胸廓和肺部體格檢查課件

胸廓和肺部體格檢查

chestandpulmonaryphysicalexaminationChestExamination

胸廓檢查landmarksonthechestwall

胸部體表標(biāo)志及分區(qū)chestshapeandwall

胸廓與胸壁breast

乳房LandmarksontheChestWall

胸壁骨髂標(biāo)志(前)Clavicle

鎖骨Manubrium

胸骨柄Manubriosternaljunction(AngleofLouis)

胸骨角Ribandintercostalspace

肋骨和肋間隙3LandmarksontheChestWall

胸壁骨髂標(biāo)志(后)Spinousprocess

脊柱棘突Costovertebralangle

肋脊角Scapula

肩胛骨Inferiorangleofscapula

肩胛下角4ReferenceLinesinFront

胸部體表標(biāo)志線(前)Midsternalline

前正中線Midclavicularline

鎖骨中線5ReferenceLinesinLateral

胸部體表標(biāo)志線(側(cè))Anterioraxillaryline

腋前線Midaxillaryline

腋中線Posterioraxillaryline

腋后線6ReferenceLinesinBack

胸部體表標(biāo)志線(后)Scapularline

肩胛線Vertebralline

后正中線7FossasandRegions

胸部四窩和背部四區(qū)Fossas:胸部凹陷suprasternalfossa

胸骨上窩supraclavicularfossa

鎖骨上窩

infraclavicularfossa

鎖骨下窩axillaryfossa

腋窩Regions:背部分區(qū)scapularregion

肩胛區(qū)suprascapularregion

肩胛上區(qū)infrascapularregion

肩胛下區(qū)interscapularregion

肩胛間區(qū)ChestWall

胸壁檢查Visibleveins:collateralcirculation,payattentiontothedirectionofbloodflow

靜脈顯露:側(cè)枝循環(huán)注意血流方向‘Grippingsnow’sensation:subcutaneousemphysema

皮膚握雪感:皮下氣腫Regionalenlargement:ribfracture,tumoronthechestwall,cardiacenlargement

局部膨隆:肋骨骨折胸壁腫瘤心臟增大Localtenderness:inflammation,ribfracture

局部壓痛:胸壁炎癥肋骨骨折Sternumtendernessandpercussionpain:leukemia

胸骨壓痛叩擊痛:白血病AbnormalIntercostalSpace

肋間隙改變Recessedornarrowed凹陷或變窄（容積縮小）depressedwheninspiration:airwayobstruction

吸氣時(shí)凹陷:大氣道阻塞one-sidedepression:atelectasis,pleuraladhesion

一側(cè)變窄凹陷:肺不張胸膜粘連Wideorswelling

膨隆或增寬（容積增大）generalintensewhenexpirating:emphysema,bronchialasthma

呼氣時(shí)膨隆:肺氣腫支氣管哮喘one-sideintense:pleuraleffusion,pneumothorax

一側(cè)增寬膨隆:胸腔積液氣胸Chestshape

胸廓形態(tài)Normal:Ap:T=1:1.5正常形態(tài):前后徑:橫徑＝1:1.5Abnormal:形態(tài)異常:FlatchestandBarrelchest

扁平胸和桶狀胸Rachiticchest:Pigeonchest,Rachiticrosary,Funnelchest,Harrisongroove

佝僂病胸:雞胸串珠胸漏斗胸肋膈溝Regionaltransfiguration

局部變形Thorax-vertebrae-malformation-induced

胸椎嚴(yán)重畸形ApTFlatchestandBarrelChestDeformity

扁平胸和桶狀胸Anterior-posteriordiameterofchestshapeincreasedandequaltotransverse

胸廓前后徑增大等于橫徑Intercostalwiderandribflattenout

肋間增寬走向變平13PigeonandFunnelChestDeformity

雞胸和漏斗胸14BreastExamination

乳房檢查Galactophoreanatomise:breastandnipple,regionallymphnodes

乳腺解剖

乳房與乳頭鄰近淋巴結(jié)Breastsubarea:upperandlower,outerandinner

乳房分區(qū)

