胸部检查-1

PhysicalExaminationOfChestandLungchestexamination胸廓检查pulmonaryexamination肺部检查(视、触、叩)pulmonaryauscultation肺部听诊signsinpulmonarydisease肺部常见疾病体征Contents内容ChestExamination胸廓检查landmarksonthechestwall胸部体表标志及分区chestshapeandwall胸廓与胸壁breast乳房LandmarksontheChestWall胸壁骨髂标志(前)Clavicle锁骨Manubrium胸骨柄Manubriosternaljunction(AngleofLouis)胸骨角Ribandintercostalspace肋骨和肋间隙LandmarksontheChestWall胸壁骨髂标志(后)Spinousprocess脊柱棘突Costovertebralangle肋脊角Scapula肩胛骨Inferiorangleofscapula肩胛下角ReferenceLinesinFront胸部体表标志线(前)Midsternalline前正中线Midclavicularline锁骨中线ReferenceLinesinLateral胸部体表标志线(侧)Anterioraxillaryline腋前线Midaxillaryline腋中线Posterioraxillaryline腋后线ReferenceLinesinBack胸部体表标志线(后)Scapularline肩胛线Vertebralline后正中线FossasandRegions胸部四窝和背部四区Fossassuprasternalfossasupraclavicularfossainfraclavicularfossaaxillaryfossa胸部凹陷胸骨上窝锁骨上窝锁骨下窝腋窝Regionsscapularregionsuprascapularregioninfrascapularregioninterscapularregion背部分区肩胛区肩胛上区肩胛下区肩胛间区ChestWall胸壁检查Visibleveins:collateralcirculation,payattentiontothedirectionofbloodflowRegionalenlargement:ribfracture,tumoronthechestwall,cardiacenlargementLocaltenderness:inflammation,ribfracture“Grippingsnow”sensation:subcutaneousemphysemaSternumtendernessandpercussionpain:leukemia静脉显露:侧枝循环注意血流方向局部膨隆:肋骨骨折胸壁肿瘤心脏增大局部压痛:胸壁炎症肋骨骨折皮肤握雪感:皮下气肿胸骨压痛叩击痛:白血病AbnormalIntercostalSpace肋间隙改变Recessedornarroweddepressedwheninspirating:airwayobstructionone-sidedepression:atelectasis,pleuraladhesionWideorswellinggeneralintensewhenexpirating:emphysema,bronchialasthmaone-sideintense:pleuraleffusion,pneumothorax凹陷或变窄(容积缩小)吸气时凹陷:大气道阻塞一侧变窄凹陷:肺不张胸膜粘连膨隆或增宽(容积增大)呼气时膨隆:肺气肿支气管哮喘一侧增宽膨隆:胸腔积液气胸胸膜肥厚、粘连Chestshape胸廓形态Normal:Ap:T=1:1.5Abnormal:FlatchestandBarrelchest胸廓正常形态前后径:横径1:1.5胸廓形态异常扁平胸和桶状胸ApTBarrelChestDeformity桶状胸Anterior-posteriordiameterofchestshapeincreasedandequaltotransverse胸廓前后径增大等于横径Intercostalwiderandribflattenout肋间增宽走向变平RachiticchestPigeonchestRachiticrosaryFunnelchestHarrisongroove佝偻病胸鸡胸串珠胸漏斗胸肋膈沟PigeonandFunnelChestDeformity鸡胸和漏斗胸Rachiticrosary串珠胸RegionaltransfigurationThorax-vertebrae-malformation-induced局部变形胸椎严重畸形BreastExamination乳房检查Galactophoreanatomy:breastandnipple,regionallymphnodes乳腺解剖:乳房与乳头邻近淋巴结Breastexamination:inspectionandpalpation乳房检查:视诊与触诊Breastsubarea:upperandlower,outerandinner乳房分区:外上与外下内下与内上InspectionofBreasts乳房视诊Breast乳房Contour轮廓Normal:symmetrichemisphere对称半球形Asymmetric不对称enlarged:inflammation,tumor增大:炎症肿瘤under-sized:hypogenesis缩小:发育不良Skin皮肤Redness:inflammation发红:炎症Peaud’orange(orangepeel):malignancy桔