Physical-examination(体格检查)

PhysicalexaminationDepartmentofEndocrinologyHainanmedicalcollegeWangXinjun（王新军）[e-mail]18789826999PhysicalexaminationItistheprocessofexaminingthepatient’sbodytodeterminethepresenceorabsenceofphysicalproblems.Weuseeachofourfoursensestoelicitsignsofdisease:Inspection视诊（sightandsmell）Palpation触诊（touch）Percussion叩诊（touchandhearing）Auscultation听诊（hearing）“teachtheeyetosee,thefingertofeel,andtheeartohear”Whatisthefifth?Smelling（嗅诊）InspectionInspectionisthesearchforphysicalsignsbyobservingthepatientwithyoureyesandsenseofsmell.FirststepinexaminingapatientorbodypartItincludesageneralsurveyofthepatient’smentalstatus（精神状况）posture（姿势）bodymovementgait（步态)breathodor（呼吸气味）skintypepatternofspeechstature（身材）stateofnutrition（营养状况)acromeglyHowtoinspectMakesuretheroomisinacomfortabletemperatureUsegoodlighting,preferablysunlightLookandobservebeforetouchingComparesymmetricalbodypartsMentalstatusandpersonalgroomingDoesthepatientlookwellorsick?Ishecomfortableinbed?Doesheappearindistress?Ishealertorishegroggy?Doeshelookacutelyorchronicallyill?poornutritionsunkeneyestemporalwastinglooseskinDoesthepatientappearclean?Isherhaircombed?Doesshebitehernails?Posture姿势ItmayrevealsignificantinformationCongestiveheartfailure:sitinachairtheentirenightThusthepositionsofthepatientatthetimeoftheexaminationmaysuggestcertaindiseasepossibilitiesPalpationPalpationisemployedoneverypartofthebodyaccessibletotheexaminingfingers.ThepalpationofabdomenisparticularlyimportantTheexaminertouchesandfeelsthepatient’sbodypartwithhishandstoexaminetexture（质地）Moistureskintemperaturecharacteristicsofmassestenderness（触痛）ofanorganorbodypartCharacteristicofmassessize（大小）shapeconsistency（密度）motilitysurfaceregularitypresenceorabsenceofexpansileortransmittedpulsation.MethodsofpalpationAlwaysbeginpalpationinanareaoftheabdomenthatisfarthestfromthelocationofpainTypesofpalpationLightpalpation（浅部触诊）Deeppalpation（深部触诊）Bimanualpalpation（双手触诊法）LightpalpationDeeppalpationUsedtodetermineorgansizeaswellasthepresenceofabdominalmassesThepatientshouldbeinstructedtobreathequietlythroughthemouthandtokeeparmsatthesidesDeeppalpationBimanualpalpationUsestwohands,oneoneachsideofthebodypartbeingpalpatedItisemployedduringtheprocessesofbreastsliver,spleen,kidneyorabdominalmassesexaminationBimanualpalpationPercussionPercussionistheactofstrikingthesurfaceofthebodytoelicitasound.PercussionofabodypartproducesasoundthatindicatesthetypeoftissuewithintheorganItisparticularlyimportantinexaminingthechestandabdomenPercussionItisusedtodetectdiaphragmaticmovement（横隔膜运动）,thesizeofheart,edgeofliverandspleenetal.MethodsofPercussionIndirectpercussion（间接叩诊法）Directpercussion（直接叩诊法）IndirectPercussionTheexaminerplacesthemiddlefingerofonehand(lefthand)firmlyagainstthepatient’ssurfacewall(chestorabdomen),withpalmandotherfingersheldoff(离开)theskinsurfaceThetipoftherightlongfingerofthehandstrikesaquick,sharpblowtotheterminalphalanxoftheleftfingerontheskinsurfaceIndirectPercussionThemotionofthestrikingfinger（叩击手指的运动）shouldcomefromthewrist（手腕）andnotfromtheelbow（肘）Usually,twoorthreestaccatoblowsarestruckinoneplace,andthenthepleximeterismovedelsewhereforasecondseriesofblowstocomparethesounds.DirectpercussionWhenyouelicitsoundbystrikingthebodysurfacedirectlywithyourfingers,hand,orreflexhammer,theprocedureiscalleddirectorimmediatepercussion.PercussionAccordingtotheidentityofthetissue,amountofairgascontaininganddistanceoftheorganfromtheskinsurface,thepercussionsoundinclude:resonance（清音）Tympany（鼓音）Hyperresonance（过清音）Dullness（浊音）Flatness（实音）QualityofPercussionResonance清音:percussionoverastructurecontainingairwithinatissue,suchasthelung,producesaresonantTympany鼓音:percussionoverahollowair-containingstructure,suchasthestomachQualityofPercussionHyperresonance过清音:thequalityofpercussionsoundsuchasinpulmonaryemphysema（肺气肿）Dullness浊音:percussionoverasolidorgan,suchastheliverQualityofPercussionFlatness实音:flatnessoccurswhenthereisnoairpresentintheunderlyingtissue.Forexample,flatnessisfoundoverthemuscleofthearmorthigh.SoundsproducedbyPercussionRecordoffindingQualityWhereheardResonanceHollowNormallungHyperresonanceBoomingAir-filledlungsTympanyDrumlikeAbdomenDullnessThudlikeLiverFlatnessFlatMuscle,boneAuscultationAmethodusedto“listen”tothesoundsofthebodyduringaphysicalexaminationAuscultationisusedtoexaminetheheartandlungs.stethoscopeAuscultationDirectauscultationIndirectauscultationHowtousethestethoscopeDo’swarmthediaphragmorbellexplainwhatyou’relisteningforandanswerpatient’squestionpromptlyDon’tsdonotapplytoomuchpressurewhenusingthebelldonottrytolistenthroughclothingHowtoauscultateEliminatedistractingnoisesExposethebodypartyouaregoingtoauscultateUsethediaphragm(膜型）tolistenfornormalheartsounds,andbowelsoundsPressthediaphragmfirmlyUsethebell（钟型）tolistenforabnormalheartsoundsorbruits（杂音)HoldthebelllightlySMELLOdorsonthebreathfromacetone,alcohol,andsomepoisonsmayleadquicklytoadiagnosis.Foul-smellingsputumsuggestsbronchiectasisorlungabscess.Vitalsigns生命征andanthropomorphicdataTe