Palpation kwesibindi: i Timiso, imithetho kanye okulotshiweyo

Palpation - eyodwa yezindlela kakhulu ulwazi of ukuhlola, eyenziwa odokotela at the stage of luhlolo kokuqala isiguli. Mayelana naye namuhla futhi sizobe ukukhuluma.

isibindi nokwakheka

Ngaphambi kokusuka ukuhlola udaba ka palpation kwesibindi, kufanele ichaze anatomy nomzimba imisebenzi. Isibindi elise ngokushesha ngezansi diaphragm, kuya kwesokudla phezulu esiswini, futhi ingxenye encane nje kuphela yomzimba omdala itholakala ngakwesokunxele (ngokuhambisana umugqa kusho). Ngo izinsana, isibindi ithatha ingxenye enkulu kakhulu esiswini.

isibindi Topographically has evele ezimbili futhi ebukhali izinsiko zombili. I anterior (engenhla) ebusweni adherent ebusweni diaphragm futhi mabhamuza ngokuvumelana ugobile yayo. Lower itholakala emva futhi ngezansi, nge okuvelayo ezimbalwa emazikweni eduze. I evele yasenhla nemithombo yasenzansi ahlukaniswe besaba usiko ephansi, omunye onqenqemeni (caudineural) Ngokuphambene, zibuthuntu kakhulu, ngakho-ke singasho sithi ebusweni umzimba labaqaphi elingemuva.

Hlukanisa esibindini izingxenye ezimbili: ilungelo elikhulu futhi aphansi kwesokunxele, ahlukaniswe umsipha ucwezana engxenyeni mahhala elisemandleni elicinene intambo fibrous - okubizwa ngokuthi umsipha isiyingi elisukela inkaba futhi akuyona esingaphezu umthambo yene enkabeni.

I Lobe sokunene ahlukaniswe emiseleni libe izabelo eziningana yesibili. Kwenye yalezi anemifantu zitholakala gallbladder futhi vena Vienna (engezansi) ahlukaniswe ihlule isibindi okuye kwabizwa ngokuthi neseleko Tailed.

Omunye izingxenye ezibalulekile emzimbeni kuyinto inkatho okujulile transverse ukuthi ubizwa ngokuthi isango isibindi. Ngalesi kumiswa emzimbeni makhulu Umthambo hepatic esangweni Vienna nezinzwa, nilishiye libe efferent imbobo hepatic (esiphuthumayo Bile ku gallbladder) kanye lymphatics.

Ilungelo Lobe umzimba angawodwa ingxenyenamba esiyisikwele lilinganiselwe esangweni kwesibindi, kanye nokubuya umsipha fossa we gallbladder, kanye caudate Lobe kuyoshaya lapho phakathi kwesango umthambo portal hepatic.

kokusebenza kwesibindi

• Umzimba (ukulawula exchange uketshezi, amaminerali namavithamini amaningi, ama-hormone, amino acid, lipids, amaprotheni, ama-carbohydrate).
• Ingabe imali (emzimbeni buthelela BZHU, amavithamini, amaminerali, ama-hormone).
• (Ukukhiqizwa Bile) Secretory.
• Detox (eyenziwa ngenxa ISIBINDI sikhipha yemvelo - macrophage hepatic).
• Excretory (by ngibopha glucuronic acid sulfuric ezinobuthi indole, tyramine, skotola).
• Homeostatic (isibindi ehilelekile kokulawulwa hemostasis angiogenic futhi umzimba umzimba).

Ngenxa izici morphological futhi zisebenza kahle kwesibindi ngokuvamile ngempela bamangazwa ezihlukahlukene kwezifo ezingathathelani futhi ezithathelanayo. Yingakho lapho yokwelapha yokuqala nesineke kuyadingeka ukuze ukuqhuba palpation zomzimba.

Palpation kanye eshaywayo isibindi

Ngaphambi isibindi kumba batusa besebenzisa eshaywayo ukunquma kwemingcele yayo. Lokhu ngeke nje ukuthi nokwami ukwanda umzimba, kodwa futhi ukuqonda lapho kufanele ziqale palpation. Lapho izicubu eshaywayo isibindi inika blunt (zibuthuntu) umsindo, kodwa ngenxa yokuthi umoya engxenyeni engezansi yamaphaphu kancane ihlanganisa kungenzeka ukunquma kwemingcele ezimbili: weqiniso eliphelele isibindi onokuqundeka, kodwa ngokuvamile ichaze umngcele (aphansi kanye engenhla) oyisiphukuphuku ngokuphelele.

