Palpation we ubende: algorithm nobuchwepheshe

Ubende - isitho ayibhangqiwe ukuthi itholakala ohlangothini lwesobunxele esiswini. Ngaphambili ingxenye yomzimba eyakhelene esiswini, futhi emuva - kuze izinso, adrenal kanye emathunjini.

Isakhiwo ubende

Ukwakheka ubende kuchazwe ikhava serous futhi capsule yangasese, lona wamuva ezakhiwe inhlanganisela ezicutshini, muscle and imicu enwebekayo yezicubu.

I capsule ludlulele lwamathambo omzimba, yahlukanisa uginindela (the parenchyma) ku ehlukile "iziqhingi" nge trabecular. Ngo uginindela (ezindongeni arteriole) ahlelwe round noma ngamaqhubu okusaqanda ka lymphoid (lymph follicle). At inhliziyo uginindela kuyinto indwangu reticular eligcwele ezihlukahlukene amaseli: amangqamuzana abomvu egazi (ikakhulukazi ezibolile), leukocyte nama-lymphocyte.

isitho umsebenzi

• Ubende ohilelekile lymphopoiesis (ie umthombo lymphocyte).
• Ubamba lichaza lo hematopoietic futhi mzimba nemisebenzi umzimba.
• Ukubhujiswa kwabantu qeda we-platelet ne-amangqamuzana abomvu egazi.
• Sebethule igazi.
• Ngo kusaqalwa embryogenesis isebenza njengoba isitho hematopoietic.

Okusho ukuthi, umzimba wenza imisebenzi eminingi ebalulekile, ngakho ukunquma kwezinso ku kusaqalwa inhlolovo kumele ukuqaliswa lokuqala palpation kanye eshaywayo we ubende.

I-oda palpation yezitho zangaphakathi

Ngemva lokuqoqa izikhalazo, umlando wezokwelapha kanye ukuxilongwa okwejwayelekile, udokotela ngokuvamile iqala ukuba izindlela ngokomzimba zokutadisha, nakho zihlanganisa palpation kanye eshaywayo.

ukuhlukanisa:

• Surface palpation lapho Kutholwe soreness obuhlukahlukene ensimini voltage imisipha besisu, ukuvuvukala, kanye ezihlukahlukene seal kumiswa (umbhunu, izimila, isizinda). Bawuthwale ingcindezi emnene iminwe isigamu-uzimisele, kusukela kwesobunxele iliac esifundeni kwewashi.
• palpation Deep kwenziwe ukulandelana elandelayo: izimpumputhe , ileum (ekugcineni ingxenye), ikholoni (zehla izigaba ukwehla), transverse ikholoni amathumbu, isisu, isibindi, amanyikwe, ubende, nezinso, wenziwa usebenzisa Ukungena iminwe ezijulile udokotela e komgodi ongaphakathi kwamathumbu.

Endabeni izinsolo izifo splenic (noma izithelo zawo ngenxa isifo sesibindi) ebambe eshaywayo ngempela, a palpation kwesibindi kanye ubende.

Imithetho General palpation

Palpation (palpation) we ubende - eyodwa yezindlela kakhulu ulwazi locwaningo ngokomzimba, olwenziwa udokotela. Endabeni ukukhuphuka kancane emzimbeni, uma ubende akulula ukuba kuphenywe, qiniseka udokotela uncoma ukudlula ultrasound ukuqinisekisa / ekuphikiseni zokugula Kusolakala e ingane noma umuntu omdala.

isimo lesiguli:

• Lisalele (kulesi sikhundla Kunenkolelo palpation sesibindi ubende).
• Ngohlangothi sakhe sokunene. Isandla sokunene siphansi kwekhanda lami, futhi kwesokunxele kufanele ibheke endololwaneni, babeka esifubeni sakhe (le ndlela ibizwa ngokuthi palpation we ubende of Sali). Ngaphezu kwalokho, ikhanda lesiguli kufanele kancane esitshekile esifubeni, kwesokudla umlenze ngqo nomlenze kwesokunxele kufanele ibheke at inyonga nedolo amalunga omzimba.