外上與外下內(nèi)下與內(nèi)上Breastexamination:inspectionandpalpation

乳房檢查

視診與觸診15InspectionofBreastsContour

乳房輪廓視診Normal:symmetrichemisphere

對(duì)稱半球形Asymmetric

不對(duì)稱enlarged:inflammation,tumor

增大:炎癥腫瘤under-sized:hypogenesis

縮小:發(fā)育不良16InspectionofBreastSkin

乳房皮膚視診Redness:inflammation

發(fā)紅

炎癥Peaud’orange(orangepeel):malignancy

桔皮樣水腫

惡性腫瘤Retraction:scar,tumor

回縮下陷

瘢痕腫瘤orangepeelretraction17Nippleretraction

乳頭回縮Bilateralandlifelong:hypogenesis

雙側(cè)長(zhǎng)期:發(fā)育異常Unilateralandrecent:inflammationandmalignancy

單側(cè)近期:炎癥腫瘤Indrawingofthenipple18NippleDischarge

乳頭分泌物非哺乳期

無(wú)分泌物哺乳期

乳白色非哺乳期分泌物血性

乳腺癌膿性

乳腺炎淡黃色

乳腺導(dǎo)管病變PalpationoftheBreasts

乳房觸診Technique:examinewiththeflatofthehandandtipsofthefingers

檢查手法:用指腹或手掌輕壓滑動(dòng)Order:fromhealthtodisasterside

檢查順序:先健側(cè)后患側(cè)upper,lower,outer,inner

外上→外下→內(nèi)下→內(nèi)上20PalpationMethodoftheBreasts

乳房觸診檢查方法Onemanualpalpation

單手觸診Bimanualpalpation

雙手觸診21PalpationofRegionalNodes

淋巴結(jié)觸診檢查方法PathologicalFindings

觸診異常改變Skin:Increasedconsistency,Diminishedelasticity,Tenderness

皮膚:硬度增加彈性消失壓痛Masses:LocationandsizeContour,margin,rigidity;Tenderness,mobility

包塊:部位與大小外形邊緣硬度壓痛活動(dòng)度Lymphadenovarix:Axillary,Suprasternalfossa

淋巴結(jié):腋窩鎖骨上窩淋巴結(jié)增大CommonDiseases

乳腺常見病變Acutemastadenitis

急性乳腺炎Cystichyperplasia

乳腺囊性增生Fibroma

乳腺纖維瘤Cancer

乳腺癌Gynecomastiainthemale

男性乳房增生gynecomastia24PulmonaryPhysicalExamination

肺部體格檢查inspection,palpationandpercussion

視診觸診叩診TheLungInspection

肺部視診Sizeandshapeofthorax

胸廓與肺的外形

Respiratoryfrequency

呼吸頻率Depthandrhythm

呼吸深度和節(jié)律

Respiratorymovement

呼吸運(yùn)動(dòng)SizeandShapeofThorax

胸廓與肺外形Lungvolumevariation:barrelchest,flatchest

肺容積改變:

桶狀胸扁平胸Chestmalformation:rachiticchest,kyphosis,coliosis

胸廓畸形:佝僂病胸駝背脊柱側(cè)凸27RespiratoryFrequency

呼吸頻率Normalrespiratoryrate:

正常:12~20次/分Bradypnea:ratelessthan12perminute

呼吸過(guò)緩:＜12次/分Tachypnea:rategreaterthan24perminute

呼吸過(guò)速:＞20次/分ImportantPatternofBreathing

重要呼吸節(jié)律類型Kussmals

酸中毒深大呼吸Sleepapnea

睡眠呼吸暫停Cheynestrokes

潮式呼吸Pursedlipbreathing

縮唇呼吸Orthopnoea:shortofbreathinsupineposition,getssomereliefbysittingorstandingup端坐呼吸:平臥時(shí)氣短坐起或站立呼吸困難可緩解RespiratoryMovement

呼吸運(yùn)動(dòng)Normal:Symmetric

正常:對(duì)稱胸腹式呼吸Enhancedordecreased,unilateralorbilateral

呼吸增強(qiáng)或減弱單側(cè)或雙側(cè)Inspiratorydyspnea,‘threedepressionssign’

吸氣性呼吸困難“三凹征”Expiratorydyspnea,protractionofintercostal

呼氣性呼吸困難肋間隙膨隆呼氣延長(zhǎng)EffortofVentilation

用力呼吸Personappearsuncomfortable.Breathingseemsvoluntary

病人呼吸不適主動(dòng)用力呼吸Accessorymusclesareinuse,expiratorymusclesareactiveandexpirationisnotpassiveanymore

輔助肌用力呼氣肌收縮Thedegreeofnegativepleuralpressureishigh

胸腔壓力升高Therespiratoryrateisincreased

呼吸頻率加快TheLungPalpation

肺部觸診Chestexpansion

胸廓擴(kuò)張度Trachealposition

氣管位置Pleuralfrictionfeelings

胸膜摩擦感Vocal(tactile)fremitus

語(yǔ)音震顫ChestExpansion

胸廓擴(kuò)張度Comparebilateraldynamiceventsofrespiration

測(cè)定雙側(cè)呼吸動(dòng)度33AbnormalChestExpansion

胸廓擴(kuò)張度異常Asymmetricalchestexpansionisabnormal

胸廓擴(kuò)張度不對(duì)稱提示異常Theabnormalsideexpandslessandlagsbehindthenormalside

胸廓擴(kuò)張度減小一側(cè)為病變側(cè)Anyformofunilaterallungorpleuraldiseasecancauseasymmetryofchestexpansion

