Palpation o ke akepaʻa: na modalities, rula a me ka transcript

Palpation - kekahi o ka loa informative ano o ka lapaʻau 'ana, laweia mai ma na kumu ao ma ke kahua o ka loiloi mua ninaninau o ka hoʻomanawanui. About ia ia i keia la, a mākou e'ōlelo.

ake'anatomia

Mamua o ka holo mai e makaikai i ke kahe ana o palpation o ke akepaʻa, mākou e hoakaka i ka'anatomia a me ke kino. Ake ke aupuni 'koke ma lalo o ka diaphragm, ma ka pono i loko o ka luna o ka abdomen, a me wale i ka hapa uuku wale no o ke kino o kekahi kanaka makua aia ma ka hema (i kulike ai me ke kaulana laina). Ma nā pēpē i, ke ake i ka nui hapa o ka abdomen.

Topographically ake He mau surfaces a me nā lua penei. Ke anterior (mauka) ili adherent i ka ili o ka diaphragm a me bulges i kulike me kona curvature. Lower ua ke aupuni 'ma ke kua, a ma lalo, a me kekahi mau nā manaʻo mai e pili nā loko. Ka luna, a malalo surfaces hoʻokaʻawaleʻia ma ka laloʻoi maka, i nā kaʻe (caudineural), ma ka Akä, nui hoopaa, a nolaila, e hiki e wahi ana i na kino hope ili honua.

Maopopo ma ke akepaʻa nā māhele: he nui pono, a malalo hema, hoʻokaʻawaleʻia ma ka crescent ligament i loko o ka noa loa o ka i waiho nei i ke anuanu fibrous kaula - ka ai-kapaia hoʻopoepoe ligament i kŰlń ao, mai ka piko a me ka mea i oi ma mua o ka ulu umbilical aa koko.

Ka lobe'ākau ua kaawale ma ka auwaha i loko o kekahi mau kula kiʻekiʻe mahele. Ma kekahi o kēia mau Groove i ke aupuni 'gallbladder a me ka vena Vienna (lower) hoʻokaʻawaleʻia ma kekahi apana o ke akepaʻa'aʻaʻa i ua kapa waʻa, appendage.

Kekahi o ka mea nui loa o ke kino o ka hohonu transverse Groove i ka haawi ia ia i ka puka pā o akepaʻa. Ma keia ho okumu i loko o ke kino e nui hepatic artery puka Vienna a me nā aʻalolo, a haʻalele ia efferent hepatic leki uea (ke piʻoloke o ka bile i loko o ka gallbladder) a me lymphatics.

Ka'ākau lobe kino kaʻawale huinahalike hapa iki i ka mea i kaupalena 'ia i ka puka pā o ke ake, a me ka poepoe ligament fossa o ka gallbladder, a me ka caudate lobe e holo ana ma laila ma waena o ka puka pā, a hepatic Ka nū aa koko.

ake kuleana pili i

• Metabolic (ʻana mai o ka hoonohonoho hou loli, nā minelala hao a me nā wikamina, hormones,'amino nāʻakika, lipids, nā polokina, carbohydrates).
• Ua waihoia (i loko o ke kino loaa BZHU, nā wikamina, nā minelala hao, hormones).
• Secretory (bile? Iecaianoaaiiuo).
• Detox (lawe mai no a hiki i ka aoao maoli ake kānana - hepatic macrophages).
• Excretory (ma ka paa glucuronicʻakika a sulfuricʻawahia waiwai indole, tyramine, skotola).
• Homeostatic (ake komo i loko o ka mana o angiogenic a me metabolic hemostasis o ka meaola).

Aie i ka morphological a me ka iaea ooieoeiiaeuiiai hiʻona o ke akepaʻa Ua pinepine loa iho la lakou i keʻano o ka ole-communicable a me ka communicable maʻi. I mea no ke aha ia ka mua hoʻomanawanui lapaʻau mea pono e hoʻomaka palpation o ke kino.

Palpation a me ka percussion ake

Ma mua o ka probing ake waiho aku hoʻohana percussion e hooholo kona palena. Kēia e lawe i wale i ke kino māhuahua, akā, no hoi, e ike i kahi mea e hoʻomaka palpation. I ka percussion ake'aʻaʻa haawi i ka kūmūmū (hoopaa hoi i) kani, akā, ma muli o ia ka mea i ka haʻahaʻa o ka akemāmā hapa 'ia' uhi ia mea hiki e hooholo i ka palena elua: o ka oiaio a me ka loa ake dullness, akā, pinepine hoakaka i ka palena (haʻahaʻa a me ka hoaka o) o loa stupidity.

