Documenti di Didattica
Documenti di Professioni
Documenti di Cultura
Part II
1
Palpation, Percussion
& Auscultation
Palpate mass
Percussion
Auscultation
Signs of common diseases.
2
Masses
Characteristics:
Location, size, contour,texture, tenderness,
pulsation, movability
Physical:
Abdominal wall: venter musculi or tendinous inte
rsections of musculus rectus abdominis
Abdominal cavity: lumbar centrum, sacral promo
ntory 骶骨岬 , abdominal aorta, inferior pole of rig
ht kidney, transverse colon, sigmoid colon, cecu
m 盲肠
3
Masses: Physical
4
Pathological
Shifting or swelling of parenchymatous 实质的 organ
Tumor or cyst
Lymphadenectasis 淋巴结肿大
5
Fluidthrill 液波震颤
volume of ascites
>3000ml
6
Succussion Splash
Caused by increased air and fluid in the
stomach, as seen with pyloric obstruction,
gastric dilatation or large hiatus hernia
7
Percussion
Technique: indirect percussion
8
Abnormal Percussion Notes
9
Dullness Area of Liver
Superior border: 1-2 inter
costal spaces higher than
inferior lung border
Inferior border: 1-2 cm hi
gher than detected by pal
pation
Liver span:9-11cm (right
midclavicular line)
10
Abnormal Percussion Findings
Enlarged: hepatic congestion, hepatitis, liver abs
cess, liver carcinoma
Diminished: liver cirrhosis or necrosis
Disappeared: perforation of gastrointestinal tract
, abdominal surgery
Upward shifting : fibrosis or atelectasis of right lu
ng, large volume of air or gas in the gastrointesti
nal tract
downward shifting: emphysema, right side pleur
al effusion, hepatoptosia 肝下垂
11
Spleen Percussion
Location:
9th ~11th ICS alongside left midaxillary line
Diameter:
superio-inferior 长度 : 4-7 cm
The anterior border should not exceed anterior a
xillary line
Abnormal findings:
Enlarged: splenomegaly
Diminished: too much gas in surrounding organs
12
Traube’s Area 胃泡鼓音区
Borders
Upper: left lung,
diaphragm
Lower: Rib
Right: liver
Left: spleen
13
Ascites
Shifting dullness:
Free fluid causes air-containing gut to float up to t
he most superior position
The volume of ascites usually exceeds 1000ml if de
tectable.
14
Ascites
dullness sites
ascites
17
Ovarian cyst
18
Percussion pain
Liver area
Hepatitis
Liver abscess
Kidney area
Nephritis
Pyelonephritis 肾盂肾炎
Renal tuberculosis
Calculus
perinephritis
19
Costovertebral Angle Tenderness
20
Percussion of Bladder
21
Auscultation
Bowel sounds
Principle:peristaltic activity emits various
gurgling and bubbling sounds as air and
fluid interfaces change with contraction
waves.
Normal: 4~5/min
22
Abnormal:
Increased: >10/min: hypermotile states such a
s acute gastroenteritis, blood in the small bowe
l
High-pitched tinkling:intestinal fluid and air under pr
essure, as in early obstruction
Decreased:postlaparotomy, eletrolyte imbalanc
e, senile constipation
Absence: acute peritonitis, paralytic ileus
one must listen for at least a full 3 minutes bef
ore pronouncing that peristalsis 蠕动 has ceased
23
Friction Rub
Principle:
Irritated fibrin-laden periton
eal surfaces grate with moti
on, seen in localized peritoni
tis.
Scratch sound:
Aids in static border definition
Inferior border of the liver
Ascites (<120ml)
Scratch test
25
Hepatic Cirrhosis
26
Acute Perforated Gastric or
Duodenal Ulcer
Inspection:forced supine position, decreased
or disappeared abdominal respiration
Palpation: tenderness in epigatrium or RUQ, r
ebound tenderness, rigid abdominal wall
Percussion: increased resonance over liver, sh
ifting dullness
Auscultation: decreased or absence of bowel
sounds
27
Writing up the physical examination
28
QUESTIONS
29