腹部触诊---Palpation of the Abdomen
产科四步触诊的方法和内容
产科四步触诊的方法和内容
产科四步触诊是指产科医生在进行孕妇产前检查时进行的一种重要的体格检查方法，通过手触摸来了解胎儿的位置、胎位、胎心率等信息。
这个过程通常包括以下四个步骤：
1. 腹部触诊（Abdominal Palpation）：
-目的：了解胎儿的位置和胎位。
-方法：医生通过手在孕妇的腹部轻柔触摸，感受胎儿的位置、大小、硬度等。
-内容：包括测定胎头或臀部的位置，判断是否为头位、臀位或横位。
2. 胎位触诊（Fetal Presentation Palpation）：
-目的：确认胎儿的头位或臀位。
-方法：通过触摸，确定胎儿头部或臀部的位置。
-内容：确定胎儿是头位还是臀位，以及胎头的方向。
3. 胎方位触诊（Fetal Lie Palpation）：
-目的：确定胎儿的长轴方向。
-方法：通过触摸，判断胎儿的头朝向，即是面朝上还是面朝下。
-内容：判断胎儿是处于纵位（头朝下）还是横位（头朝侧）。
4. 胎心触诊（Fetal Heart Palpation）：
-目的：评估胎心率。
-方法：通过手触摸孕妇的腹部，听取或感受胎心的跳动。
-内容：测量胎心率，正常情况下胎心率在特定范围内。
这些触诊步骤是产前检查中的重要组成部分，可以帮助医生了解胎儿的位置、姿势、发育情况以及胎心的正常性，从而及时发现和处理可能的问题，确保母婴的健康。
这些检查通常在孕中期和晚期进行，但医生可能会根据具体情况决定何时进行触诊。
Abdominal Examination(腹部检查)
❖ Left lumber region左侧腹 部；左腰部
Descending colon(降结肠); jejunum(空肠) or ileum(回肠); left kidney
❖ Hypogastric region下腹部
Ileum; sigmoid colon; ureter; full bladder; pregnant uterus(子宫)
Question 3: What are the distinct benefits and disadvantages in Four-quadrant and Ninesection methods?
anterior superior iliac and midabdominal line √ across the middle of linking line formed by
right anterior perior iliac and midabdominal line
❖ Left hypochondrial region 左上腹部；左季肋部
Right lobe of liver(肝右叶); gallbladder; hepatic flexure of colon; right kidney; right adrenal gland
❖ Right lumber region 右侧腹部；右腰部
Ascending colon; jejunum(空肠); right kidney
❖ Right iliac region右下腹 部；右髂部
腹部体格检查(双语)-精品医学课件
2 并发症 Complicatons
出血（Bleeding） 穿孔（Perforation） 幽门梗阻（Pylorioc obstruction） 癌变（Gastric carcinoma）
胃肠急性穿孔：
• 腹痛剧烈 • 腹壁呈板样强直 • 明显压痛、反跳痛 • 肝浊音界缩小或消失 • 肠鸣音减弱或消失
一 腹部叩诊音
Percussion of Abdomen 1 鼓音：大部分区域 2 高度鼓音：肠麻痹 3 浊音、实音：积液、
肿瘤。
二肝及胆囊叩诊
Liver and Gallbladder Percussion
1 叩诊方法 （1） 间接叩诊法
Indirect Percussion
肝区叩诊
Liver Percussion
（2）叩击痛
2 正常范围 3 肝浊音界变化的临床意义
肝叩诊临床意义：
肝浊音界扩大：肝癌、肝脓肿、肝炎、 肝淤血和多囊肝等
肝浊音界缩小：暴发性肝炎、急性肝 坏死、肝硬化和胃肠 胀气等
肝浊音界消失：急性胃肠穿孔、人工 气腹
三 脾 脏 叩 诊 Spleen Percussion 1 叩诊方法
2 正常范围 3 脾浊音界变化的临床意义
胃泡鼓音区叩诊
四 移动性浊音 Shifting dullness 1 叩诊方法
移动性浊音（二）
移动性浊音
（2） 膝肘位叩诊
2 腹水与卵巢囊肿鉴别
腹水叩诊的鉴别诊断
1、肠管内大量液体潴留，可出现 移动性浊音，但常伴有肠梗阻 征象。
2、充盈的膀胱。
3 巨大卵巢囊肿
巨大卵巢囊肿
视诊 触诊 叩诊
腹部体格检查
Physical examination of abdomen
英文病例范文
英文病例范文(中英文版)English Sample Medical Case:John Doe, a 35-year-old male, presented to the emergency department with a chief complaint of severe abdominal pain. The pain started suddenly two hours prior to his arrival and was described as sharp and radiating to his back. Upon examination, his vital signs were stable, but he appeared pale and diaphoretic. The abdomen was tender to palpation, particularly in the upper right quadrant. Laboratory investigations revealed an elevated white blood cell count and increased liver function tests. A diagnosis of acute cholecystitis was suspected, and an ultrasound was ordered to confirm the presence of gallstones.张三，35岁男性，因剧烈腹痛到急诊科就诊。
