Palpation nke splin: ihe algọridim na technology

Splin - unpaired ngwa ahụ na-emi odude na n'aka ekpe nke afo. The n'ihu ahụ òkè bụ n'akụkụ aka afo, na azụ - na akụrụ, adrenal na eriri afọ.

Ọdịdị nke ahụ splin

The mejupụtara kọwaa splin serous cover na onwe Capsule, nke ikpeazụ kpụrụ a Nchikota connective anụ ahụ, muscle na-agbanwe emep uta eri.

The Capsule na-aga n'ime ọkpụkpụ nke ozu, kewara ndị pulp (na parenchyma) n'ime iche iche "isuo" na trabecular. Na pulp (mgbidi nke arterioles) na-mere ndokwa gburugburu ma ọ bụ oval nodules nke lymphoid anụ ahụ (lymphoid follicles). Na obi nke pulp bụ ndị reticular ákwà nke jupụtara na a dịgasị iche iche nke mkpụrụ ndụ: mkpụrụ ndụ ọbara uhie (ukwuu n'ime rere ere), leukocytes na lymphocytes.

ngwa ọrụ

• The splin bụ idem ke lymphopoiesis (ie a isi iyi nke lymphocytes).
• Atụ ke hematopoietic na dịghịzi ọrụ nke organism.
• The mbibi nke ndị na iyuzucha nke platelet na mkpụrụ ndụ ọbara uhie.
• Deposition nke ọbara.
• Ná mmalite nkebi nke embryogenesis arụ ọrụ dị ka a hematopoietic ngwa.

Nke ahụ bụ, ahụ na-eme ọtụtụ ihe dị mkpa ọrụ, ya mere iji chọpụta abnormalities ná mmalite nkebi nke nnyocha e mere ga akpa mmejuputa palpation na percussion nke splin.

Iji nke palpation nke esịtidem akụkụ

Mgbe obon mkpesa, ọrịa mmadụ na izugbe ule, dọkịta na-emekarị amalite anụ ahụ ụzọ nke ọmụmụ, nke na-agụnye palpation na percussion.

ịmata ihe dị iche:

• N'elu palpation na nke ahụrụ soreness mgbanwe ubi voltaji abdominal mọzụlụ, ọzịza, na a dịgasị iche iche nke akara guzobere (hainia, etuto ahụ, ọnụ). Ebu ya site nwayọọ mgbali ọkara kpebisiri mkpịsị aka, malite n'aka ekpe iliac region counterclockwise.
• Deep palpation rụrụ na-eso usoro: ìsì , ileum (njedebe akụkụ), colon (nārigo nārida na ngalaba), transverse colon eriri afọ, afo, imeju, pancreas, splin, akụrụ, a rụrụ iji miri penetration mkpịsị aka dọkịta na abdominal uji eze.

Na ikpe nke ana enyo enyo nke splenic ọrịa na (ma ọ bụ ya na-abawanye n'ihi ọrịa imeju) ejide percussion bụchaghị, a palpation imeju na splin.

General iwu palpation

Palpation (palpation) nke splin - otu n'ime ndị kasị ihe ọmụma ụzọ nke anụ ahụ nnyocha, ekenịmde a dọkịta. Na ikpe nke a nta mmụba ke idem, mgbe splin dịghị mfe achọ ileba, jide n'aka na dọkịta na-atụ aro Itie ultrasound iji gosi / ịgbagha ọkọdọhọ daa ọrịa na a nwa ma ọ bụ okenye.

onye ọrịa ahụ ọnọdụ:

• Supine (na a ọnọdụ ẹkenịmde palpation umeji splin).
• Ụgha na ya n'akụkụ aka nri. The n'aka nri bụ n'okpuru isi m, na n'aka ekpe ga-kpudo na n'ikpere aka, na, tukwasi ya obi (a Usoro a na-akpọ palpation nke splin nke Sali). Ọzọkwa, ọrịa isi ga-ubé weturu ka obi, ụkwụ aka nri ogologo na ekpe ụkwụ ga-kpudo na ukwu ya na ikpere nkwonkwo.

