The Physical Examination of Abdomen (3)_ Percussion

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The Physical Examination of Abdomen (3)_
Percussion
???????????????????? ???????????????????? Professo
r?Doctor director ?Neurologist
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Percussion

• Percussion is used to demonstrate the presence of
  gaseous distension and fluid or solid masses
• The size of the organ
• and Percussion pain

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• ??????????????????,??????????????????????????????
  ??,????????????

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??Abdomen Percussion Sound

• All four quadrant of abdomen are evaluated by
  percussion
• Tympany is the most commom percussion note in
  abdomen
• presence of gas within the stomach,small
  bowel,colon.

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• Dullness exists in liver (right hypochondrium
  region)
• spleen (left
  hypochondrium region)
• distended urinary bladder
  (suprapubic area)
• enlarged uterus
  (suprapubic area)
• psoas (back side)

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• Increasing in Dullness region
• organ swell
• tumor
• ascites
• Increasing in tympany
• gaseous distension
• perforation

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• ?????,?????????????,?????????, ???????????????????
  ?????????

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Percussion of Liver

• upper border of liver
• right midclavicular line
• right anterior axillary line
  
• right scapular line
• relative dullness area
• absolute dullness area

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• lower border of liver
• right midclavicular line
• Anterior median line
• tympany dullness

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• ?????????,????????????????,???????????????????,??
  ????????????,????12??,???????,????????(???)

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Normal Liver Border

• upper border
• right midclavicular line the fifth
  interspace
• right axillary line the senenth interspace
• right scapular line the tenth interspace
  lower border
• right midclavicular line right costal
  margin

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Measurement

• Size
• right midclavicular line 9-11cm
• anterior median line 4-8cm

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• ??????????????????5??,??????????????????????,?91
  1cm???????????7??,??????10???????????????10??

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Change of Liver Border

• Increasing in liver dullness area
• liver carcinoma, liver abscess, hepatitis,
  polycystic
• Decreasing in liver dullness area
• acute hepatic necrosis, cirrhosis, gaseous
  distension
• Absence of liver dullness area
• acute perforation of hollow viscus

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Percussion Tenderness of Liver and Gallbladder
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• ?????? ??????? ?????????????????? ??????
  ??????????????? ?????
  ?????????? ???????????? ???

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Traube Area
Traube area
9.5cm6.0cm
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• ??????????(traube?)???????,??????????????????????
  ??,?????,????,??????????????????????????????traube
  ??????

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??Percussion of Spleen

• route
• left midaxillary line
• normal spleen border
• left midaxillary line the ninth-eleventh
  interspace
• longitude 4-7cm
• Change of spleen border
• increasing enlarged spleen
• decreasing gastric dialation, left
  pneumothorax

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• ??????????????,??????????????????911?????????,?
  ????47cm?????????????????????????????????????????
  ???

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??Shifting Dullness

• The quantity of ascites is more than 1000ml

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Percussion of ascites
tympany
dullness
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Shifting Dullness

• ???????,??????,???????,?????,????????,????????,???
  ??????,???,???,????????,??????,?????????,??????,??
  ???????????????????????

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Shifting Dullness
tympany
dullness
supine
tympany
dullness
lateral position
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• Manipulation

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• ?????????????????,?????,????????????,?????????
  ?????????????????????????????1000ml???,??????????

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Differential diagnosis between Ovarian cyst and
ascites
ascites
ovarian cyst
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Differential diagnosis between Ovarian cyst and
ascites
tympany
tympany
dullness
dullness
ascites
ovarian cyst
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Ruler Pressing test
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• ????????????????,????(1)????????????????,??????
  ???(2)????????????(3)????(ruler pressing
  test)?????

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??Percussion of ridge costal angle
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Sensitive to percussion in ridge costal angle
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• ?????????????????,??????????,?????????????(??),??
  ??????????????????,???????????????????????,???????
  ?????

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??Bladder Percussion

• Locationsuprapubic area
• Empty bladder tympany
• Filling with urinary dullness

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• ?????????????,?????,??????????,?????,?????????????
  ??????,?????????????

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• ???
• ??????(?????????????????????)(18?)

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• (1)?????(Traube?)(4?) ???????????????,?????????(
  2?) ?????????(2?)

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(2)???????????(8?)

• ???????,??????,???????,?????,????????,????????,??
  ???????,???,???,????????,??????,?????????,??????,?
  ????????????????????????

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(3)????????????(4?)

• ???,????????????,????????????????,????????????????
  ?

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(4) ??(3?,?????2?)(2?)

• ??????(Traube?)?????????(1?) ???????????????,???
  ??,?????,??????,???5-13cm,???2.7-10cm,????????????
  ????,????,??????? ?????????????,???????????
  ???????????????(1?) ????? ????????????????????
  ???????(1?) ??????????????

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• ??????
• (?)??
• (?)??
• (?)??????(??????????????)?
• ??????????
• ???????????????

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• ????????
• (?)????
• (?)????
• 1?????????
• 2???????