Palpation o ka spleen: he algorithm a me ka 'ike loea hou

Spleen - unpaired hui, i ua aia ma kaʻaoʻao hema o ka abdomen. Ka mua kino hapa i mea e pili ana i ka opu, a me ka hoʻi - a hiki i ka hakuʻala, adrenal a me ka naʻau liʻiliʻi.

Ka 'ole o ka spleen

Ka haku mele 'ana i ho'ākāka' spleen serous aloha a me ka paulele i ka hoʻomana mea hōʻikeʻikeʻuʻuku, ka hope i hanaʻia e kekahi hui malu pu ana o connective'aʻaʻa, Muscle a me ka laholio olona.

Ka mea hōʻikeʻikeʻuʻuku ae i loko o ka iwi o ke kino, e hoʻokēʻai i kaʻiʻo pepa (ka parenchyma) i loko o kaawale "mokupuni" me ka trabecular. Ma kaʻiʻo pepa (na paia o na arterioles) e hoonohonoho a a me ka'ololaha nodules o lymphoid'aʻaʻa (lymphoid follicles). Ma ka naau o kaʻiʻo pepa o ka reticular lole a ua hoopihaia me kaʻano o ke keena: ulaula koko aeee (ka hapanui e amo), leukocytes a me lymphocytes.

hui, kēia kuleana pili i

• Ke spleen Ua hoʻomau ana ma ka lymphopoiesis ( 'o ia hoʻi ke kumu o lymphocytes).
• 'Oe e komo i loko o ka hematopoietic a me ka'ōnaehana paleʻea oihana o ka meaola.
• I ka make ana o ke a no ka maluhiluhi o platelets a me kaʻulaʻula koko keena.
• Palapala moʻopane o ke koko.
• Ma nā kahua o ka hoʻonaʻauao kakahiaka nui o ka embryogenesis hana like me ka hematopoietic hui,.

Ia mea, i ke kino hanaʻia he nui nui oihana, a no ia mea, e hooholo abnormalities i loko o nā kuʻina kakahiaka o ka anamanaʻo pono mua manaʻo o ka palpation a me percussion o ka spleen.

Ka mea o ka palpation o na nā loko

Ma hope o kaʻohiʻohi hoopii, 'inikua mōʻaukala a me ka mau ninaninau, ke kauka ana hoʻomaka i physical ano o ke ao, i nā palpation a me ka percussion.

hoomaopopo:

• ʻilikai palpation ma i ia akulla soreness e loli iki kahua anakahi uila abdominal nāʻiʻo, haanou ana, a me keʻano o ka hōʻailona, ho okumu (hernia, hikoko, aka wahi). E lawe aku ia ma akahai puʻe hapa-manao manamana lima, e hoʻomaka ana mai ka hema iliac māhele counterclockwise.
• Deep palpation lawe mai i loko o ka kēia kaʻina: makapo , ileum (hopena aoao), AeXIeAaOIePEAaI (e pii aku ana, a iho mai ana na pauku), transverse AeXIeAaOIePEAaI naʻau liʻiliʻi, opu, akepaa, pancreas, spleen, puupaa, ua lawe mai ka hoʻohana hohonu anal manamanalima kauka i loko o ka abdominal lua.

Ma ka hihia o ka hoʻohuoiʻia o splenic mai (a me kona mea ulu no ke ake maʻi) e paa ana percussion pono, he palpation ke ake a me ka spleen.

General lula palpation

Palpation (palpation) o ka spleen - kekahi o ka loa informative ano o physical noiʻi, lawelawe 'ia e ke kauka. Ma ka hihia o ka hōʻemi iki mahuahua i loko o ke kino, i ka wa a ka spleen mea i oluolu i kaʻimi, eʻoiaʻiʻo i ke kauka ia kekahi e hooholo ia ana o ultrasound e hōʻoia / hōʻoleʻia kāna i ka oleloia pathology i loko o ke keiki a me ka makua.

ka hoʻomanawanui ka kūlana:

• Supine (i loko o keia oihana ua paa palpation ke ake a me ka spleen).
• E moe ana ma kona mauʻaoʻao'ākau. Ka lima'ākau o lalo o koʻu poʻo, a me ka hema, e lena i ke kuʻekuʻe aku, a waiho iho la ia ma kona umauma (i kēiaʻano hana ua kapaia palpation o ka spleen o Sali). A, i ke ahonui o ka poo e ke iki ka lń i ka umauma, pono wāwae pololei, a me ka uha hema E e lena i ke ki kala a me ka iho ami.

