Palpation o te kōateate: he hātepe me te hangarau

Kōateate - okana unpaired kei e te i te taha ki maui o te puku. Ko pātata ki te kopu te wahi tinana mua, me te hoki - ki te whatukuhu, adrenal me te whēkau.

Ko te hanganga o te kōateate

Ko te hanganga takihi tautuhi cover serous me capsule tūmataiti, te whakamutunga i hanga e te huinga o te kiko tūhonohono, uaua me muka rapa.

haere te capsule ki te kōhiwi o te tinana, me te wehe i te penupenu (te parenchyma) ki motuhake "motu" ki trabecular. I roto i te penupenu (nga taiepa o te arterioles) e whakaritea a tawhio noa nodules porotītaha o kiko lymphoid (follicles lymphoid) ranei. I te ngakau o te penupenu ko te papanga reticular ki tonu nei i te he momo o ngā pūtau: pūtau toto whero (te nuinga pirau), leukocytes me lymphocytes.

mahi okana

• he wāhi i roto i te lymphopoiesis te kōateate (arā he puna o lymphocytes).
• Whai wāhi i roto i te hematopoietic me ārai mate mahi o te rauropi.
• Ko te whakangaromanga o te whakapau o platelets me pūtau toto whero.
• Waipara o toto.
• I roto i te tīmatanga o te embryogenesis mahi rite te okana hematopoietic.

Ko, mahi te tinana maha ngā mahi nui, a reira ki te whakatau i abnormalities i roto i te tīmatanga o te rangahau me te whakatinanatanga tuatahi o te palpation me percussion o te kōateate.

Ko te tikanga o te palpation o whekau

I muri i te kohikohi amuamu, hītori hauora me te whakamātautau whānui, te tikanga tīmata te tākuta ki tikanga tinana o ako, e ngā palpation me te percussion.

wehewehe:

• Mata palpation i ai kitea tetahi raru rerekē mara ngaohiko uaua puku, pupuhi, me te momo o te hiri hanganga (whaturama, pukupuku, kōpuku). Kawe i te reira na roto i te pēhanga ngawari maihao hawhe-piko, timata i te rohe iliac maui Tētākaraka.
• palpation Deep kawea atu i roto i te raupapa e whai ake nei: matapo , ileum (mutunga wahi), kopirua (e piki me ngā wāhanga e heke), whēkau hake kopirua, puku, ate, repe taiaki, kōateate, whatukuhu e kawea, i roto i te whakamahi i maihao kătahi hohonu tākuta i roto i te kōhao puku.

I roto i te take o te māharahara o mate splenic (ona hua e tika ana ki te mate ate ranei) e pupuri percussion tika, he palpation te ate , me te kōateate.

ture General palpation

Palpation (palpation) o te kōateate - tetahi o nga tikanga tino kōrero o te rangahau tinana, whakahaeretia e te tākuta. I roto i te take o te hua iti i roto i te tinana, ina e kore te mea ngāwari ki te whatumanawa, te kōateate, kia tino taunaki ana te tākuta wahi o te ultrasound ki te whakau / turaki i te māuiuitanga kiia i roto i te tamaiti pakeke ranei.

mana o te manawanui:

• Maungārongo (i roto i tenei tūranga tū te palpation te ate, me te kōateate).
• E takoto ana i runga i tona taha ki matau. Ko te ringa matau ki raro i toku matenga, a kia piko te maui i te whatīanga, ka whakatakotoria ki runga ki tona uma (huaina tenei tikanga ko palpation o te kōateate o Sali). Ano, te matenga o te manawanui kia paku tītaha ki te pouaka, tika waewae matau, me kia piko te waewae maui i te hope, me te turi hononga.

Palpation o nga takihi: hātepe

1. Me tūnga tona tākuta ringa maui na e takoto ai i runga i te taha ki maui o te pouaka o te tumu parau, ki te wā i waenganui i te 7 me te rara te 10 i roto i runga i ngā rārangi axillary, ka whakarato i te pēhanga iti. A, no te Me whai te maihao o te ringa matau te-piko hawhe, ka kei i runga i te kikorangi costal mahue kia e te ringa waenganui pātata ki te rara 10.
2. A, no te hopoi i te manawanui i roto i, neke te kiri te raro ki te hanga i te puninga o te kiri.
3. I muri i te ringa launoa o tākuta ô te kopu (puku).
4. Ko te manawanui i te tono o te tākuta e te manawa hohonu, i raro i neke iho i te mana o te HWM kōateate. I roto i te take o te whakanui ake i te tākuta maihao ka farerei ona pou raro. kia me taua mahi e rave rahi taime tukurua.

tikanga o ngā hua

I raro i ngā āhuatanga noa (i roto i te iwi hauora), e kore te mea nga korero te kōateate. Okotahi he asthenics (te nuinga wahine). Palpate te takihi i roto i ētahi wā kia i te Karauna o te HWM (pneumothorax, kiripūkahu) me splenomegaly, e ko, he hua i roto i te rahi te tinana. Ko atu noa te huru rite i roto i te āhua e whai ake nei:

• Diseases o te toto.
• pathologies ate ma'i (splenomegaly! he tohu o te takawhita tomokanga ranei syndrome hepatolienal).
• Koi me ngā tukanga hopuhopu ma'i (endocarditis mate, malaria, taipō piwa, sepsis).
• Diseases o te kiko tūhonohono.
• Infarctions abscesses o te kōateate ranei.

Nuinga o ngā wā, ara palpation kōateate rahi ongonoa. Okotahi he infarcts okana, episplenitis capsules kurut tere. I roto i enei take, riro te kōateate tino tairongo (arā, mamae i runga i palpation).

