Palpation a ndulu ndi: ndi aligorivimu ndi luso

Ndulu - unpaired limba kuti ili kumbali yakumanzere ya pamimba. Kutsogolo thupi gawo lanji pafupi m'mimba, ndipo kumbuyo - kwa impso, adrenal ndi intestine.

Kapangidwe ka ndulu ya

The zikuchokera kumatanthauza ndulu serous chivundikirocho ndi kapisozi payekha, yotsirizira popangidwa ndi osakaniza minofu connective, minofu ndi ulusi zotanuka.

The kapisozi akudutsa mu mafupa a thupi, kulekanitsa zamkati (a parenchyma) mu osiyana "zilumba" ndi trabecular. Mu zamkati (mpanda wa arterioles a) imakonzedwa chonse kapena tinatake tozungulira chowulungika minofu lymphoid (lymphoid follicles). Pa mtima zamkati ndi a reticular nsalu wodzala zosiyanasiyana maselo maselo ofiira a magazi (makamaka kuvunda), leukocytes ndi lymphocytes.

ntchito limba

• Ndulu ndi kulowerera lymphopoiesis (ie gwero la lymphocytes).
• Nawo mu hematopoietic ndi chitetezo ntchito za chamoyo.
• Chiwonongeko cha utsi wa maselo othandiza magazi kuundana ndi maselo ofiira.
• Mafunsidwe a magazi.
• Mu magawo oyambirira embryogenesis ntchito monga chiwalo hematopoietic.

Ndiko kuti, thupi amagwira ntchito zambiri zofunika, choncho kudziwa kuvutika mu magawo oyambirira a kafukufuku ayenera kukhazikitsa woyamba wa palpation ndi percussion a ndulu ya.

Dongosolo la palpation a ziwalo

Pambuyo kusonkhanitsa madandaulo, mbiri zachipatala zoona ambiri, dokotala zambiri wayamba njira thupi la kafukufuku, monga palpation ndi percussion.

kusiyanitsa:

• Pamwamba palpation imene wapezeka soreness osiyanasiyana m'munda voteji minofu m'mimba, kutupa, ndipo zosiyanasiyana chisindikizo mapangidwe (chophukacho, zotupa, mfundo). Kulinyamula ndi wofatsa kuthamanga theka akuyesetsa zala, kuyambira kumanzere iliac dera counterclockwise.
• Nato palpation ikuchitika mu ndondomeko izi: akhungu , ileum (mapeto gawo), m'matumbo (akwera zigawo ukutsika), yopingasa m'matumbo intestine, m'mimba, chiwindi, kapamba, ndulu, impso, ikuchitika ntchito kwambiri malowedwe zala dokotala zonse m'mimba.

Pankhani ya kukayikitsa matenda splenic (kapena kuchuluka kwake chifukwa chiwindi matenda) akugwira percussion kwenikweni, ndi palpation chiwindi ndi ndulu.

malamulo General palpation

Palpation (palpation) a ndulu ya - mmodzi wa njira zambiri zothandiza pa kafukufuku thupi, wochitidwa ndi dokotala. Mu nkhani ya kuchuluka pang'ono m'thupi, pamene ndulu si kophweka kufufuzanso, onetsetsani dokotala akuonetsa Ndime ya ultrasound kutsimikiza / kutsutsa kudwala ananena mu mwana kapena wamkulu.

za wodwalayo:

• Supine (mu udindo uwu umachitika palpation chiwindi ndi ndulu).
• Kunama mbali lake lamanja. Dzanja lamanja ndi pansi pa mutu wanga, ndipo kumanzere ayenera ndichotse pa chigongono, namsenza pamtima (njira imeneyi imatchedwa palpation a ndulu ya Sali). Komanso, mutu wodwalayo ayenera pang'ono linapendekeka m'chifuwa, pomwe mwendo molunjika ndi mwendo kumanzere ayenera ndichotse pa ntchafu ndipo bondo mafupa.