Palpation o na spleen: algorithm

1. pono e hoʻonoho kona lima hema kauka no laila, i ka mea moe ma kaʻaoʻao hema o ka pahu o ke kumuhana, i ka wā mawaena ma waena o ka 7th, a 10th ka iwiʻaoʻao i loko o e like me ka axillary laina, a ke i ka hōʻemi iki puʻe. A hiki pono i na manamana o ka lima'ākau o ka hapa-alo aku, a aia ma ka lima hema costal e pio mai ai ia i ka waena manamana pili i 10th ka iwiʻaoʻao.
2. I ka wā o ka hoomanawanui hanu ana i loko, ka ili ua 'oni iki e kō ana e lilo i ka pa o ke ili.
3. lima exhalation kauka i ka hope o komo iloko o ka opu (abdomen).
4. Ke hoomanawanui i ka noi 'ana o ke kauka i ka hanu nui, oiai ma lalo o ka aoao o ka spleen diaphragm höʻike ia. Ma ka hihia o ka hoʻoulu i nā manamana kauka e halawai me kona haʻahaʻa pou. I kekahi hana pono e puana mau manawa.

ʻano o nā hualoaʻa

Ma lalo o maʻamau kumu (i ola kanaka), ka spleen mea ole palpable. 'Ia nā asthenics (ka hapanui wahine). Palpate ka spleen i loko o kekahi mau hihia e ia ma ka ia kāna o ka diaphragm (pneumothorax, pleurisy) a me ka splenomegaly,ʻo ia hoʻi, he mahuahua ma ke kino nui. A like me ke ano i oi, he pono ole i loko o ka hahai Hawaii:

• Maʻi o ke koko.
• Maʻi ake pathologies (splenomegaly nei mea he hoailona ia no ka puka hypertension ole hepatolienal maʻi pale).
• Huʻi a me ka maʻi infectious keʻano o ka hanaʻana (endocarditis maʻiʻaʻai, malaria, typhoid kuni, sepsis).
• Maʻi o ka connective'aʻaʻa.
• Infarctions a abscesses o ka spleen.

Loa pinepine, a hiki palpation painless hoonee aku spleen. 'Ia i hui infarcts, kokololio tensile capsules episplenitis. Ma kēia hihia, ke spleen lilo loa ikepili koʻikoʻi ( 'o ia hoʻi, ola ma palpation).

Ma cirrhosis o ke ake, a me nā maʻi maʻi o ka spleen kae o ke anuanu, huʻi ia keʻano o ka hanaʻana - pahee.

Hana mau mea IeAUPIIe, IAa IO mehana ma ka huʻi nā mea palahēhē, maʻi nā mea palahēhē a ake cirrhosis lilo anuanu.

Alaila magnification palpated kino hapa paha e uuku a nui ka waiwai, a pehea spleen, milo lākou mai o ka lua penei e hōʻike i ka oiaio loa nui kino. Penei, he kŘpa a uuku mahuahua Hōʻike he auoiaea kino kae o ka costal e pio mai ma 2-7 knm, a ua malama i ka huʻi nā mea palahēhē (typhoid, meningitis, sepsis, lobar pneumonia, a no laila, ma) a me ka maʻi maʻi (naau maʻi, cirrhosis, erythremia, leukemia, anaemia) a me ka ike ole etiology e ia lŘlŘ oi pinepine i loko o ui kanaka (hiki ma hereditary syphilis, rickets)

Alaila nuʻa palpable spleen kaʻe (ina mahuahua) ka hiki ke hoʻoholo i ka hopena e pili ana i ke kuhikuhi kaʻina. Ia mea, ka mea hou i ka li nui i hiki mai ma ke kino, i ka denser a me ka paʻakikī i ko kona parenchyma, mai i ka mea, penei i ka nui pahee a me ka'ōlewa ma mua o ka maʻi spleen palena ma ka huʻi keʻano o ka hanaʻana.

A hiki aku i ke kino, he nui, i ka wa a ka haʻahaʻa kaʻe ua ho'ākāka 'ia i loko o ka pelvic lua, e hoʻomaka palpation o ka spleen ka loa na mea a' aʻole i koi kuikawa Hawaiʻi.