疼痛在就诊前两小时突然开始，表现为尖锐并向背部放射。
检查时，他的生命体征稳定，但面色苍白且出汗。
腹部触诊时，尤其右上象限区域明显疼痛。
实验室检查显示白细胞计数升高和肝功能测试异常。
肝脏触诊操作流程及评分标准
肝脏触诊操作流程及评分标准英文回答：Liver palpation is a physical examination technique used to assess the size, texture, and tenderness of the liver. It is an important tool in diagnosing liver diseases and can provide valuable information about the overall health of the liver. The procedure involves applying pressure with the fingertips or the palm of the hand to different areas of the abdomen to feel for the liver edge.The liver is located in the right upper quadrant of the abdomen, just below the rib cage. To perform liver palpation, the patient should lie flat on their back with their arms by their sides. The examiner should stand on the right side of the patient and place their left hand behind the patient's back to support and stabilize the body. With their right hand, the examiner should start palpating in the right lower quadrant and move upwards towards the costal margin, feeling for the liver edge.During palpation, the examiner should assess the size, shape, and consistency of the liver. A normal liver is usually not palpable, but in some cases, such as hepatomegaly (enlarged liver) or liver disease, the liver may be felt below the rib cage. The liver edge should be smooth and firm, without any irregularities. Tenderness or pain upon palpation may indicate inflammation or infection of the liver.In addition to palpation, other diagnostic methods such as imaging tests (ultrasound, CT scan, MRI) and blood tests (liver function tests, viral hepatitis markers) are often used to evaluate liver health and diagnose specific liver conditions.Liver palpation can be graded using different scoring systems, such as the scratch test or the hooking maneuver. These scoring systems assess the ease of liver palpation and the distance from the costal margin to the liver edge. For example, in the scratch test, the examiner uses their fingernail to gently scratch the skin overlying the liveredge. The distance between the scratch mark and the costal margin is then measured. A shorter distance indicates a deeper liver edge and may suggest hepatomegaly.Overall, liver palpation is a valuable clinical tool to assess liver health and diagnose liver diseases. It is a non-invasive and relatively simple procedure that can provide important information about the liver's size, texture, and tenderness.中文回答：肝脏触诊是一种用于评估肝脏大小、质地和压痛的体格检查技术。
腹部触诊精品PPT课件
ห้องสมุดไป่ตู้ 腹部触诊的体位
腹部触诊方法
• 浅部触诊法 • 深部滑行触诊法 • 深压触诊法 • 双手触诊法 • 冲击触诊法 • 钩指触诊法
腹部触诊方法
浅部触诊法
• 手指掌面轻压腹壁，
腹壁压陷约1cm
• 适合：腹壁紧张度、
表浅的压痛、肿块、 搏动和腹壁上的肿物。
腹部触诊方法
深部滑行触诊法
• 右手并拢的中间三指
的 病变或确定腹腔压痛点。
冲击触诊法
腹部触诊方法
• 右手并拢的中间三指取70-90角，放置于腹壁上拟检查
部位，作数次急速而较有力的冲击动作。
• 适合：大量腹水时肝、脾及腹腔包块难以触及者。