Palpation komzimba (amasu)

Lapho ephenya ngokuthengwa isibindi kufanele alandele imithetho ethile:

• Isikhundla isihloko - elele emhlane wakhe, ikhanda kancane iyokhushulwa, nezinyawo zayo ngokulambisa ibheke emadolweni noma iqonde. Hands esifubeni sakhe, ukuze anciphise ukuhamba alo lapho ukuhogela futhi uphumule imisipha yakho besisu.
• Udokotela ungumuntu osifanele esigulini.
• udokotela ngakwesokunene kancane izimisele kubeka flat ku esiswini lesiguli endaweni ye hypochondrium kwesokudla, ngezansi amasentimitha emithathu kuya kwemihlanu, lokho liwumngcele kwesibindi eshaywayo ngaphambilini kuchazwe. Ngesandla sobunxele udokotela ihlanganisa kwesifuba (ilungelo layo phansi), ne iminwe ezine kufanele ibekwe ngemuva, futhi omunye (elikhulu) umunwe wagqoka lwaleli costal. Le ndlela sizonikeza baxhashazwe kwesifuba ngesikhathi ephefumula futhi ukwandisa displacement diaphragm phansi.

• Lapho exhales isiguli, udokotela kwamandla ukudansela isiginci sakhe phansi isikhumba, ezingena esokunene sakhe ngaphakathi komgodi ongaphakathi kwamathumbu libuze isiguli sengidonsa umoya. Ngalesi sikhathi, onqenqemeni (ephansi okuyingxenye) zomzimba uwela, lingena singene ephaketheni wadala futhi amaslayidi phezu iminwe. Ngesikhathi esifanayo ingalo palpable kumelwe sihlale umile. Uma ngasizathu simbe palpate kwesibindi ehluleka, inqubo iyaphindwa, kodwa iminwe dengwane ngamasentimitha ambalwa up. Khiqiza lokhu zokukhwabanisa, ezihambayo phezulu, kuyilapho ngakwesokunene engakhubeki phezu arc costal, noma kuze kube onqenqemeni Uphenyo isibindi.

Izici

• Khiqiza palpation kwesibindi ngokuvamile ngqo imisipha besisu (usiko yangaphandle) noma ilungelo umugqa maphakathi no-clavicular. Kodwa uma kunesidingo, kumba umkhiqizo imigqa emihlanu (kusukela anterior axillary ilungelo okologrudinnoy ngakwesokunxele).
• Endabeni ekuqongeleleni palpation besisu we lemiqulu emikhulu uketshezi nzima. Khona-ke yakhetha kumba iyasebenza nomqwayiba umzimba. Ngenxa yale njongo, iminwe yesibili, yesithathu neyesine ka-ngakwesokunene khahlela-abelula ngezihluthu udonga besisu, eqalile phansi ziphethe lwaleli costal kuze kube ukuthola ukwakheka elicinene - isibindi. Phakathi umzimba lokuqala ubabonisa ekujuleni iphiko, bese ebuya futhi uhlevane kwi iminwe (uphawu ngokuthi "elintantayo ucezu ice").

Ukuhunyushwa Imiphumela (evamile)

Yeka ukuthi kungaba nemiphumela kumele sibonise palpation kwesibindi?

• Ngokuvamile, 88% of the iziguli umzimba onqenqemeni engezansi itholakala emhlabeni lwaleli costal, ngokuvumelana maphakathi nawo-clavicular umugqa kwesokudla.
• Ngo nomzimba womuntu enempilo engcupheni abukhali noma kancane babanjwa. Kuyinto soft, ngaphandle kobuhlungu, podvorachivaetsja lula ngaso palpation, bushelelezi.

Ukuhlolwa idatha (zokugula)

