Palpation chiropa ndizvo: modalities, mitemo uye inopangidza

Palpation - chimwe chezvinhu anodzidzisa nzira Diagnostics, kuitwa navanachiremba panguva pavaipfuura kutanga kuongorora murwere. About naye nhasi uye tozotaura.

chiropa anatomi

Asati atanga kuongorora nyaya palpation chiropa, tinofanira kutsanangura kuti anatomi uye muviri mabasa. Chiropa iri pakarepo pasi diaphragm, kurudyi pamusoro mudumbu, uye chete chiduku chikamu chomuviri mukuru riri kuruboshwe (maererano Zvichakadaro mutsetse). Vachangoberekwa, chiropa anotora chikamu chinokosha pamusoro mudumbu.

Topographically chiropa chine mbiri hukawanika uye miviri yehombodo. The Anterior (repamusoro) pemvura adherent kuti pemvura diaphragm uye bulges zvinoenderana kwayo curvature. Lower riri shure uye pasi, ane pfungwa shoma kubva pedyo nhengo. Okumusoro hukawanika dzakaparadzaniswa rezasi unopinza kumucheto, mumwe pamupendero (caudineural), kusiyana, mikukutu zvikuru, uye saka unogona kunzi kune muviri shure pamusoro.

Kusiyanisa zviri chiropa zvikamu zviviri: hombe rworudyi uye kuderedza kuruboshwe, akaparadzaniswa achishandisa kirisendi shwashwa iri vakasununguka chikamu riri rimwe gobvu fibrous tambo - vanonzi dzeraundi shwashwa kuti kunosvika kubva Guvhu uye haasi kupfuura vashoma achiine rukuvhute tsinga.

The akafukidza rworudyi akaparadzaniswa nevanhu mihoronga kupinda akawanda yechipiri mugove. Mune rimwe grooves izvi dziri gallbladder uye vena Vienna (nechepazasi) dzakaparadzaniswa chimedu chiropa rinenge kwave kuchinzi Tailed manda.

Chimwe chinokosha nhengo dzomuviri igomba transverse paburi kuti anonzi chiropa pasuwo. Kuburikidza inotungamirwa ichi pamuviri yakakura hepatic tsinga pasuwo Vienna uye tsinga, mugoisiira efferent hepatic mutsinga dzinofamba nemukaka (kubvisa zviri bile ari gallbladder) uye lymphatics.

Kodzero akafukidza muviri yoga mativi chakapatsanurwa kuti ndeyevanyori pasuwo chiropa, uye kumativi shwashwa fossa pamusoro gallbladder, uye caudate akafukidza anomuitira imomo pakati pegedhi uye hepatic portal tsinga.

chiropa basa

• Metabolic (kudzora exchange fluid mamineral mavhitaminzi, mahormone, amino acids, lipids, mapuroteni, makabhohaidhiretsi).
• Chiri yakaiswa (mumuviri kuunganidza BZHU, mavhitaminzi, zvicherwa, mahormone).
• Secretory (bile production).
• Detox (kunze nokuda yepanyama chiropa filters - hepatic macrophages).
• Excretory (nokusunga glucuronic asidhi uye sulfuric zvine chepfu indole, tyramine, skotola).
• Homeostatic (chiropa munyaya kudzorwa angiogenic uye metabolic hemostasis yacho muviri).

Nokuda morphological uye dzichipfekeka zvaidiwa chiropa kazhinji chaizvo vakashamiswa siyana asiri communicable uye pezvirwere zvinopomerwana. Ndokusaka apo wokutanga murwere kurapwa zvakakodzera kuita palpation muviri.

Palpation uye percussion chiropa

Pamberi inoda kufunga chiropa yemutemberi kushandisa percussion kuona nemiganhu yayo. Izvi vachafunga kwete chete muviri kuwedzera, asiwo kunzwisisa kupi kunofanira kutanga palpation. Kana percussion chiropa rinenge anopa kungopotsera (pakunzwa) inzwi, asi nokuti kuti rezasi chikamu zvemapapu aoma orifukidza zvinokwanisika kuziva miganhu maviri: wechokwadi uye mhedziso chiropa dullness, asi kazhinji kutsanangura muganhu (yakaderera uye yokumusoro) of kwakakwana youpenzi.