Palpation a ndulu kuti: aligorivimu

1. Lake dokotala dzanja lamanzere ayenera pabwino kuti yankholo kumanzere kwa bokosi phunziro, ndi imeneyi pakati pa 7 ndi 10 nthiti malinga ndi mizere axillary, ndi kupereka kuthamanga pang'ono. Pamene zala za dzanja lamanja ayenera theka akuyesetsa ndi ili kumanzere costal Chipilala kuti chala chapakati pafupi ndi nthiti 10.
2. Pamene wodwalayo amapuma mu, khungu ankatembenukira downwards kupanga khola la khungu.
3. Pambuyo dzanja mpweya dokotala likulowerera mimba (pamimba).
4. Wodwala ngati pempho la dokotala amatenga mpweya kwambiri, pamene mchikakamizo cha ndulu zakulera ukusunthira pansi. Pankhani ya kukula zala dokotala angakumane nazo mtengo wake m'munsi. Zimenezi ziyenera mobwerezabwereza kangapo.

kutanthauzira zotsatira

M'mikhalidwe yachibadwa (anthu athanzi), ndulu si palpable. Kuchotserapo ndi asthenics (makamaka akazi). Palpate ndulu zina zikhoza kukhala pa kuchotsa pa zakulera (pneumothorax, pleurisy) ndi splenomegaly, ndiko kuti, kuchuluka kukula thupi. A chikhalidwe chofanana ndi wamba limati zotsatirazi:

• Matenda a magazi.
• Aakulu chiwindi pathologies (splenomegaly muli chizindikiro cha matenda oopsa zipata kapena matenda hepatolienal).
• Pachimake ndi aakulu njira opatsirana (endocarditis matenda, malungo, tayifodi, sepsis).
• Matenda a minofu connective.
• Infarctions kapena abscesses a ndulu ya.

Nthawi zambiri, ngakhale palpation sabweretsa chisoni zikuluzikulu ndulu. Kuchotserapo ali chiwalo infarcts, mofulumira kwamakokedwe makapisozi episplenitis. Mu milandu, ndulu amakhala tcheru kwambiri (ie, chopweteka pa palpation).

Mu matenda a chiwindi ndi matenda ena okhalitsa a ndulu m'mphepete mwa yowirira njira pachimake chomwecho - zofewa.

Malamulowo zambiri wofatsa mu matenda pachimake, matenda aakulu chiwindi matenda enaake amakhala wandiweyani.

Choncho magnification palpated thupi gawo angakhale ang'onoang'ono kapena akuluakulu phindu, ndi mmene ndulu anawomba nsalu kuchokera konsekonse zingasonyeze mmene woona thupi zikuluzikulu. Choncho, kuchuluka ochepa kumasonyeza linanena bungwe thupi m'mphepete mwa Chipilala costal pa masentimita 2-7, amene asunga mwa matenda pachimake (typhoid, kakhosi, sepsis, lobar chibayo, ndi zina zotero) kapena matenda aakulu (matenda a mtima, matenda enaake, erythremia, khansa, magazi m'thupi) ndi cha etiology osadziwika kuti limapezeka kaŵirikaŵiri achinyamata (mwina chindoko cholowa, rickets)

Choncho kachulukidwe palpable ndulu m'mphepete (ngati kuchuluka) n'zotheka mumakumbukira nthawi za ndondomeko mankhwala. Ndiko kuti, kwa nthawi yaitali kutupa pano mu thupi, lolemererapo ndi kovuta kuposa parenchyma ake, amene ndizoonekeratu kuti zofewa kwambiri ndi kusintha kusiyana aakulu ndulu m'mphepete mwa njira pachimake.

Pamene thupi ndi waukulu kwambiri, pamene m'mphepete m'munsi akufotokozera M'mimbamo m'chiuno, kuchititsa palpation a ndulu ndi lophweka ndi sikutanthauza luso.

