwasa a da kwantangwalo da gwiwa gidajen abinci. Percuss haka, za daga bayyana m sun sauti ta amfani da m percussive naushe.

dauke feat. Irfan

1. Yatsa-plessimetr dole ne a shigar a kan gefen costal baka a gefen hagu na jiki perpendicular zuwa 10th haƙarƙari.
2. Ku ciyar rauni feat. Irfan a 10th haƙarƙari, farkon costal baka (hagu) har sai wani maras ban sha'awa sauti (blunting). A miƙa mulki na sauti yi alama a kan fata. Sa'an nan percussing daga axillary line (raya) anteriorly har da sauti deadening da kuma saka alamar a kan fata.
3. kashi tsawon tsakanin alamomi - shi ne dlinnik baƙin ciki (ko 10th haƙarƙari). Yadda aka saba, wannan nuna alama ne 6-8 santimita.
4. Daga tsakiyar dlinnika da perpendicular zuwa goma haƙarƙari da shi na samar da kara feat. Irfan domin sanin diamita daga cikin baƙin ciki, wanda kullum jeri daga 4 zuwa 6 santimita.
5. Yadda aka saba, gaba, na daga cikin baƙin ciki (watau ta gefen) dole ku tafi da tsakiya line cewa haɗu da free karshen 11th haƙarƙari da sternoclavicular hadin gwiwa. Ya kamata a lura da cewa lissafin girman da baƙin ciki ta amfani feat. Irfan - sosai m adadi. Gabar size, an rubuta su a matsayin sulusi da murabba'i, inda numerator - shi ne dlinnik, da kuma hada - diamita daga cikin baƙin ciki.