Palpation muviri (unyanzvi)

Apo achirova-rova chiropa vanofanira kutevera vamwe mitemo:

• Nzvimbo yacho - avete shure kwake, pamwe musoro kwakasimudzirwa zvishoma, uye tsoka dzake haawanzotauri hwakakungwa pamabvi kana twasu. Hands pachipfuva chake, kuti dzisanyanya mufambo wayo kana Kufema uye kuzorora zvako abdominal tsandanyama.
• Chiremba ndiye munhu kodzero kumurwere.
• Zvishoma hwakakungwa ruoko chiremba rworudyi anorasira sandara pamusoro murwere dumbu munzvimbo rwerudyi hypochondrium, pazasi matatu kusvika mashanu masendimita, chii muganhu chiropa kare yakajeka percussion. Noruoko rwake rworuboshwe chiremba rinofukidza chipfuva (Musana kurudyi), pamwe chete nemimwe mina igadzikwe shure, uye kupfeka costal chematenga rimwe (guru) chigunwe. Nzira iyi achapa kutadza kufamba pechipfuva panguva inhalation ndokuwedzera misha yacho diaphragm pasi.

• Kana murwere exhales, chiremba effortlessly racho rose ringakweva pasi ganda uye, chubvu rwake rworudyi ari abdominal mhango, okubvunza murwere kutora befu. Panguva ino, pamuuyo (yepazasi chikamu) muviri anowira, chinopinda kupinda akasika muhomwe uye masiraidhi pamusoro minwe. Panguva iyoyowo palpable ruoko anofanira kuramba mira. Kana kuti zvimwe chikonzero palpate chiropa rapera, muitiro inodzokororwa, asi minwe vari misha pakuona shoma kumusoro. Revai kumonyanisa ichi, uchifamba pakakwirira, ukuwo rworudyi haagumburwi pamusoro costal chinhu chakakombama, kana kusvikira vachiongorora chiropa mucheto.

Features

• Kubereka palpation chiropa kazhinji zvakananga abdominal tsandanyama (rayo pamupendero) kana kodzero nemakore clavicular mutsetse. Asi kana zvava kudikanwa, inoda kufunga zvibereko mitsetse shanu (kubva Anterior axillary kodzero okologrudinnoy kuruboshwe).
• Kana kuunganidza abdominal palpation huru zvemaBhaibheri mvura mvura yakaoma. Ipapo akareva inoda kufunga achimhanya jerky muviri. Nokuti chinangwa ichi, wechipiri, wechitatu uye chechina minwe rworudyi kava-kumusumudza nechemberi abdominal rusvingo, kubvira pasi uye ndokuguma pamwe costal chematenga kusvikira kuziva miedzo paumbwe imwe gobvu - chiropa. Mumwedzi muviri wokutanga kunosvika vanyura bapiro, uye ipapo anouya shure uye anorovera pane minwe (chiratidzo rinonzi "zvinoyangarara piece echando").

Dudziro zvabuda (romuzvarirwo)

Zvii zvinofanira kuratidza palpation chiropa?

• Kazhinji, 88% of varwere muviri ezasi unopinza riri kumativi costal chematenga, maererano nemakore clavicular mutsetse kurudyi.
• Mune utano hwevanhu muviri pamucheto unopinza kana vakagumisa zvishoma. Hazvina munyoro, nyarara, podvorachivaetsja nyore panguva palpation, pachaenzaniswa.

Kunyatsoongorora humboo (zvokurwara)