Palpation o ke kino (ʻano hana)

I ka probing ke akepaʻa pono e hahai i kekahi mau rula:

• Ke kūlana o ke kumuhana - e moe ana ma luna o kona kua, a me ke poo kānaka ke kiekie, a me kona mau wawae māhunehune lena ma na kuli a pololei. Lima ma luna o kona umauma, ma ka mea e kaupalena kona ka hoʻoneʻe i ka wa ana a me ka hoʻonānea kou abdominal nāʻiʻo.
• Ke Kauka o ke kanaka pono i ke ahonui.
• Iki manao lima'ākau kauka hoolakolako i lalo ma ka hoomanawanui i ka abdomen i loko o ka wahi o ka hypochondrium'ākau, ma lalo o ka ekolu i elima mau kenimika, ka mea ma ka palena o ke akepaʻa mua i ho'ākāka 'percussion. Me kona lima hema i ke kauka uhi i ka pahu (kona lalo akau), a me nā manamana eha e hoonohoia ke kua, a me hoʻokahi (nui) manamana lima kau ma luna o ka costal e pio. Kēia hana, e i immobility o ka pahu i inhalation a me ka hoomahuahua i ka pohupani hale o ka diaphragm lalo.

• I ka wā o ka hoʻomanawanui exhales, ke kauka Hawaiʻi keiki pulls ia i ka ili, a, ua komo 'o ia i kona lima'ākau i loko o ka abdominal lua, ua ninau mai i ka hoʻomanawanui, e lawe i ka hanu nui. I keia manawa, i ke kihi (malalo) o ke kino, e hina ia, komo i loko o ka hana eke, a ho one ei ma ka manamanalima. I ka Ia manawa palpable lima e kali oe wahi. Inā no kekahi kumu palpate ke akepaa ke aloha, ke kaʻina hana ua hou, akā, ua hoʻoneʻe i nā manamana he mau kenimika mai. Ulu keia manipulation, neʻe aʻe ia i luna, a hele i ka lima akau, aole ia i hina ma ka costal piʻo, a hiki i kaʻimi ake lihi.

hiʻona

• Paka palpation ke ake ana e kauoha abdominal Muscle (kona kae) a me ka akau hapalua like-clavicular laina. Akā, inā i ka pono aicieeaao, probing ulu laina elima (mai ka anterior axillary akau e okologrudinnoy hema).
• Ma ka hihia o ka hoʻomāhuahua o abdominal palpation o ka puke nui o ka loli pilikia. A laila, io i probing ua holo jerky kino. No keia mea, i ka lua, ke kolu a me ka ha manamana o ka lima'ākau e keʻehi-hou ma luna o ka mua abdominal paia, e hoomaka ana mai ka lalo, a pau me ka costal e pio mai i ai i ka ka loaʻaʻana o ke kahua o ke anuanu - akepaʻa. I loko o ke kino mua kŰlń ao hohonu i loko o ka eheu, a laila, hele hoʻi a me bumps ma ka manamana (he symptom i kapaia "lana'āpana o ka hau").

Ka hoohalike ana o nā hualoaʻa (maʻamau)

He aha nā hualoaʻa e hōʻike palpation o ke akepaʻa?

• Maʻamau, 88% o nā nā mea maʻi kino haʻahaʻa kaʻe ua aia puni ka costal e pio mai, ma ka laina me ka laina hapalua like-clavicular i ka akau.
• Ma ke ola i ke kanaka kino i ka maka o ka pahikaua a iki ua hoʻokōʻia. He palupalu, painless, oluolu podvorachivaetsja ma palpation, i laumania.

Loiloi 'ana o ka' ike (pathology)