皮样水肿:肿瘤Retraction:scar,tumor回缩下陷:瘢痕肿瘤orangepeelretractionNipple乳头Nippleretraction乳头回缩Bilateralandlifelong:hypogenesis双侧长期:发育异常Unilateralandrecent:inflammationandmalignancy单侧近期:炎症肿瘤Discharge:benignormalignant分泌物:乳腺导管病变indrawingofthenipplePalpationoftheBreasts乳房触诊Position病人体位sittingandsupine坐位，或仰卧位Technique检查手法examinewiththeflatofthehandandtipsofthefingers用指腹或手掌屈侧轻压Order检查顺序fromhealthtodisasterside先健侧后患侧upper,lower,outer,inner外上→外下→内下→内上PalpationMethodoftheBreasts乳房触诊检查方法Onemanualpalpation单手触诊Bimanualpalpation双手触诊PalpationofRegionalNodes淋巴结触诊检查方法PathologicalFindings触诊异常改变Skin:IncreasedconsistencyDiminishedelasticityTendernessMassesLocation,size,numberContour,margin,rigidityTenderness,mobilityLymphadenovarixAxillarySuprasternalfossa皮肤硬度增加弹性消失压痛包块部位、大小、数目外形边缘硬度压痛活动度淋巴结增大腋窝锁骨上窝CommonDiseases乳腺常见病变Acutemastadenitis急性乳腺炎Cystichyperplasia乳腺囊性增生Fibroma乳腺纤维瘤Cancer乳腺癌Gynecomastiainthemale男性乳房增生gynecomastiaPulmonaryExamination肺部检查TheLungInspection肺部视诊Sizeandshapeofthorax胸廓与肺的外形Respiratoryfrequency呼吸频率Depthandrhythm呼吸深度和节律Respiratorymovement呼吸运动SizeandShapeofThorax胸廓与肺外形Lungvolumevariation:barrelchest,flatchest肺容积改变:桶状胸扁平胸Chestmalformation:rachiticchest,kyphosis,scoliosis胸廓畸形:佝偻病胸驼背脊柱侧凸RespiratoryFrequency呼吸频率Normalrespiratoryrate:12~20/min正常:12~20次/分Bradypnea:ratelessthan12perminute呼吸过缓:12次/分Tachypnea:ratemorethan20perminute呼吸过速:20次/分BreathingPatterns呼吸模式ImportantPatternofBreathing重要呼吸类型KussmaulsSleepapneaCheynestrokesPursedlipbreathingOrthopnea:shortofbreathinsupineposition,getssomereliefbysittingorstandingup.酸中毒深大呼吸睡眠呼吸暂停潮式呼吸缩唇呼吸端坐呼吸平卧时气短坐起或站立呼吸困难可缓解RespiratoryMovement呼吸运动Normal:Symmetricthoracic-diaphragmaticEnhancedordecreasedunilateralorbilateralInspiratorydyspnea“threedepressionssign”Expiratorydyspneaprotractionofintercostal正常:对称胸腹式呼吸呼吸增强或减弱单侧或双侧吸气性呼吸困难“三凹征”呼气性呼吸困难肋间隙膨隆呼气延长TheLungPalpation肺部触诊Chestexpansion胸廓扩张度Trachealposition气管位置Pleuralfrictionfeelings胸膜摩擦感Vocal(tactile)fremitus语音震颤ChestExpansion胸廓扩张度Comparebilateraldynamiceventsofrespiration测定双侧呼吸动度AbnormalChestExpansion胸廓扩张度异常AsymmetricalchestexpansionisabnormalTheabnormalsideexpandslessandlagsbehindthenormalsideAnyformofunilaterallungorpleuraldiseasecancauseasymmetryofchestexpansionGlobalexpansiondecreaseindicatediffuselungorpleuraldisease胸廓扩张度不对称胸廓扩张度减小侧为病变侧单侧肺或胸膜疾病均可引起胸廓扩张度减小对侧代偿性增强双侧胸廓扩张度减小两肺弥散病变双侧胸腔积液TrachealPosition:Mediastinum气管位置:提示纵隔位置AnydeviationofthemediastinumisabnormalLateralshift:ThemediastinumcanbeeitherpulledorpushedawayfromthelesionP