Ma ka hihia o ka splenomegaly kūpono splenic hikoko ma palpation (nui kaʻoi loa, kona 'oihana iâ Margo crenatus) e nānā' ia e ka burr (1 i 4). Oia ka PalekanaEND_LINK hōʻailona Hōʻike i ke alo o ka amyloidosis, leukemia (maʻi myelogenous paha psevdoleykemii), malaria, cysts a me endothelium.

Ia mea, i ka spleen palpation ke kauka mea hiki ke Loiloi i ka ano o kona ili, e huai ae fibrin palapala moʻopane (e like me ka wā perisplenitah), likeʻole protrusions (ia mea, no ka laʻana, abscesses, kahe ana ke koko a me ka serous cysts, echinococcosis) a, e hooholo i ka pa apŘ o ke'aʻaʻa. Ma abscesses pinepine i loaʻa a me ka fluctuation. Na mea a pau me ka nānā 'ana palpation' ike ka loa waiwai no kaʻike, o ka hapanui maʻi o ka spleen, a me ka ho'ākāka 'ana o ka maʻi, a hiki alakai i ka splenomegaly.

Ka mea maʻamau spleen ua aia ma ka lima hema subcostal aina, kona lōʻihi (axis) ke moe ma ka umi o ka iwiʻaoʻao. Ka mana mai ka'ololaha (me ka pī) shape.

Spleen i na keiki

Ke Ana o ka spleen mea maʻamau, ke kaumaha ma muli makahiki:

• Neonates: laula, - i 38 millimeters ma ka lōʻihi - mai i 40 millimeters.
• 1-3 makahiki: loa - mai i ka 68 millimeters, laula, - mai i 50 millimeters.
• 7 makahiki: loa - 80 mm o, laula, - mai i 55 millimeters.
• 8-12 makahiki: laula, - mai i 60 millimeters ma ka lōʻihi - mai i 90 millimeters.
• 15 makahiki: laula, - mai i ka 60 mm o, a me ka lōʻihi - 100-120 mm o.

It E e hoomanao ia palpation o ka spleen i loko o nā keiki a me nā mākua, e e painless, ma ka hou, i ka spleen mea maʻamau i loko o ke keiki ua ole kona manao. Ka luna nui like 'ole mea ole loa, i ka mea, deviations liʻiliʻi i loko o ka olelo o ka hōʻemiʻana / hoʻoulu i ke kino mea,ʻaʻole e pono ia e manao like pathological Ana.

spleen percussion

Kēia papa hana ua hoʻohana 'ia ke hoʻomaopopoʻia ka Ana (palena) o ke kino.

Hoomanawanui ua hoonoho iho la ma ka akau polubokovoe kulana me ka lima kau ma luna o ke poʻo, a me kona mau wāwae māhunehune lena ma ke ki kala a me ka iho ami. Percuss ia mahope iho, e hele ana, mai akaka e kūmūmū ka leo hoʻohana maluhia percussive kui.

e hali ana i percussion

1. Manamana lima-plessimetr pono e hoʻouka kekahi ma ka lihi o ka costal e pio mai ma kaʻaoʻao hema o ke kino p ÷ haku i 10th ka iwiʻaoʻao.
2. Pana aku au i nawaliwali percussion ma 10th ka iwiʻaoʻao, i ka hoʻomaka o ka costal e pio mai (hema) a hiki i ka hoopaa hoi i kani (blunting). Ma o ka hoʻololi o ke kani e i hoailona ma ka ili. A laila, percussing mai axillary laina (hope) anteriorly a i ke kani deadening a no hoi i ka hoailona ma luna o kaʻili.
3. Hoʻohana lōʻihi ma waena o kaha - Ua dlinnik spleen (ole 10th iwiʻaoʻao). Maʻamau, ua anakahi mea 6-8 kenimika.
4. Mai ka hapalua like dlinnika ka p ÷ haku a hiki i ka umi o ka iwiʻaoʻao, a ia produces hou percussion e hooholo i ke anawaena o ka spleen, a maʻamau papa koa mai ka 4 a hiki i 6 kenimika.
5. Maʻamau, ka mea mua loa o ka spleen ( 'o ia hoʻi kona maka) pono e hele medial laina e hoʻohuiʻia ka noa hope o ka 11th iwiaoao, a me ka sternoclavicular ami. It E e hoʻomaopopo i ka i ka ho omaulia ana o ka nui o ka spleen hoʻohana percussion - loa He kokekau wale huahelu. hui, ka nui ua palapala me ka hapa, ma ka numerator - Ua dlinnik, a me ka denominator - ke anawaena o ka spleen.