• Kana chiropa wakashamira, palpation chichagamuchirwa riri pazasi costal chematenga, izvo zvinogona kunopupura wake kusuduruka. Mukutsigira ichi kana kuti mvumo zvaanofanira percussion, kuti tizive miganhu muviri.
• Kana kukura chiropa haina kushandurwa, asi miganhu hepatic dullness haachatauri pasi - chiratidzo nhego prolapse.
• Kushaya chete muganhu ezasi rinoratidza nokuwedzera chiropa kuti unowanikwa venous stasis, kuzvimba chiropa uye biliary turakiti, chenjera utachiona (marariya, korera, fivha, manyoka), cirrhosis (kuchava kutanga kwekupwanyiwa).
• Kana rezasi muganhu wacho haachatauri kumusoro, zvinokwanisika kufungidzira zvinoderedza kukura muviri (semuenzaniso, panguva chinouraya nzendo cirrhosis).
• Rearranging hepatic yokumusoro muganhu (kana pasi) kazhinji zvinoratidza kuzotadzira nhengo (semuenzaniso, kenza chiropa kana echinococcosis). Kakawanda kacho ari kuchengetwa nokuda mukuru nzvimbo diaphragm panguva pamuviri, ascites, flatulence, nekuti panguva yakaderera aperture urongwa visceroptosis, pneumothorax, emphysema, uyewo vanenge kuerera aperture pamusoro chiropa nokuda kuunganidza gasi.
• Pulmonary infarction, kuunyana yakaderera chikamu chayo, mabayo, pleurisy mativi vanogonawo vatevedzere kumusoro misha muganhu repamusoro muviri.
• Mune zvimwe zviitiko, kuwanika kwete chete kuti palpation pakati kumucheto chiropa, asi vo muviri wose. Kuti izvi zvidaro, zvigunwe vanoiswa zvakananga pasi kurudyi costal chematenga. Chiremba zvinyoronyoro kufurira, zvishoma nezvishoma mumatope masangano chiropa zvidzidzo, vanoongorora yayo pamusoro (nodular, mvere, kumeso), unaku (gobvu, nyoro), kuvapo / kusavapo marwadzo.

• Myagkovataya, flat, kumeso nomumativi woita kumucheto nounyoro - zviratidzo kuzvimba pamuviri kana kuoneka rikwanise ropa stasis nokuda mwoyo kutadza.
• Lumpy, nematambudziko, nemvumi pamupendero iri pasika echinococcosis uye njovhera. Very gobvu ( "danda") vagara vandifungira chiropa zvaparadzwa nhengo nemasero kenza.
• Plotnovata pamucheto chiropa inoratidza hepatitis uye pavanoparidza tuberosity - cirrhosis.
• Marwadzo ari palpation chiropa anogona kuitika nokuda anogumbura urongwa, kana nokuda kwayo distension Kamudzira (mu congestive chiropa).

Palpation chiropa muvana

Inoda kufunga achangoberekwa chiropa, kazhinji kuitwa pa mid-clavicular uye Anterior axillary mitsetse nokutamira palpation. In ruoko ichi pokutsvaga wevana masiraidhi kure kumucheto chiropa, achiita zvinogoneka kwete chete yokuziva kukura kwomuviri, asiwo palpation tinyatsonzwisisa pamupendero wayo. Norm nokuti vachangoberekwa ndiwo mabasa hepatic pamucheto costal chematenga vaviri (asi kwete kupfuura) ane sendimita. Kukoshesa chaiitirwa mune midclavicular mutsetse. muviri pamupendero saizvozvo inofanira kuva nyarara, mvere, unopinza uye munyoro kwakavharwa nenyama.

In vana utano pasi pemakore nomwe pamucheto chiropa, kazhinji makabuda kubva costal chematenga uye kodzero ruripo palpation. Nokuti vana utano kusvika makore matatu, kuti ndeyokuva tsanangudzo chiropa pamucheto iri 2 kana 3 masendimita pazasi kurudyi costal kumahombekombe. Pashure pemakore manomwe chiropa miganhu anoenderana nedzevakuru.

Kuongorora kuti chiropa nenzira Kurlova

Kuzosimbisa chirwere ichi kana kuti zvokurwara inotungamirira kuti kukanganisa kukura muviri, zvakakodzera kuti tiite palpation chiropa Kurlov. Nokuti ichi shandisa tapping (percussion) kuona rokumusoro muganhu uye ipapo palpated (kana percussion) - yakaderera. Uyezve, maererano ane oblique nzira yepazasi kumucheto muganhu wayo, uye kure pakati okumusoro miganhu takatsunga vatatu points. Wokutanga rinoenderana midclavicular mutsetse, wechipiri - the midclavicular, uye wechitatu - kuruboshwe costal chematenga. The Prefecture Kukura inofanira kuva 9, 8, 7 dzinotaura azvaitwa.