Palpation nke splin: algọridim

1. N'aka ekpe ya dọkịta ga-positioned nke mere na ọ dabeere na n'aka ekpe nke igbe isiokwu, nkeji n'etiti 7th na 10th ọgịrịga dị na axillary ahịrị, na inye a nta nsogbu. Mgbe ahụ, mkpịsị aka-nri ga nwere a ọkara kpebisiri na odude na ekpe costal njiko nke na n'etiti mkpịsị aka n'akụkụ 10th ọgịrịga.
2. Mgbe onye ọrịa ahụ na-eku ume, na anụ a gbanwere ala-etolite a anọghị n'ogige atụrụ nke anụ.
3. Mgbe ume e kupụrụ ekupụ dọkịta n'aka penetrates n'afọ (afo).
4. Onye ọrịa na arịrịọ nke ndị dọkịta na-ewe a miri emi ume, mgbe n'okpuru nduzi nke splin diaphragm akpali ala. Na ikpe nke na-amụba mkpịsị aka dọkịta ga-ezute ya ala osisi. Dị otú ahụ edinam ga-ugboro ugboro ugboro ugboro.

nkọwa nke nsonaazụ

N'okpuru nkịtị ọnọdụ (na ndị ahụ siri ike), na splin bụghị palpable. Wezụga na asthenics (ukwuu n'ime ndị inyom). Tụlee ọdịdị splin na ụfọdụ nwere ike ịbụ na omission nke diaphragm (pneumothorax, pleurisy) na splenomegaly, ya bụ, onye na-abawanye na ahu size. A yiri ọnọdụ bụ ihe nkịtị na ndị na-esonụ na-ekwu:

• Ọrịa nke ọbara.
• Adịghị ala ala imeju pathologies (splenomegaly n'ime ebe a bụ ihe ịrịba ama nke portal mgbali elu hepatolienal syndrome).
• Nnukwu na-adịghị ala ala na-efe efe Filiks (endocarditis ọrịa, ịba, ọrịa ịba ahụ ọkụ, sepsis).
• Ọrịa nke connective anụ ahụ.
• Infarctions ma ọ bụ ahụ etuto nke splin.

Ọtụtụ mgbe, ọbụna palpation enweghi mgbu ikpọ splin. Wezụga na ngwa infarcts, ngwa ngwa tensile capsules episplenitis. Na ndị a, ndị splin na-aghọ nnọọ mwute (ie, na-egbu mgbu na palpation).

Na imeju nke imeju na ndị ọzọ na-adịghị ala ala ọrịa nke splin ọnu a na ok, nnukwu otu Filiks - adụ.

Nne na-emekarị nwayọọ na nnukwu na-efe efe, ala ala na-efe efe na imeju na imeju na-aghọ oké.

Ntem magnification palpated ahụ òkè nwere ike nta ma ọ bụ ibu uru, na otú splin ua si n'ọnụ nwere ike na-egosi ezi ruo n'ókè ibu ahu. N'ihi ya, a dịtụ obere abawanye egosi ihe mmepụta ahụ ihu costal njiko na 2-7 cm, nke a hụrụ na nnukwu na-efe efe (ịba, meningitis, sepsis, lobar oyi baa, na na) ma ọ bụ ala ala ọrịa na (ọrịa obi, ọrịa imeju, erythremia, leukemia, anaemia) na-amaghị ama etiology na emee ọzọ mgbe na-eto eto (ikekwe na butere n'aka syphilis, rickets)

Ntem njupụta palpable splin ihu (ma ọ bụrụ na-abawanye) bụ ike iru nkwubi okwu banyere ndị ọgwụ usoro. Nke ahụ bụ, ogologo mbufụt ugbu ke idem, ndị denser na ike karịa ya parenchyma, site na nke ya, ndị a na ndị ọzọ adụ na mgbanwe karịa na-adịghị ala ala splin onu ke nnukwu n'ibu.

Mgbe ahụ bụ oke buru ibu, mgbe ala onu na a kọwara na pelvic uji eze, na-eduzi palpation nke splin dị nnọọ mfe ma na-adịghị achọ pụrụ iche usọ.

