Palpation chiwindi: modalities ya malamulo ndi mawu olembedwa

Palpation - mmodzi wa njira zambiri zothandiza pa diagnostics, kuyendetsedwa ndi madokotala pa siteji ya kuona koyamba kwa wodwala. About lero ndipo ife kulankhula.

chiwindi thunthu

Asananyamuke kufufuza nkhani ya palpation a chiwindi, tiyenera chimatanthauza thunthu ndi thupi ntchito. Chiwindi inali yomweyo pansipa chifundamtima, kumanja pamwamba pa pamimba, ndi mbali yaing'ono chabe thupi la munthu wamkulu ili kumanzere (malinga ndi mzere zikutanthauza). Pa ana akhanda, chiwindi amatenga mbali yaikulu ya pamimba.

Topographically chiwindi ali pamalo awiri ndi mbali ziwiri. The zapambuyo (kumtunda) padziko adherent pamwamba pa zakulera ndi bulges motsata kupindika wake. M'munsi ili kumbuyo ndi pansi, ndi zidindo ochepa kuchokera ku ziwalo pafupi. Chapamwamba ndipo m'munsi pamalo ankasiyana m'mphepete m'munsi lakuthwa, ena m'mphepete (caudineural), mosiyana, wosasamala kwambiri, choncho akhoza zimachitika thupi kumbuyo pamwamba.

Kusiyanitsa mu chiwindi magawo awiri: ufulu zazikulu ndi wamanzere, wosiyana ndi kachigawo mitsempha mu gawo ufulu umene muli wandiweyani fibrous chingwe - otchedwa zozungulira mitsempha chochokera m'michombo ndi si zoposa atachuluka umbilical mtsempha.

The Lobe lamanja ankasiyana mizere m'zigawo zingapo sekondale. Mu umodzi wa grooves izi zili ndulu ndi vena Vienna (m'munsi) olekanitsidwa ndi chidutswa cha minofu chiwindi wakhala ukutchedwa tailed mafuta.

Imodzi mwa mbali zofunika za thupi kwambiri yopingasa poyambira amene amatchedwa chipata chiwindi. Kudzera mapangidwe ili m'thupi ndi lalikulu kwa chiwindi mtsempha wamagazi chipata Vienna ndi mitsempha, ndi kuwasiya iwo efferent kwa chiwindi ritsa (achoke wa ya ndulu mu ndulu) ndi lymphatics.

Ufulu Lobe thupi akutali lalikulu kachigawo kuti ndi woperewera ku chipata cha chiwindi, ndi kuzungulira mitsempha fossa a ndulu, ndi caudate Lobe anakafika uko pakati pa chipata kwa chiwindi mtsempha zipata.

ntchito chiwindi

• Kagayidwe kachakudya (kulamulira kuwombola madzimadzi, mchere ndi mavitameni, mahomoni, amino zidulo, lipids, mapuloteni, chakudya).
• Unayikidwa (mu thupi kudziunjikira BZHU, mavitamini, mchere, mahomoni).
• Secretory (ya ndulu kupanga).
• Detox (ikuchitika chifukwa Zosefera zachilengedwe chiwindi - kwa chiwindi macrophages).
• Excretory (by kumanga asidi glucuronic ndi sulfuric poizoni indole, tyramine, skotola).
• Homeostatic (chiwindi nawo ulamuliro wa angiogenic ndi kagayidwe kachakudya hemostasis wa chamoyo).

Chifukwa mbali morphological ndi zinchito a chiwindi zambiri anadabwa kwambiri pa zosiyanasiyana matenda si opatsirana ndi opatsirana. Ichi ndi chifukwa chake choyamba wodwala mankhwala n'kofunika kuchita palpation za thupi.

Palpation ndi percussion chiwindi

Pamaso pa chiwindi akufufuza mpata amalangiza ntchito percussion kudziwa malire ake. Izi osati kuganiza kuwonjezeka thupi, komanso kumvetsa kumene ayenera kuyamba palpation. Pamene percussion chiwindi minofu amapereka yosamveka (kuzimiririka) phokoso, koma chifukwa chakuti mmunsi mwa phapo pang'ono amaivundikira ndi n'zotheka kudziwa malire awiri: woona ndi mtheradi chiwindi afiira, koma amalitchula malire (m'munsi ndi chapamwamba) wautsiru mtheradi.

Palpation wa thupi (njira)

Pamene akufufuza mpata chiwindi ayenera kutsatira malamulo:

• Udindo wa nkhaniyi - atagona pa nsana wake, ndi mutu pang'ono kukwezeka, ndi mapazi ake atachoka ndichotse pa maondo kapena molunjika. Manja pachifuwa pake, pofuna kuchepetsa sayenda ake pamene wina akapuma ndi masulani minofu m'mimba wanu.
• dokotala ndi munthu woyenera wodwalayo.
• Pang'ono wopindidwa lamanja dokotala kutchera lathyathyathya pa pamimba wodwalayo m'dera la hypochondrium lamanja, m'munsimu masentimita atatu kapena asanu, kodi kumalire a chiwindi poyamba kumatanthauza percussion. Ndi dzanja lake lamanzere dokotala chimakwirira chifuwa (kumanja kwake pansi), ndi zala zinayi adzaikidwe kuseri, ndi munthu (wamkulu) chala kuvala Chipilala costal. Njira adzapereka kulephera kuyenda m'chifuwa pa inhalation ndi kuonjezera kusamuka kwa chifundamtima kunsi.

• Pamene wodwala exhales, dokotala effortlessly chimakakamiza pansi pa khungu ndipo, plunging dzanja lake lamanja mu zonse m'mimba, akufunsa wodwalayo kupuma kwambiri. Panthawi imeneyi, m'mphepete (m'munsi gawo) la thupi ukugwa, likulowerera mu thumba analenga ndi zithunzi pa zala. Pa nthawi yomweyo dzanja palpable ikufunika n'kupuma. Ngati pazifukwa zina palpate chiwindi sichitha, ndondomeko akubwerezedwa, koma zala ndi osamukira ndi masentimita angapo mmwamba. Ndisonyezeni mpheto ichi, kusunthira apamwamba ndi apamwamba, pamene dzanja lamanja sapunthwa pa Arc costal, mpaka kumalire kafukufuku chiwindi.

Features

• Ndisonyezeni palpation chiwindi kawirikawiri mwachindunji minofu m'mimba (m'mphepete ake akunja) kapena ufulu m'ma clavicular mzere. Koma ngati akufunika kutero, kusanthulasanthula zokolola mizere zisanu (kuchokera zapambuyo axillary ufulu okologrudinnoy kumanzere).
• Pankhani ya kudzikundikira palpation m'mimba mwa magawo waukulu wa madzimadzi kovuta. Kenako anayamba akufufuza mpata ikutha jerky thupi. Chifukwa chaichi, wachiwiri, wachitatu ndi wachinayi zala za dzanja lake lamanja yamba-unagunda pa kutsogolo khoma m'mimba, kuyambira pansi, kutsiriza ndi Chipilala costal kuti kudziwika ndi mapangidwe wandiweyani - chiwindi. Pa thupi loyamba chimafikira kwambiri mu mapiko, ndiyeno abwelela ndi tokhala pa zala (a chizindikiro amatchedwa "akuyandama chidutswa cha ayezi").

Kumasulira zotsatira (yachibadwa)

Kodi zotsatira ayenera kusonyeza palpation chiwindi?

• Mwachibadwa, 88% mwa odwala thupi m'munsi m'mphepete lili padziko Chipilala costal, mu mzere ndi m'ma clavicular mzere kumanja.
• Mu thupi lathanzi anthu m'mphepete mwa lakuthwa kapena pang'ono anamaliza. Ndi zofewa, sabweretsa chisoni, zosavuta podvorachivaetsja pa palpation, yosalala.

Lowunikira la deta (kudwala)