腹部触诊方法
钩指触诊法
• 检查者位于患者右肩旁，面向
其足部，右手掌搭在右前胸下 部，右手第2-5指弯曲成钩状 ， 嘱患者做深呼吸，吸气时进一 步屈曲指关节。
对腹膜刺激，引起腹膜增厚，肠管、肠系膜粘连， 全腹紧张度增加，触之柔韧而具有抵抗力，不易 压陷，见于结核性腹膜炎、腹膜转移癌等。
腹部触诊内容 腹壁紧张度
局部腹壁紧张度增强
上腹或左上腹肌紧张--急性胰腺炎； 右上腹肌紧张--急性胆囊炎； 右下腹肌紧张--急性阑尾炎,胃肠穿孔。
腹部触诊内容 腹壁紧张度
腹部触诊内容
• 腹壁紧张度 • 压痛及反跳痛 • 肝、脾等脏器触诊 • 腹部肿块 • 液波震颤 • 振水音
腹部触诊内容 肝脏触诊
3.脏器触诊—肝脏触诊
• 单手触诊法 • 双手触诊法 • 钩指触诊法
腹部触诊内容 肝脏触诊
3.脏器触诊—肝脏触诊
腹部触诊内容 肝脏触诊
3.脏器触诊—肝脏触诊
腹部触诊内容 肝脏触诊
中医的望闻问切英文术语
中医的望闻问切英文术语中医的望、闻、问、切是诊断疾病的基本方法，可以通过观察、听闻、询问、触摸病人来确定疾病的性质和病情。
以下是望、闻、问、切的英文术语及其简要解释：1. 望(wàng)：Observation望指通过观察病人的外表、面色、神情、舌苔、舌质等来诊断疾病。
因此，英文中对于“望”的术语常用observation或inspection来表示。
例如：- Observation of the tongue and its coating 舌象观察- Facial observation 面部观察- Observation of the skin and hair 皮肤和头发观察2. 闻(wén)：Olfaction闻指通过闻病人的口臭、汗臭及大便、尿臭等来诊断疾病。
因此，英文中对于“闻”的术语常用olfaction来表示。
例如：- Olfactory examination of the stool 大便气味的嗅觉检查- Odor of sweat 汗臭味- Smell of urine 尿液气味3. 问(wèn)：Inquiry问指通过询问病人的病史、症状及体感来诊断疾病。
因此，英文中对于“问”的术语常用inquiry或interrogation来表示。
例如：- Inquiry of physical conditions 身体状况询问- Interrogation about symptoms 症状询问- Inquiry of medical history 医疗史询问4. 切(qiè)：Palpation切指通过触摸病人的身体或特定部位来了解疾病的性质和病情。
因此，英文中对于“切”的术语常用palpation来表示。
例如：- Palpation of the pulse 脉搏触诊- Palpation of the abdomen 腹部触诊- Palpation of the meridians 经脉触诊总之，中医的望、闻、问、切是一种基于直觉和经验的综合诊断方法，通过观察、听闻、询问和触摸来确定疾病的性质和病情。
腹部触诊
⒊检查内容及临床意义： ①部位： 从包块的部位可以推测属何种脏器如 上腹中部包块常提示胃或胰腺肿瘤、 囊肿；右上腹包块多与肝、胆有关； 脐周触到大而不规则并有压痛的包块 多提示TB性腹膜炎所致肠管粘连；两 侧腹部包块多提示结肠癌的可能；女 病人髂窝部包块应注意卵巢肿瘤之可 能。 ②大小： 凡触及包块均应准确测量并作记录， 以利于动态观察 (长×宽×厚（cm）或用恒定的实物表示)
7
反跳痛(rebound tenderness) 用手触诊腹部出现压痛后，手指于 原处稍停片刻，使压痛趋于稳定，然后 迅速将手抬起，如此时患者感觉腹痛骤 然加重并常伴痛苦表情或呻吟即为反跳 痛。 系因腹膜壁层受炎症累及的征象， 当突然抬手时腹膜被牵拉引起疼痛。 压痛点—见下图 ↓
8
9
㈢脏器触诊 ⒈肝脏触诊： 用于了解肝下缘的位置和肝的 大小、 质地形态、有无 压痛 及搏动等。 ⑴方法—— 体位--病人仰卧，双腿曲膝，腹壁放松。 手法--单手触诊法 双手触诊法 钩指触诊法(适用于儿童和腹壁薄软者) 冲击触诊法(浮沉触诊法)(用于大量腹水者)
16
⑥肝区摩擦感：肝周炎时，肝表面和邻近的腹膜可 因有纤维素渗出物而变得粗糙。二 者相摩擦所产生的振动可用手触及， 称肝区摸擦感。 ⑦肝震颤(liver thrill)： 用浮沉触诊法检查。手指压下时感到一 种微 细的震动感，称肝震颤，见于肝包虫病，由于包 囊中的多数子囊浮动撞击 囊壁而形成震颤。
⑴急性胰腺炎：上或左上腹压痛
⑵出血性胰腺炎：腰部皮下淤斑 ⑶慢性胰腺炎：上腹横行条索状块 ⑷胰腺癌：上腹包块坚硬，结节状 ⑸胰头癌：Courvoisier征 ⑹胰腺囊肿：上或左上腹囊性肿块
36
㈣腹部包块 ⒈正常腹部可触及的包块 腹直肌肌腹及腱划 腰椎椎体及骶骨岬（L 4-5 及S1 向前的突出） 乙状结肠粪块 横结肠 盲肠 右肾下极 腹主动脉（触及有搏动） ⒉异常包块 除上述以外的包块→异常 常是肿大的实质性脏器（肝、脾）或扩大的空 腔内脏（胃、肠），也可为肿瘤、 囊肿、炎性 组织或肿大的淋巴结。
- 1、下载文档前请自行甄别文档内容的完整性，平台不提供额外的编辑、内容补充、找答案等附加服务。
- 2、"仅部分预览"的文档,不可在线预览部分如存在完整性等问题,可反馈申请退款(可完整预览的文档不适用该条件!)。
- 3、如文档侵犯您的权益，请联系客服反馈,我们会尽快为您处理(人工客服工作时间：9:00-18:30)。
♣ The examiner may tentatively exert
pressure on the abdomen through the patient’s own hand, and gradually
increase the pressure, while assuring the patient that the examination will
breathe slowly and deeply ♣ For the examiner:
1) make certain that his hands are warm 2) assure the patient that he will make an effort not to cause discomfort and follow up this assurance
cause no discomfort.