N'ihe banyere splenomegaly dapụtara splenic etuto ahụ site palpation (ihe kpomkwem, ya margo crenatus) kpebisiri ike na site a burr (1 ruo 4). Ndị dị otú ahụ a na-achọpụta ọrịa ịrịba ama na-egosi na ọnụnọ nke amyloidosis, leukemia (adịghị ala ala myelogenous ma ọ bụ psevdoleykemii), ịba, cysts na endothelium.

Nke ahụ bụ, n'oge splin palpation dọkịta bụ ike na-amata ọnọdụ nke ya n'elu ala, iji chọpụta fibrin deposition (dị ka mgbe perisplenitah), dị iche iche protrusions (ya bụ, ihe atụ, ahụ etuto, na-agba ọbara na serous cysts, echinococcosis) na iji chọpụta njupụta nke anụ ahụ. Na ahụ etuto mgbe hụrụ na mmajijiji. Ihe niile na-kpebisie ike site palpation ọmụma bụ nnọọ ihe bara uru maka nchoputa nke ọtụtụ ọrịa nke splin, na definition nke ọrịa, nke pụrụ iduga splenomegaly.

The nkịtị splin dị na ekpe subcostal region, ya ogologo axis ụgha tinyere iri ọgịrịga. Authority nwere oval (agwa) udi.

Splin na ụmụ

The akụkụ nke splin nkịtị, dabere na afọ:

• Neonates: obosara - na 38 millimeters n'ogologo - ruo 40 millimeters.
• 1-3 afọ: ogologo - ruo 68 millimeters, obosara - aka 50 millimeters.
• 7 afọ: ogologo - 80 mm, obosara - elu 55 millimeters.
• 8-12 afọ: obosara - ruo 60 millimeters n'ogologo - ruo 90 millimeters.
• Afọ 15: obosara - ruo 60 mm, na ogologo - 100-120 mm.

Ọ ga-eti na palpation nke splin na ụmụaka nakwa ndị toworo eto, kwesịrị enweghi mgbu, ke adianade do, na splin nkịtị na a na nwa na-adịghị kpebisiri ike. The n'elu nha bụghị zuru, ya bụ, obere deviations na ntụziaka nke usen / amụba ahụ dịghị mkpa ka na-ahuta ka enweghị nchịkwa akụkụ.

splin percussion

Nke a na usoro a na-eji na-eme atụmatụ akụkụ (ókè) nke ahu.

Ndidi na-etinye na nri polubokovoe ọnọdụ na aka enịm n'elu isi, na ụkwụ ya sonso kpudo na ukwu ya na ikpere nkwonkwo. Percuss ndị a, na-aga site na anya masịrị na ụda iji jụụ percussive efega.

ebu percussion

1. Aka-plessimetr ga-arụnyere na ihu costal njiko na n'aka ekpe nke ahu perpendicular ka 10th ọgịrịga.
2. Wepụta na-adịghị ike percussion na 10th ọgịrịga, na mmalite nke costal njiko (n'aka ekpe) ruo mgbe a dull ụda (blunting). Na ntughari nke ụda ka a akara na akpụkpọ. Mgbe ahụ percussing si axillary akara (n'azụ) anteriorly ruo mgbe ụda deadening na-etinye a akara na akpụkpọ.
3. nke ogologo n'etiti akara - bụ dlinnik splin (ma ọ bụ 10th ọgịrịga). Nọmalị, a na-egosi bụ 6-8 sentimita.
4. Si ufọt dlinnika na perpendicular na iri ọgịrịga na ọ na-arụpụta ihe ọzọ percussion iji chọpụta na dayameta nke splin, nke na-ejikarị àmà site 4 6 sentimita.
5. Nọmalị, n'ihu akụkụ nke splin (ie, n'ọnụ ọnụ ya) ga-aga medial akara na-ejikọ ndị free njedebe nke 11 ọgịrịga na sternoclavicular nkwonkwo. Ọ ga-kwuru na ngụkọta oge nke ndị size nke splin iji percussion - nnọọ ndika ọgụgụ. ngwa size na-dere ka a nta, ebe numerator - bụ dlinnik, na denominator - dayameta nke splin.