Pankhani ya splenomegaly chifukwa zotupa splenic ndi palpation (yeniyeni, margo ake crenatus) ofunitsitsa ndi burr (1 mpaka 4). Chotero chizindikiro matenda limasonyeza kukhalapo kwa amyloidosis, khansa (aakulu myelogenous kapena psevdoleykemii), malungo, cysts ndi endothelium.

Ndiko kuti, pamene ndulu palpation dokotala amatha kuona chikhalidwe cha pamwamba pake, kuti azindikire Ulimbo mafunsidwe (monga pamene perisplenitah), protrusions zosiyanasiyana (kuti Mwachitsanzo, abscesses, magazi ndi cysts serous, echinococcosis) ndi kudziwa osalimba a minofu. Mu abscesses Nthawi zambiri ndipo fluctuation. Chirichonse anatsimikiza ndi mfundo palpation ndi wapatali kwambiri kwa matenda a matenda ambiri a ndulu, ndi tanthauzo la matenda, zomwe zingachititse kuti splenomegaly.

Ndulu yachibadwa lili kumanzere subcostal dera, nguli yaitali mabodza pamodzi nthitiyo chakhumi. Authority ali ndi chowulungika (nyemba) mawonekedwe.

Ndulu ana

Miyeso ya ndulu ndi wabwinobwino, malingana ndi zaka:

• Neonates: m'lifupi - mpaka 38 millimeters m'litali - mpaka millimeters 40.
• zaka 1-3: kutalika - mpaka millimeters 68, m'lifupi - 50 millimeters.
• zaka 7: kutalika - 80 mm, m'lifupi - mpaka 55 millimeters.
• zaka 8-12: m'lifupi - 60 millimeters m'litali - mpaka 90 millimeters.
• Zaka 15: m'lifupi - 60 mm, kutalika - 100-120 mm.

Tiyenera kukumbukira kuti palpation a ndulu ana komanso akulu, ayenera kukhala sabweretsa chisoni, kuwonjezera, ndulu yachibadwa mu mwana sanalemberetu. The makulidwe pamwamba ndi malire, ndiye zolakwika yaing'ono motsogozedwa kucheperachepera / kuwonjezeka thupi Sikuti kuonedwa monga miyeso pathological.

ndulu percussion

Njira ntchito amanena miyeso (malire) za thupi.

Wodwala aikidwa mu lamanja polubokovoe malo ndi manja anaikidwa pa mutu, ndi mapazi ake atachoka ndichotse pa ntchafu ndipo bondo mafupa. Percuss motere zopita bwino wowachititsa phokoso ntchito chete percussive nkhonya.

kunyamula percussion

1. Chala-plessimetr ayenera kuikidwa pa m'mphepete mwa Chipilala costal kumanzere ya thupi perpendicular kwa nthiti 10.
2. Muzicheza ofooka percussion pa nthiti 10, chiyambi cha Chipilala costal (kumanzere) mpaka phokoso kuzimiririka (blunting). Pa kusintha kwa phokoso kupanga chilemba pa khungu. Ndiye percussing ku mzere axillary (kumbuyo) anteriorly mpaka phokoso mochititsa ndiponso anaika chizindikiro pa khungu.
3. gawo kutalika pakati zizindikiro - ndi dlinnik ndulu (kapena 10 nthiti). Mwachibadwa, chizindikiro ichi ndi 6-8 masentimita.
4. Kuyambira m'ma dlinnika ndi perpendicular kwa nthiti lakhumi ndi amabala percussion kuti adziwe ndi awiri a ndulu, amene bwinobwino ranges ku masentimita 4 mpaka 6.
5. Mwachibadwa, mbali kutsogolo kwa ndulu ya (ie m'mphepete ake) Musapite medial mzere kuti zikugwirizana ndi ufulu mapeto a nthiti 11 ndi olowa sternoclavicular. Tikumbukenso kuti mawerengedwe a kukula kwa ndulu ntchito percussion - pafupifupi kwambiri. kukula limba ananena kachigawo ndi kumene numerator - ndi dlinnik, ndi chimene chachititsa - m'mimba mwake wa ndulu ya.