Palpation we ubende: algorithm

1. Yakhe udokotela isandla sobunxele kumele kahle ukuze sisekuciniseni ohlangothini lwesobunxele kwesifuba mayelana nale ndaba, isikhawu phakathi 7th futhi ubambo 10th ngokuhambisana axillary imigqa, ukunikeza ingcindezi kancane. Lapho iminwe yesandla sokunene kumele babe nengxenye-uzimisele futhi etholakala ngakwesokunxele lwaleli costal ukuze umunwe phakathi eseduze ubambo 10th.
2. Lapho isiguli siphefumula e, isikhumba kugudlukela phansi ukwakha emphethweni isikhumba.
3. Ngemva isandla okhishwa ngamakhala kadokotela lingena esiswini (esiswini).
4. Isiguli ngesicelo udokotela ethatha umoya kakhulu, kuyilapho ngaphansi kwethonya diaphragm ubende wehlela. Endabeni okwandisa udokotela iminwe uzohlangana isigxobo yayo aphansi. Lezo kumele liphindwe izikhathi eziningana.

ukuhumusha imiphumela

Ngaphansi kwezimo ezivamile (kubantu enempilo), ubende akuyona palpable. Okuhlukile asthenics (ikakhulukazi abesifazane). Palpate ubende kwezinye izimo kungase kube ukungenzi diaphragm (pneumothorax, pleurisy) kanye splenomegaly, okungukuthi, ukwanda ngobukhulu umzimba. Isimo esifana landile uthi ezilandelayo:

• Izifo yegazi.
• pathologies isibindi Okungalapheki (splenomegaly lapha kuwuphawu nomfutho wegazi ophezulu portal noma hepatolienal syndrome).
• Acute nezinqubo ezithathelwanayo okungamahlalakhona (endocarditis ukutheleleka, umalaleveva, i-typhoid fever, sepsis).
• Izifo ezicutshini.
• Infarctions noma abscesses we ubende.

Ngokuvamile, ngisho palpation kobuhlungu ubende lakhulisiwe. Okuhlukile isitho infarcts, okusheshayo eqine amaphilisi episplenitis. Kulezi zimo, ubende siba nezinzwa ezisenza sizwele kakhulu (okungukuthi, okubuhlungu palpation).

Ngo isifo sokusha kwesibindi nakwezinye izifo we onqenqemeni ubende of obukhulu, izinqubo-acute efanayo - esithambile.

Ukungaguquguquki ngokuvamile omnene izifo sibi, izifo ezingamahlalakhona kanye isibindi sibe sesomile iba obukhulu.

Ngakho ukukhulisa palpated umzimba ingxenye kungenzeka ukubaluleka emincane noma emikhulu, futhi kanjani ubende baphotha aphume imiphetho kungase kubonise ngokwezinga kweqiniso umzimba emikhulu. Ngakho, ukukhuphuka elincane ubonisa emphethweni okukhipha umzimba lwaleli costal at 2-7 cm, okuyinto okubonakale izifo sibi (typhoid, meningitis, sepsis, lobar inyumoniya, njalo njalo) noma izifo (isifo senhliziyo, isifo sokuqina kwesibindi erythremia, wegazi, isifo sokulahlekelwa igazi) futhi omsakazo engaziwa ukuthi isikhathi esiningi siye sitholakale kubantu abasha (cishe ugcunsula ngofuzo yamathambo)

Ngakho ukuminyana ubende palpable onqenqemeni (uma ukwanda) kungenzeka ukuba bafinyelele iziphetho mayelana nenqubo kadokotela. Okungukuthi, abangabantwana eside yisishiso ekhona emzimbeni, luthe ukuqina, kanti kunokukwenza parenchyma yayo, kusukela lapho kusobala ukuthi elithambile kakhulu futhi nezimo kuka e ezingamahlalakhona ubende onqenqemeni kuzinqubo oyingozi.

Lapho umzimba likhulu kakhulu, lapho onqenqemeni engezansi ichazwa ngalo ingaphakathi okhalo, ukuqhuba palpation we ubende silula futhi ayidingi amakhono akhethekile.

Endabeni splenomegaly okuholela izimila splenic ngu palpation (ngokunembile, Margo yayo crenatus) zinqunywa a Burr (1 kuya 4). uphawu okunjalo zokuxilonga kubonisa khona amyloidosis, ene-leukemia (ezingamahlalakhona myelogenous noma psevdoleykemii), umalaleveva, izinhlumba futhi endothelium.