♣ When the patient has relaxed, the examiner again places his own hand on the abdomen and allows the patient to
maintain contact with his hand. This usually completes the relaxation of the
Board-like rigidity板状腹
If abdominal wall is palpated as obviously tense, even as rigid as a board, board-like rigidity is so called. This sign is caused by the spasm of abdominal muscle due to peritoneal irritation, as the perforation of the gastrointeatinal diseases or rupture of
3) Then check other areas in the same manner for comparison.
2. the contentenseness腹壁紧张 度
In normal persons, abdominal wall is somewhat tense, but usually soft when palpated and easily depressed , and is called abdominal softness(腹壁柔软).
with fingers together and arm relaxed and forearm on a horizontal plane.
♠ The examiner presses with his fingers.
c) To palpate four quadrants deeply
♦ Using the palmer surface of the fingers,
tenseness(紧张度), tenderness(压痛), masses, etc.
♠ Examination begins with gentle
maneuvers and then palpation occurs more deeply.
♠ Examiner uses the palms of his hands
abdomen.
This change in the order of examination is necessary because the auscultatory
findings may be markedly altered by any manipulation of the abdominal wall.
kneading. This sign is usually seen in tuberculosis peritonitis or cancerous
peritonitis.
2) The decrease of abdominal tenseness
The decrease of abdominal tenseness is
examiner palpates in four quadrants to identify masses, tenderness, pulsations, etc.
♦ The abdominal wall should be depressed more than 2 cm.
♦ When deep palpation is difficult,
caused by the decrease or disappearance of abdominal muscle’s tension(张力), the sign
usually found in chronic deeline(消耗性疾病) or drainage
of large amount of ascites.
smoothness, irregularity, the hardness or softness and listen with stethoscope for a
bruit over the mass. ♠ If there is tenderness, determine the point of maximum tenderness and its
examiner may want to use left hand placed over right hand to help exert pressure.
♠ If a mass is suspected, determine its size, contour, mobility, tenderness,
questions regarding the history. 6) If the patient remains tense or if the abdominal wall is very muscular, better results may be obtained by having the patient flex the
the viscera.
Dough kneading sensation 揉面感；柔韧感
If abdominal wall is palpated as pliable and tough, and if it has resistance
and is not easily depressed, then the examiner feels the sensation of dough
Consequently percussion and palpation, which may increase or decrease peristaltic sounds, are deferred until auscultation has
been completed.
The final step in the abdominal examination is palpation. This procedure is usually the most important and often the most difficult to perform accurately.
b) tenderness and rebound tendernes压痛 和反跳痛
distribution.
♠ To check for rebound tenderness,
1) palpate deeply at the point of tenderness, pause briefly, then remove the fingers quickly.
2) Watch the patient’s face to see whether it hurts.
Palpation of the Abdomen
♣ Palpation and percussion usually follow inspection in the examination of the other
body systems. ♣ Following inspection, the examiner should perform auscultation of the
While some pathological conditions can lead to an increase or decrease of
abdominal tenseness.
1) The increase of abdominal tenseness
♣ Abdominal tenseness increases, not
thighs and knees.
It should be emphasized again that during the preliminary stages muscle relaxation is the goal. At this time no attempt should be made either to elicit discomfort or to
ticklish patient, and the examination proceeds as usual.
4) begins with gentle exploration of the abdominal wall and with no effort made to
palpate deeply 5) As with inspection, the initial step in palpation may be facilitated by distracting conversation or