• Ngati chiwindi wakulitsidwa, palpation adzakhululukidwa ili pansipa Chipilala costal, zomwe umboni wa kosangalatsa ake. Pothandizira izi kapena kuti chiyanjo m'pofunika percussion, kuti kudziwa malire a thupi.
• Ngati kukula kwa chiwindi ndi sanasinthe, koma malire a afiira kwa chiwindi ankatembenukira pansi - chizindikiro cha limba prolapse.
• Kuchepetsa yekha malire m'munsi chikusonyeza kuwonjezeka mu chiwindi kuti amapezeka stasis venous, kutupa mu chiwindi ndi kapepala biliary, matenda pachimake (malungo, kolera, tayifodi, kamwazi), matenda enaake (siteji koyamba).
• Ngati malire m'munsi ali ankatembenukira oposa, n'zotheka kuganiza kuchepetsa kukula thupi (mwachitsanzo, pa magawo osachiritsika matenda enaake).
• Rearranging kwa chiwindi chapamwamba malire (kapena pansi) kawirikawiri limasonyeza kuwonongeka kwa chiwalo (mwachitsanzo, khansa chiwindi kapena echinococcosis). Nthawi zambiri zimawonedwa chifukwa malo okwezeka chifundamtima woyembekezera, ascites, flatulence, chifukwa pa otsika kabowo dongosolo visceroptosis, pneumothorax ndiko kumayambitsa komanso milandu kumaliseche kabowo pa chiwindi chifukwa kudzikundikira mpweya.
• M'mapapo mwanga infarction, makwinya mbali m'munsi, chibayo, pleurisy amaganiza amathanso yesezera ndi kusamutsidwa m'mwamba malire thupi chapamwamba.
• Nthawi zina, alipo osati kuti palpation wa m'mphepete mwa chiwindi, komanso thupi lonse. Kuti zimenezi zitheke, zala anayikidwa mwachindunji pansi lamanja costal Chipilala. dokotala pang'onopang'ono akukankha, kutsetsereka maphunziro kayendedwe chiwindi, mumayesto ndi pamwamba pake (nodular, yosalala, yosalala), kapangidwe (wandiweyani, zofewa), pamaso / pakalibe ululu.

• Myagkovataya, mosabisa, yosalala pamwamba ndipo anamaliza m'mphepete mwa mwachikondi - zizindikiro za kutupa mu thupi kapena chiwonetsero cha pachimake stasis magazi chifukwa chakuti mtima.
• Chimauma vuto lomwe m'mphepete zimawonedwa pa echinococcosis ndi chindoko. wandiweyani kwambiri ( "mtengo") anatsimikiza ndi chiwindi ziwalo kuonongeka ndi maselo a khansa.
• Plotnovata m'mphepete mwa chiwindi zikusonyeza chiwindi, ndi molumikizana ndi tuberosity wa - matenda enaake.
• Ululu pa palpation chiwindi angayambe chifukwa njira yotupa, kapena distension kapisozi ake (mu congestive chiwindi).

Palpation a chiwindi ana

Akufufuza mpata chiwindi akhanda zambiri ikuchitika pa m'ma clavicular ndi zapambuyo mizere axillary kupita palpation. Mu dzanja ili kufufuza zithunzi dokotala kansalu a chiwindi, kukhala kotheka osati kudziwa kukula kwa thupi, komanso palpation ziyenera a m'mphepete ake. Wakudziko kwa ana ndi ntchito ya m'mphepete kwa chiwindi wa Chipilala costal awiri (koma osati kwambiri) kwa centimeter a. Lowunikira kunachitidwa mu mzere midclavicular. thupi m'mphepete Choncho ayenera kukhala sabweretsa chisoni, yosalala, lakuthwa ndi zofewa zotanuka.

Ana athanzi osakwana zaka m'mphepete asanu ndi awiri a chiwindi, kawirikawiri mutuluka kuchokera Chipilala costal ndi ufulu lilipo chifukwa palpation. Pakuti ana athanzi kwa zaka zitatu, ponseponse ndiye matanthauziro a m'mphepete chiwindi ndi 2 kapena 3 cm pansipa lamanja costal malire. Patatha zaka zisanu ndi ziwiri za malire chiwindi zizigwirizana anthu akuluakulu.

Investigation a chiwindi unsembe Kurlova

Kutsimikiza matenda a ichi kapena icho kudwala kuti kumabweretsa kupotoza kukula thupi, ndikofunikira kugwira palpation a chiwindi Kurlov. Pakuti ichi ntchito pogogoda (percussion) kudziwa malire chapamwamba ndipo kenako palpated (kapena percussion) - m'munsi. Komanso, malinga ndi njira oblique wa m'mphepete m'munsi mwa malire ake, ndi mtunda pakati pa malire chapamwamba ndipo m'munsi ofunitsitsa ndi mfundo zitatu. Woyamba unali wolingana ndi mzere midclavicular, wachiwiri - pa midclavicular, ndi wachitatu - anachoka costal Chipilala. Kukula prefecture akhale 9, 8, 7 amanena motero.