Okungukuthi, phakathi palpation ubende udokotela uyakwazi ukuhlola isimo ubuso bayo, ukuthola fibrin sebethule (njengalapho perisplenitah), ziboya ehlukahlukene (okungukuthi, ngokwesibonelo, abscesses, ukopha futhi izinhlumba serous, echinococcosis) kanye ukunquma kwabantu nezicubu. Ngo abscesses ngokuvamile atholakala nokushintshashintsha. Konke kunqunywa inani palpation ibaluleke kakhulu ukuze kuhlonzwe izifo eziningi ubende, futhi incazelo isifo, okungase kuholele splenomegaly.

Ubende evamile Itholakala kwesokunxele esifundeni subcostal, kuma-axis awo eside amanga kanye ubambo yeshumi. Authority ine okusaqanda (emabhontjisi) ukuma.

Ubende ezinganeni

Ubukhulu we ubende kungokwemvelo, kuye ngokuthi yobudala:

• Neonates: ububanzi - 38 kwangu ubude - kuze kufinyelele 40 kwangu.
• iminyaka 1-3: ubude - kuze kufinyelele 68 kwangu, ububanzi - kuze kufinyelele amamilimitha angu-50.
• iminyaka 7: obuphelele - 80 mm, nobubanzi - kuze kufinyelele 55 kwangu.
• iminyaka 8-12: ububanzi - kuze kufinyelele amamilimitha angu-60 ubude - kuze kufinyelele 90 kwangu.
• iminyaka engu-15: ububanzi --60 mm, futhi ubude - 100-120 mm.

Kufanele kukhunjulwe ukuthi palpation we ubende ezinganeni kanye abadala, kufanele kube kobuhlungu, ngaphezu, ubende kuyinto evamile e ingane akunqunywa. Amasayizi Izindaba ezingenhla azilona ngokuphelele, okungukuthi, ngeziphambeko ezincane bebheke ngincipha / okwandisa umzimba akudingekile kumelwe libhekwe njengelingcwele Ubukhulu sokugembula.

ubende eshaywayo

Le ndlela isetshenziswa ukulinganisa Ubukhulu (imingcele) komzimba.

Sibekezele ibekwa kwesokudla polubokovoe isikhundla ngezandla ibekwe phezu kwekhanda, ngezinyawo zakhe ngokulambisa ibheke at inyonga nedolo amalunga omzimba. Percuss elandelayo, ayesuka ecacile udosi lwepeni umsindo usebenzisa amagalelo ethule percussive.

Ethwele eshaywayo

1. Umunwe-plessimetr kumele ukufakwa onqenqemeni lwaleli costal ohlangothini lwesobunxele yomzimba perpendicular ubambo 10th.
2. Chitha eshaywayo buthaka ubambo 10th, ekuqaleni lwaleli costal (ngakwesokunxele) kuze umsindo zibuthuntu (blunting). Ngesikhathi ukwedlulela umsindo wenze uphawu esikhunjeni. Khona-ke percussing kusukela umugqa axillary (bakhulise) anteriorly kuze ukubulala umsindo futhi ubeke uphawu esikhunjeni.
3. ingxenye obuphelele phakathi amamaki - kuyinto ubende dlinnik (noma ubambo 10). Ngokuvamile, le nkomba 6-8 amasentimitha.
4. Kusukela maphakathi no dlinnika le perpendicular ubambo yeshumi futhi ukhiqiza eshaywayo okwengeziwe ukunquma ububanzi we ubende, okuyinto evamile zokhahlamba kusuka 4 kuya ku-6 ngamasentimitha.
5. Ngokuvamile, ngaphambili ingxenye ubende (ie usiko) Ningangeni umugqa medial exhumanisa ekupheleni mahhala ubambo 11 kanye ngokuhlanganyela sternoclavicular. Kufanele kuqashelwe ukuthi ukubala usayizi ubende usebenzisa eshaywayo - sibalo eseduze kakhulu. usayizi isitho liqoshwe njengombhali ingxenyenamba, lapho numerator - kuyinto dlinnik, kanye zihilela - ububanzi we ubende.