I roto i te cirrhosis o te ate, me ētahi atu mate mau o te mata kōateate o te pūrerehu, taua tukanga whakapeka - ngohengohe.

Ko te tikanga ngawari i mate whakapeka, mate ma'i ōritetanga me riro mātotoru ate cirrhosis.

Fakatatau ki ai pea whārahinga palpated wahi tinana iti nui ranei uara, me pehea kia tohu kōateate whatu i roto o ngā tapa te whānuitanga pono tinana nui. Ko te kupu, he hua āhua iti tohu te mata o te kikorangi costal tinana putanga i 2-7 cm, kitea nei i roto i te mate whakapeka (taipō, meningitis, sepsis, lobar kakā, a na i runga i) ranei mate mau (mate ngakau, cirrhosis, erythremia, kanisā, anemia) me o te etiology unknown e puta ake pinepine i roto i te iwi taitamariki (pea i roto i te pakewakewa tuku, kōiwi)

Fakatatau ki ai kiato mata kōateate nga korero (ki te hua) he taea ki te whakatau e pā ana ki te tukanga whakahaunga. Ko, te roa te mumura reira i roto i te tinana, te apiapi, me maro atu i tona parenchyma, i nei whai reira e te atu ngohengohe me te ngāwari atu i roto i te mata kōateate ma'i i roto i ngā tukanga whakapeka.

A, no te he nui rawa te tinana, ka tautuhia te mata o raro e i roto i te kōhao papatoiake, ki te whakahaere i palpation o te kōateate he tino māmā, me te e kore e rapua e pūkenga motuhake.

I roto i te take o te splenomegaly hua pukupuku splenic i palpation (atu ïa, tona crenatus Margo) kua oti te whakarite e te Burr (1 ki te 4). he tohu tātaritanga taua tohu te aroaro o amyloidosis, kanisā (myelogenous ma'i psevdoleykemii ranei), malaria, cysts me endothelium.

Ko, i roto i te palpation kōateate taea ki te aromatawai i te huru o tona mata, ki te kitea pūtōtepe waipara te tākuta he (pērā i ka perisplenitah), ngā protrusions (e ko, mo te tauira, abscesses, toto me cysts serous, echinococcosis) me ki te whakatau i te kiato o te kiko. I roto i abscesses maha kitea me tātāu. Ko tino faufaa mo te tātaritanga o te nuinga o te kōateate mate, me te whakamāramatanga o te mate, e taea e arahi ki te splenomegaly mea katoa e takoto e mōhiohio palpation.

Ko te kōateate noa e kei roto i te rohe subcostal mahue, takoto tona tuaka roa haere te tekau te rara. Mana he porotītaha (pīni) āhua.

Takihi i roto i ngā tamariki

Ko te āhuatanga o te kōateate he noa, i runga i tau kei:

• Neonates: whanui - ki te 38 mitamano i roto i te roa - ki runga ki te 40 mitamano.
• 1-3 tau: roa - ki runga ki te 68 mitamano, whanui - ki runga ki te 50 mitamano.
• 7 tau: roa - 80 mm, whanui - ki runga ki te 55 mitamano.
• 8-12 tau: whanui - ki runga ki te 60 mitamano i roto i te roa - ki runga ki te 90 mitamano.
• 15 tau: whanui - ki runga ki te 60 mm, me te roa - 100-120 mm.

Kia mahara te reira e palpation o te kōateate i roto i ngā tamariki me te pakeke, kia kia mamae kore, i roto i te tua, ko noa te kōateate i roto i kore e whakaritea te tamaiti. E kore e pūmau nga rahi i runga, e ko, ine iti i roto i te ahunga o te whakaiti / e kore te mea e tika ana ki te kia i titiro rite āhuatanga pathological te whakanui ake i te tinana.

percussion kōateate

whakamahia tēnei tikanga te ki te whakatau tata i te taha (rohe) o te tinana.

whakanohoia manawanui kei roto i te tūranga polubokovoe tika ki ringa whakanohoia ki runga ki te matenga, ki ona waewae e papaki ana piko i te hope, me te turi hononga. whai Percuss, haere i mārama ki te puhuki te tangi te whakamahi i ata whiu percussive.

e mau ana percussion

1. Me tāuta maihao-plessimetr i runga i te mata o te kikorangi costal i te taha ki maui o te tinana hāngai ki te rara 10.
2. Te whakapau percussion ngoikore i te rara 10, te timatanga o te kikorangi costal (maui) tae noa ki te tangi puhoi (blunting). I te whakawhitinga o te tangi hanga he tohu i runga i te kiri. Na percussing i rārangi axillary (muri) anteriorly tae noa ki te tupapakutanga hoki tangi, a hoatu ano he tohu i runga i te kiri.
3. roa wāhanga i waenganui i tohu - ko kōateate dlinnik (ranei rara 10). Tikanga, tenei tohu ko 6-8 henimita.
4. Mai i waenganui dlinnika te hāngai ki te tekau te rara, me te hua reira percussion atu ki te whakatau i te diameter o te kōateate, e te tikanga pae i 4 ki te 6 henimita.
5. Tikanga, te wahi mua o te kōateate (arā tona mata) kore me haere raina medial e hono te mutunga noa o te rara 11 me te tahi sternoclavicular. Me kï reira e te tātaitanga o te rahi o te kōateate te whakamahi i percussion - ahua rawa āwhiwhiwhi. tuhia rahi okana te rite te hautanga, te wahi i te taurunga - he dlinnik, me te tauraro - te diameter o te kōateate.