腹部常见病变的症状与体征

The Abdominal Examination,董国芳,腹部常见病变的症状与体征,胃、十二指肠溃疡 急性腹膜炎 肝硬化 急性阑尾炎 急性肠梗阻 腹部包块,胃、十二指肠溃疡,症状 特点:节律性 周期性 季节性 慢性复发性 体征 并发症,急性腹膜炎,范围：弥漫性、局限性来源：继发性、原发性性质：无菌性、感染性,腹膜炎三联征,压痛反跳痛腹肌紧张,肝 硬 化,症状： 代偿期 失代偿期 体征,门静脉高压的表现,腹水侧支循环的建立与开放 脾肿大,食管和胃底静脉曲张 腹壁静脉曲张 痔静脉曲张,Appendicitis,Pain usually starts periumbilically(脐周）and migrates to the RLQCoughing usually exacerbates（加剧） pain. Time course is less than 36 hours. Any pain in RLQ is suspicious for appendicitis.,急性阑尾炎,麦氏点压痛与反跳痛Rovsing sign阳性Psoas sign腰大肌征阳性直肠右前壁触痛或触及肿块严重者可及局部腹肌紧张,Appendicitis,May see early voluntary guarding and then involuntary guarding Needed to also perform a rectal exam and gynecologic exam to rule out other causes,Acute Cholecystitis,Inflammation of the gallbladder due to gallstones with associated inflammation. Patients usually have fever, RUQ tenderness and a + Murphys sign. Murphys sign: inspiratory arrest during deep palpation of the RUQ,肠梗阻,原因机械性动力性血管性,肠梗阻,临床表现：痛、吐、胀、闭体征：腹部膨胀 肠型和蠕动波 压痛和反跳痛 肠鸣音改变,腹 部 包 块,病因：,炎症性肿瘤性梗阻性先天性寄生虫性其他,1.炎症性,肝炎胆囊积液阑尾脓肿回盲部结核盆腔结核肾结核,2.肿瘤性,肝癌胆囊癌胃癌结肠癌卵巢癌子宫肌瘤肾癌卵巢囊肿白血病浸润脾脏,3.梗阻性,幽门梗阻肝淤血肠套叠尿潴留肾盂积水,4.先天性,多囊肾肝囊肿,5.寄生虫性,肝包虫病肠虫症血吸虫病致脾肿大,腹块体检的注意点,位置 大小 形态 质地 压痛 搏动 活动度,正常腹部可能触及的“包块”,腹直肌肌腹与腱划锥体与骶骨岬乙结肠与粪块横结肠盲肠剑突,腹部各区常见包块,上腹部左上腹部右上腹部,腹部各区常见包块,脐部包块 左下腹 右下腹 下腹部,Final tips,ALWAYS do a rectal exam as part of the abdominal exam when possible. ALWAYS consider gynecologic or obstetric（妇产科） causes of abdominal pain in women (and check for pregnancy status). ALWAYS examine the groin and upper thigh to rule out inguinal and femoral hernias （腹股沟疝）as a source of pain.,小 结,分区检查者和被检查者 站位,爱伤观念 体位,暴露范围顺序(听诊)可及与不可及可信与不可信轻重缓急,Please note the following:A normal kidney is not palpableA normal liver edge may be palpableA palpable spleen is considered en