• Uma isibindi lakhulisiwe, palpation kuyothiwa akhiwe ngezansi lwaleli costal, ongathuthukisa afakaze shift wakhe. Ukweseka lokhu noma ukuthi ukwamukelwa kuyadingeka ukuze eshaywayo, ukuze kutholakale imingcele emzimbeni.
• Uma usayizi isibindi engashintshwa, kodwa imingcele onokuqundeka hepatic sigudluke phansi - uphawu isitho prolapse.
• Offset kuphela umngcele engezansi ibonisa ukwanda isibindi ezenzeka stasis emithambo yegazi, ukuvuvukala esibindini futhi ipheshana biliary, izifo sibi (umalaleveva, ikholera, typhoid, isifo sohudo), isifo sokusha (esigabeni sokuqala).
• Nangabe ubude obulindelweko aphansi kugudlukela phezulu, kungenzeka ukuba usola ukuncishiswa ngobukhulu umzimba (isb, ngesikhathi izigaba esibulalayo ngokoma kwesibindi).
• Rearranging hepatic umngcele engenhla (phezulu noma phansi) akuvamile kubonisa umonakalo isitho (isib nomdlavuza wesibindi noma echinococcosis). Ezimweni eziningi siyenzeka ngenxa esiphakeme diaphragm ngesikhathi sokukhulelwa, ascites, ukubuyisa, ngoba ongaphakeme beso ilungiselelo visceroptosis, pneumothorax, emphysema, kanye ezimweni of a beso osenyameni kwesibindi ngenxa ekuqongeleleni igesi.
• infarction yamaphaphu, ukuba nemibimbi ingxenye yalo ephansi, i-pneumonia, pleurisy emaceleni futhi bangase balingise displacement phezulu umngcele somzimba wakhe.
• Kwezinye izimo, alitholakali nje kuphela palpation ka emaphethelweni isibindi, kodwa futhi wonke umzimba. Kuze kube yimanje, iminwe ibekwe ngqo ngaphansi kwesokudla lwaleli costal. Udokotela ngobumnene ukusunduza, beya ezifundweni ukunyakaza isibindi, ukuhlola kanye ubuso bayo (nodular, abushelelezi, bushelelezi), ukuthungwa (obukhulu, ethambile), khona / ukungabikho ubuhlungu.

• Myagkovataya, flat, surface bushelelezi futhi onqenqemeni oyindilinga ngimnene - izimpawu ukuvuvukala emzimbeni noma ukubonakaliswa acute igazi stasis ngenxa yokuhluleka inhliziyo.
• Lumpy, esingemnandi, onqenqemeni obukhulu siyenzeka at echinococcosis nogcunsula. obukhulu kakhulu ( "ukhuni") inqunywa isibindi izitho kabana amangqamuzana omdlavuza.
• onqenqemeni Plotnovata kwesibindi kusikisela ukushisa kwesibindi, ngokuhlanganyela tuberosity - isifo sokusha.
• Ubuhlungu ku palpation kwesibindi singenzeka ngenxa izinqubo ukuvuvukala, noma distension yayo capsule (e isibindi congestive).

Palpation kwesibindi ezinganeni

Iphenya isibindi kuzalwa, ngokuvamile eyenziwa maphakathi no-clavicular futhi anterior axillary imigqa yokuhamba palpation. Kulesi isandla ihlola amaslayidi wezingane umphetho kwesibindi, senza akwazi ukubonisa hhayi kuphela ukucacisa ubukhulu umzimba, kodwa futhi ukuhlolwa palpation nasemaphethelweni ayo. Norm izinsana Yizinga nasemaphethelweni hepatic lwaleli costal ku ezimbili (kodwa hhayi ngaphezulu) of a isentimitha. Ukuhlolwa lwenziwe emgqeni midclavicular. umzimba onqenqemeni ngaleyo ndlela kufanele kube kobuhlungu, bushelelezi, abukhali futhi soft nokunwebeka.

Ngo banezingane eziphile kahle ezingaphansi kweminyaka engu-eziyisikhombisa onqenqemeni kwesibindi, ngokuvamile kuphuma kusukela lwaleli costal futhi ilungelo iyatholakala palpation. Ukuze izingane enempilo kuze kube iminyaka emithathu, kuyinsakavukela kuyinto kwencazelo onqenqemeni isibindi kuyinto 2 noma 3 cm ngezansi kwesokudla wekhasi costal. Ngemva kweminyaka eyisikhombisa kwemingcele isibindi zivumelana labo abadala.

Ukuphenywa isibindi ngendlela Kurlova

Ukuqinisekisa sitholakele lokhu noma lokhuya zokugula eholela ukuhlanekezela usayizi umzimba, idingekile ukuze palpation kwesibindi Kurlov. Ngenxa yalesi ukusebenzisa u- (eshaywayo) ukunquma mkhawulo bese palpated (noma eshaywayo) - ephansi. Ngaphezu kwalokho, ngokuhambisana inkambo etshekile of onqenqemeni engezansi walo, kanye nebanga phakathi kwemingcele engenhla nengezansi zinqunywa amaphuzu amathathu. Eyokuqala sifana umugqa midclavicular, owesibili - the midclavicular, kanti eyesithathu - kwesokunxele lwaleli costal. Usayizi Prefecture kufanele kube 9, 8, 7 ubheke ngokulandelana.