• Inā ke akepaʻa ua ho'ākeaʻia, palpation ia e ke kai piha ma lalo o ka costal e pio mai, a hiki i hoike o kona naeaeaa. Ma kākoʻo mai o keia a ua apono ia ka pono i ka percussion, ma ka mea e hooholo i ka palena o ke kino.
• Inā i ka nui o ke akepaʻa ua ole hoʻololi, akā, i nā palena o ka hepatic dullness 'oni iki iho - he hoailona o ka hui, prolapse.
• Offset wale ka haʻahaʻa palena Hōʻike he mahuahua i loko o ke ake e ia lŘlŘ ma venous stasis, li nui i loko o ke ake, a biliary'āpana, huʻi nā mea palahēhē (malaria, cholera, typhoid, me ka hi koko), cirrhosis (ka loiloi mua ke kahua).
• Inā ka lalo kali ua 'oni iki luna, ka mea i hiki ke manao ka ho'ēmiʻana i loko o ke kino nui (e laʻa me, ma na kahua o ka hoʻonaʻauao maʻi o cirrhosis).
• Pūʻali hepatic luna palena (i ole ia) kākaʻikahi Hōʻike poino o ka hui, (e laʻa me, ake maʻi 'aʻai ole echinococcosis). Ma ka hapanui o na hihia ka mea, ua ike no ia i ke kulana kiʻekiʻe o ka diaphragm i hāpai keiki, ascites, flatulence, no ka mea, ma haʻahaʻa puka hoʻoponoponoʻana o Kamehameha visceroptosis, pneumothorax, emphysema, e like me ka manawa o ka hookuuia puka ma ke akepaʻa, ma muli o ka hoʻomāhuahua o ke kinoea.
• Pulmonary infarction, wrinkling kona haʻahaʻa, pneumonia, pleurisy kapakahi i kekahi simulate ka keu aku pohupani hale palena mauka kino.
• Ma kekahi mau hihia, i loaʻa ole wale i ka palpation o ka lihi o ke akepaʻa, akā, i ke kino a pau. No keia hopena, e hoonoho iho ai i ka manamana ma lalo o ka akau costal e pio. Ka rabi, i ua mālie ke keku, ka hāʻuleʻana neʻe ake haʻawina, ka loiloi 'ana me kona luna (nodular, i laumania, ala apuupuu), hionapāʻili (anuanu, palupalu), imua / e kaawale aku o ka eha.

• Myagkovataya, i lalo, Kaulu, a ua hoʻokōʻia kae o ka palupalu - na hoailona o ka li nui i loko o ke kino a me ka hoike ana o ka huʻi koko stasis ma muli o ka naʻau ole.
• Lumpy, bumpy, ao kaʻe ua mālama i echinococcosis a me ka syphilis. Loa anuanu ( "lāʻau") ua nānā 'ia e ake poino nā loko ma ka maʻi' aʻai keena.
• Plotnovata kae o ke akepaʻa paipai hepatitis, a ma ka huipūʻana me ka tuberosity - cirrhosis.
• Pain ma palpation ke akepaʻa ke'ākoʻakoʻa ma muli o keʻano o ka hanaʻana i ka hoʻoʻino, a ma kona distension mea hōʻikeʻikeʻuʻuku (i loko o congestive ake).

Palpation o ke akepaʻa i loko o na keiki

Probing keiki akepaa, IeAUPIIe, IAa IO lawe mai ma ka hapalua like-clavicular a anterior axillary laina ma ka neʻe palpation. Ma keia lima inspecting pediatrician ho one ei i ka lihi o ke akepaʻa, e hiki ole wale, e hooholo i ka nui o ke kino, akā, i palpation auhau o kona maka. Kūmau no nā pēpē i mea no ka hana o ka hepatic kae o ka costal e pio mai ma luna o elua (akā,ʻaʻole oi) o ke kenimika. Loiloi i mālama 'ia i loko o ka midclavicular laina. kino kaʻe pela e e painless, malimali, hoopaapaa a me ka pahee laholio.

I ola na keiki ma lalo o ka makahiki o ehiku kae o ke akepaʻa, i hookuu protrudes mai ka costal e pio mai, a me ka pono i loaʻa no ka palpation. No ka mea, ola na keiki i ka makahiki ekolu, i ka kūmau o ka wehewehena o ke akepaʻa kaʻe o 2 a 3 knm ma lalo o ka akau costal palena pau. Ma hope o nā makahiki o ke akepaʻa palena hoʻopili like i ka poe i loko o nā mākua.

Hoʻokolokolo 'ana o ke ake ano Kurlova

E hoʻokūpaʻa i kaʻike, o keia paha ua pathology e hiki aku ai i ka ei o ke kino nui, pono e lawe mai palpation o ke akepaʻa Kurlov. No keia hoʻohana i ka 'enehana hou (percussion) ho oholo i ka luna palena, a laila, palpated (ole percussion) - lalo. No hoi, ma ka like ana me kekahi kēlā papa o ka lalo kae o kona palena, a me ka mamao ma waena o ka luna, a malalo palena e hooponoponoia ia mea, ma ka ekolu wahi. Ka mua hoʻopili like i ka midclavicular laina, i ka lua - ka midclavicular, a me ke kolu - ka haʻalele costal e pio. Ke Kulanakauhale nui e e 9, 8, 7 hoʻohuli i niioaaonoaaiii.