肺或胸膜疾病均可引起對(duì)側(cè)代償性增強(qiáng)Globalexpansiondecreaseindicatediffuselungorpleuraldisease

雙側(cè)胸廓擴(kuò)張度減小提示

兩肺彌漫病變雙側(cè)胸腔積液TrachealPosition:Mediastinum

氣管位置:提示縱隔位置被檢者取坐位或仰臥位右手的示指與環(huán)指置于兩側(cè)胸鎖關(guān)節(jié)中指置于氣管上觀察中指是否位于示指與環(huán)指中間35AbnormalTrachealPosition

氣管位置異常Anydeviationofthemediastinumisabnormal

提示縱隔位移異常Pull:(Lossoflungvolume)Atelectasis,fibrosis,agenesis,surgicalresection,pleuralfibrosis

移向患側(cè)(肺容積縮小)肺不張肺纖維化胸膜粘連Push:(Spaceoccupyinglesions)pleuraleffusion,pneumothorax,largemasslesions

推向健側(cè)(胸腔容積增大)胸腔積液氣胸巨大占位Mediastinalmassesandthyroidtumors

縱隔或甲狀腺腫瘤PleuralFrictionFeelings

胸膜摩擦感Mechanism:pleuralsurfaceroughness

機(jī)制:胸膜表面粗糙Feelingfrictionlikeleatherrubbingbybreathing

隨呼吸感覺到如皮革相互摩擦Touchinventro-locationofthethorax

胸廓下前側(cè)部位易觸及Asignofacutepleuritis

提示胸膜炎Tactile

Fremitus

語(yǔ)音震顫Principle:wavefromtractalongthelungandpleuraltothechestwall

機(jī)制:聲波→氣道→肺泡→胸膜腔→胸壁振動(dòng)→手掌Influencefactor:laryngealbulk,respiratoryopen,conductivemediumanddistance

影響因素:喉音大小氣道通暢傳導(dǎo)介質(zhì)傳導(dǎo)距離38Technique

檢查方法Fromuppertolower

自上而下Fromprothoraxtoback

由前至后Contrastalternation

交替對(duì)比39PathologicalConditions

異常改變Weakenordisappear:Obstructiveatelectasis,emphysema,Pleuraleffusion,pneumothorax,subcutaneousemphysema

減弱或消失:阻塞性肺不張肺氣腫胸腔積液氣胸皮下氣腫Enhanced:Consolidationoflungtissue:lobarpneumonia,pulmonaryinfarction.Largecavityinthelung,esp.nearthepleura:lungabscess,cavernouspulmonarytuberculosis

增強(qiáng):肺實(shí)變:大葉肺炎肺血栓栓塞近胸膜肺空洞:肺膿腫肺結(jié)核空洞TheLungPercussion

肺部叩診Percussionnote

叩肺音Lungborder

叩肺界Diaphragmaticexcursion

叩肺下界移動(dòng)度Techniques

叩診方法Mediatepercussion

間接叩診法Fromuppertolower,fromoutertoinner

自上而下由外向內(nèi)Prothoraxalongintercostal,backinlevel

前胸沿肋間叩后背水平叩42PercussionNotesoftheLung

肺部叩診音Normalchest:resonance

正常:肺部清音Inferior>superior,left>right,anterior>posterior

下＞上左＞右前胸＞后背Dullnessifthelungoverlapswithneighboringorgan(liverandheart)

與鄰近臟器(心臟和肝臟)重疊:相對(duì)濁音Influencingfactors:Chestwallthicknessandairinthelung

影響因素:胸壁厚度肺內(nèi)含氣量PathologicalPercussionNotes

病理性叩診音Dullness

濁音Volumereduction:pneumonia,TB,atelectasis,lungedema

肺含氣量減少:炎癥實(shí)變肺腫瘤肺不張F(tuán)latness

實(shí)音

Airlesstissue:lungtumor,lungabcess,pleuraleffusion

胸膜(腔)胸壁增厚:

胸腔積液胸膜肥厚MASSTBfluidHyperresonance

過(guò)清音Lungtoleranceincrease:emphysema

肺內(nèi)含氣量增加:肺氣腫Tympany

鼓音Gasinpleuralcavity:pneumothorax

胸膜腔氣體:氣胸Cavernousinthelungs

肺部空洞

LungBorder

叩診肺界Kronig’sisthmus: