The principle of palpation of the spleen is analogous to palpation of the palpation of the liver. Before the end of the day, you should fix it in the position of the sick person on the back, and then it should be done in the position on the right side.

The ailment is guilty of lying on the right side of the leg, with the left hand bent in the knee and the tazostegon slopes, and with the left hand bent in the lithic slope. Likar to sit on the stile, right-handed blya lizhka sick, denounced to the new. Palpation of the spleen is bimanual: the hand of the left hand with plasma is placed on the lower part breast cancer on the lithium of the costal arch and lightly heal the area, so that you encircle the ruff of the breast cell to the side for an hour to breathe and push down the diaphragms of the spleen. Kintsev phalanges of 2-5 fingers right hands spread parallel to the anterior edge of the spleen 3 cm lower than the rosette, known during percussion. Another third moment of palpation is to cover the skin folds and "gut": when you see it, if the front row is loose, the fingers touch your hands to pull the skin straight to the navel (open the fold) pіdreber'ya (confirmation of the kishenі). The fourth moment is the dressing of the spleen: upon completion of the education of the "kishena", as soon as you come to visit you, who is sick to ask for a glimpse of the spleen. One hand in a whole hour lightly onslaught on the lower part of the breast plate and on the lil costal arch, and fingers palpate the hand, the spike is straightened and hesitates a small swift ruff right up to the spleen. As soon as the spleen is better, then you have been eating it in the swarm and even more tactilely in sight (pic. 77). At the time of palpation of the spleen, it means localization (in centimeters from the edge of the costal arch), consistency, shape and tenderness.

In a healthy person, the spleen is not palpable, the anterior edge is located 3-4 cm apart from the costal arch, and the spleen can be palpated at the edge of the costal arch, which is already increased by 1.5 times.

Fig. 77. Palpation of the spleen.

Decreased spleen (splenomegaly) is more susceptible to hepatitis, liver cirrhosis, cholangitis, typhoid fever, malaria, leukemia, hemolytic anemia, thrombosis of splenic vein, etc. At gostrich Infectious diseases, For example, typhoid fever, for the stagnant stagnation of blood in the village, won its own soft consistency, and when chronic ailments From the results of the pathological process, it becomes schooling.

The edge of the spleen is most often slightly rounded in the case of an increase, and in the case of a large number of symptoms, it is painless. more views appear at state-of-the-art development pathological process in viglyadi traumatic spleen disease or thromboembolic process.

The spleen is an unpaired parenchymal organ, which has a small ovoid shape and an inflamed lower pole.

It is located in the very bottom of the lithium, the front side of its shlunkovaya (visceral) surface of the von lies down to the shlunka, and the rear-lower dilyanka (nirkovy surface) - up to the adrenal gland. At the bottom of the tsikavii for us, the organ sticks to the vigine of the intestine.

Being roztasovanoy іd lіvim dome of diaphragms (between the ninth and eleventh ribs), the spleen is overwhelmed by a dichotomous looseness. Її dovga hang (so the titles "long-length") stand in the norm with the course of the tenth rib.

In people with asthenic statues, the spleen grows lower and more vertically, while in volodar hypersthenic statues, it grows more and more horizontally.

zavdannya look around

The palpation of the spleen is transferred to the spleen immediately. With help you can:

• make a form to the body;
• assessment of the stance of the surface structures;
• set the consistency of the fabric;
• assess the steps of decay to the body;
• detect the manifestation of ailments and іnshih key manifestations, Scho vkazuyut on vіdhilennya vіd norms.

Before the time, start before palpation, qualification of the drug, take care of collecting money for the history of the ailment. In most cases, additional help is needed to establish the cause of the damage, so that the normal robotic spleen can be switched over.

Zovnishniy oglyad

The first crocus in the pre-sledged spleen є the last look of the abdomen, which includes:

• assessment of its value;
• the establishment of symmetrical right and left halves;
• assessment of the degree of turn of death, apparent in the region of the edge-edge arc.

Have a great people zovnishniy viglyad abdomen (th form and size) depends on the type of condition, type of statue, level of physical development and level of growth.

The presence of pathological processes in the draining will inevitably provoke an increase, both insignificant and colossal (in most cases, the organ can reach the level of the club hole).

Overwhelming growth of the spleen with an increase in the size of the abdomen, with any wine becoming asymmetric (for the obvious vibration of the other half).

In a sick person, like a seeding horizontally, a cut through the black wall can be cut out of a pathologically abnormal spleen. A large world is typical for women with ailments, who suffer from cachexia.

Zbіlshennya abdomen supravodzhutsya zgladzhuvannyam or signs of death, like at the skin healthy people є from the left edge of the costal arch. For children with ailments, you can wind up the lower part of the breast plate (on the left side).

percussion

Kozhen fakhivets, who is a vicon of percussion (prostration) of the spleen, knows about the small size of the organ, which is grown in the lavage of the lactic acid, so that the manipulation of the breast can be doubled on top of the third

Oskilki dilyanka of spleen, available for puffing, excretion with organs, to avenge disgust (lungs, intestines, slurry), we shorten the option of “preliminaries” є without an average quiet percussion according to Yanovskiy, but the results are absolutely dull.

In the case of an average percussion percussion (the whole option is full of mobility), fachivets should only consider dullness, an increase in the amount of air-containing tissues in the percussion zone, which is given in case of a thumping sound.

For the additional quiet percussion, you can see the approximate size of the spleen. For an hour, you can see the management of ailments:

• Take an upright position with your arms straight forward.
• Lie down on the right side my hand in lіktyovy slopes and poklavi її on the surface of the breasts (the right hand is guilty of perebuvati under the head). The right leg of the patient is guilty, but the left leg is bent in the colony and in tazostegnous loam... This is the posture for maximum relaxation of the muscles of the anterior abdominal wall.

Itself in the ciches of the position of the preliminaries, the change of the small cinder is brought up to the right or downward towards the spleen, which means that you think about the results of palpation.

In order to increase the upper boundary between the organ, the finger, the viscous role of the plessimeter, set in the middle of the middle groin line and the level of the high-pitched intercostal space and start to the percussion, moving down the intercostal space.

The signal until the ruch is pinned is the moment, if the thick, Legendary sound will sacrifice a dull moment. The cordon (behind the aid of the dermograph, or by the way of fixing the little one of the left hand) means from the side a proper tympanic sound.

To set the lower border of the spleen, the finger-plessimeter is guilty of being placed on the middle groin line in a straight line, parallel to the ochikuvano cordon (trochus below the costal arch). Directly the percussion is going from bottom to top: from a clear sound to the cob of dullness. A message about passing the cordon to shy away from the side of a clear sound.

By starting the front cordon to mark us to the organ, put a finger-plessimeter on the front wall of the abdomen ( more navel, At the level of the tenth mid-ribs) parallel to the transmission cordon. Perkutate slid, letting through to the transverse axis of the spleen dullness until the first signs of dullness appear.

The front view is placed on the other side, a clear sound can be heard. The front border of the spleen normally passes one to two centimeters from the front groin line (livish).

To reveal the rear cordon to the organ, the finger-plessimeter is positioned perpendicular to the tenth rib (directly percussion can be parallel to the cordon). Collapsing between two lines (rear and shoulder blades), go to percussion until a trocha is dull to the sound (back to front).

Having inserted the upper and lower boundaries of the pre-sounded organ, we see it between them, as a result of which we can see the difference in diameter, which is located between the ninth and eleventh ribs. It is normal to get used to food, warehouses up to six centimeters.

When you go out, you see the front and back cordon of the spleen, you get the value of the longest (in healthy people, it’s about six to eight centimeters).

Increased significance of the transverse and long axis of the spleen dullness to the non-transferable evidence of the improvement of the organ, which is found in the patients who are watching:

• ailments of blood-forming organs (hemolytic anemias, thrombocytopenic purpura,);
• by the broken exchange of words (amiloidosis, for diabet ta in.);
• infectious ailments (painter, cranial, viscous and rotten typhus, brucellosis);
• blood circulation (abo spleen veins);
• pechinki ailments (cirrosis, hepatitis);
• lesions of the spleen (echinococosis, firing process, Pukhlinoyu, traumatic pohkodzhennyam).

With the presence of hospitable infectious ailments (especially with sepsis), the spleen swells up a consistency. Damage to the body is susceptible to amyloidosis, chronic infectious processes, blood problems, oncological disorders, portal hypertension.

In addition to cysts, infarctions, syphilic hums, echinococosis, the surface of the spleen swells with irregularities. Ailment to the body of a vein as a result of a thrombosis, inflammation, as well as thrombosis of the splenic vein.

Percussion of the spleen is carried out, displayed in this video:

Norms for children and adults

In the protocol of ultrasound diagnosis of the spleen, it is necessary to indicate the specific value of three linear changes (information about those, which the organ of improvement, is not given in numbers, in the notice).

Normal size of the spleen (in the middle) in older patients are presented in the list below:

• її dzhina can range from eight to chotiirteen centimeters;
• width - from five to seven centimeters;
• tovshchina - from three to five centimeters.

Massa healthy spleens in females do not overturn 150 g, in choloviks they have a head in between 190 to 200 g. Another indicator of a normal body will turn us into an area of ​​maximum health. The normal indicator is from forty to fifty square centimeters.

It is necessary to be reasonable, so that the values ​​are averaged, and the magnitude of any internal organs Individual in skin people.

The parameters of a healthy spleen in children change all hour (in general, in terms of size and size of continuously growing body).

Average indicators of the size of the body for children, which can be applied to different categories, indicated in the list:

• In newborns, the size of the spleen is 40 mm, the thickness is 20 mm, and the width is 38 mm.
• For children from one rock to three rocks, the organ becomes 68 mm, thickness - 30 mm, width - 50 mm.
• Up to seven rocks of the spleen can be increased up to 80 mm, thickness - up to 40 mm, width - up to 55 mm.
• For children of eight or twelve rocks, the organ becomes 90 mm, thickness - 45 mm, width - 60 mm.
• Up to the fiftieth century, the length can be from 100 to 120 mm, the thickness is 55 mm, and the width is too large.

Based on the list given, it is possible to establish that the size of the spleen is removed in the course of ultrasound monitoring, according to the applicable standards.

In case of inconsistency of indicators in a car, it is possible to detect little child availability:

• leukemia;
• hematologic syndrome;
• tuberculosis;
• anemia;
• cranial typhus;
• disease of pechinki.

Methods of palpation of the spleen

Palpation (production) is one of the main methods of spleen detection.

When you visit the surface area of ​​the left edge, it is necessary to come with a special respect, to help the body slightly improve, allowing you to get the perfect cone-shaped edge illumination, yak ribbed.

As well as a sick person is susceptible to splenomegaly (as a result of a large swelling of the spleen), as well as provoking the vibrations of a larger part from the edge of the costal arch, at the end of the costal arch, because of the need for a large amount of palpation.

Oscillations of palpation of the spleen, healthy at vertical position ill, in most cases it is seen twisting through strong muscles of the abdominal muscles, її good:

• in the position of the sick person on the back;
• in the first diagonal (45 degrees) position on the right side.

In that, and in general, the method of palpation is ordered by the same principles. The position of a sick person on the boat, as a result of a good relaxation of the muscles of the left half of the abdomen, and a slight decrease in the volume of the body downwards, which is more suitable for palpation.

At the same time, the situation is tied with deyakie non-hands for a lykar. I’m guilty of the production of the spleen, I’m guilty of something else at the couch, or stand on one of her handles.

• A lot of bimanual palpation in the patient's position is to lie on the back on a soft slick on a low pillow. Yogo feet are guilty of butyahnut, and hands are laid by the bridle of tuluba. Having approached the sled from the right side, the doctor borrowed a special order from her.

The right hand (palpate) the hands with a plasom laid down on the left part of the abdomen in such a rank, while the left part of the abdomen is flared towards the pubis, and the end phalanxes are closed and three of the ribs of the ribs were fluttered on one edge of the edge.

Kintseva phalanx of the middle finger is guilty of roztashovuvatsya in the cuff, fixed by the lower edge of the tenth rib and the tip of the eleventh rib. Great finger I don’t take the right of the hand in the process of managing the participation.

The hand of the left hand is placed on the left part of the breast plate of the sick bridle of the tenth-tenth ribs on the equal front axillary (pahvovy) line. Guilty fingers are thrown into the side of the ridge stop.

For an hour after the dying of the spineless ruffs, the doctor's hand is guilty of the triples between the spine of the costal arch, letting go to increase the spirited excursion of the diaphragms, so that the spleen goes down. In the process of palpation, the vicon has a glimpse of the regulation of the patient's behavior.

Even in the course of percussion or superficial palpation of the bullet, information about the localization of the lower border of the spleen is taken out, fingers palpate the brushes to become one or two centimeters lower. Pislya tsyo likar to rob shkirnu fold having taken shkirni pokrivi the anterior wall of the abdomen by three-chotiri centimeters in a straight line, to the protylezhny costal dusi.

The staff of the whole reception of the drug will open a supply of shkiri with their fingers, which will lay down without any problems. Like a cymbal, the patient robs the vidikh, and the vison palpates the fahivets at once from the lowering of the abdomen, gently curling the fingers of the right hand in the middle black empty(Pid kutom at 35-45 degrees), put your hand in the rest of the position until the end of the offensive breath.

The space, lacking a thin surface of the hand and costal arch, is sufficient for traversing the lower pole of the spleen. Proponuvavshy to the patient, the gibbous and non-volatile tumble of the stomach, likar with the fingers of his left hand pushing on the left costal arch, the splinter is flanked by the rupture.

For a moment, fingers palpate the hands, being unruffy, get lost in the blood empty, nudging the anti-vyshtovuk ruch of the abdominal wall.

At the moment of death, I see the lowering of the left dome of diaphragms, which displaces the spleen downward, as if you were eating a piece of the intestine. Before the hour vidihu the organ turns in the cob position. The very moment, if the little spleen is on the fingers, the likar will be victorious for the assessment of how I will become and the quality.

Innocent spleen may not be consumed in the quest, all deprived of their lower edges with the fingernose phalanges of the fingers. In such vipadas, the fachіvets, which pragmatically pinch the organ, is guilty for an hour to inhale, lightly stick the brush forward, straighten the fingers, shuffle them or stroke it (from above), or push it (from below) to the ruch.

It is necessary to memorize, so that the palpation will not be protected by the obstruction of the body, which is suspiciously infuriating.

• Repeated until the end of the day(Call me with a stretch of two or three dyhal cycles), listen to the palpation in the position of the patient on the right boat, named in honor of the proponated Swiss diagnostician and clinician Herman Sali.

Lagging on the bik, the patient is guilty of turning to the right side (down to 45 degrees) to the surface of the couch, pushing the fold down at once to the right side. The right leg of the sick person is guilty but it is twisted, and the liva - to loosen up the muscles of the abdomen - is half-bent in colonic slopes and the trocha is brought up to the tulub.

The specialist can take a particular position, however, if it is obvious that there is a low couch and a lack of nagness exchange of pastoral slopes You will be able to see the palpation of the sitting on the right side or down in front of the post on the right. The same position is given the ability of the right hand to flatten out on the patient's belly.

The given method of palpation of the spleen according to Sali is practically not related to the generalized method of bimanual dosage, which is used in the patient's position, but to lie on the back.

• In order not to get rid of the bad spleen from the bad nirkoy, it is necessary to carry out the palpation in the position of the ailing standing. The price of a provocation of the spleen from one side, in connection with which the procedure of palpation appears to be difficult, and from the second, the lowering of the nirka and lays down the production of the organ.

Splenomegaly allows namatsati on the front edge to tell us to the body the manifestation of characteristic viral patterns, which are present in the nyrka, over a number of authorities and specific features.

• When explicit(Purchase of old age in the black empty) palpation of the spleen can be difficult. In such vipadki її promatuvannya zdіysnyuyut in the position of the sick person, lying on the right boat (yak when advised on Sali). It is possible to establish the manifestation of splenomegaly in patients with ascites swelling by using the method of balancing palpation, in the position of lying on the back.

Specialist, like a healthy manipulation, with the help of the phalanges of the knuckles at once and three of the knuckle fingers, palpate his hands with a series of short, frequent and jerky blows on the anterior wall of the abdomen (none

Straightly applied pochtovhіv, scho get used with the mark of natrapiti on the organ, but perpendicular to the ochіkuvannyy lower edge.

On the very ear of the ear, the impact of the jerky blows was started on the left part of the abdomen on the edge of the anorectal (scallop) line of the anal ring, step by step oversupply of the fingers to the costal dusi.

The price of shifting is trivial to quiet feast, as long as there is no vidchutya zitknennya with a firm mind, which comes when there is a lot of empty woods, and at the same time, fusing and I know about the end of the phalanxes of the fingers.

Dana's manifestation will be called a symptom of "floating kryzhinka". Itself at the moment of such zitknen obmatsuyut the surface of the organ.

Video showing the technique of palpation of the spleen:

Norms and pathology

Selezinka, yak take care of the fate of the form immune system In the fight against pathologies of the cystic brain and blood, in all types of carbohydrate and lipid metabolism, the role in the human body is even more important.

It is the very fact that insignificant troubles in the robotic organ (and even more growth) can be found, by way of serious concern.

In cich vipadkah the patient is directed to ultrasound dosage. Indicator norms є:

• Growth of the spleen from the left side, under the lower part of the diaphragms. The middle of a healthy organ is guilty of lying down to the shlunk, and the tail of the lump of the spleen is localized at the center of the spleen (this is the name of the entry into her nerves and arteries and the way of lymph vessels and veins).
• The appearance of parenchyma, which has a single-grain structure.
• The diameter of the splenic vein, which does not overlap, is 0.5 cm.
• Evidence of a homogeneous ecostructure.
• There are some blotches on the spot.
• Evidence of new outlines, how to make a mistake.

Signs of pathology can be presented:

• The emergence of a heterogeneous structure (as a rule, to produce good stuff).
• Due to malignancy (a blame for oncological ailments of blood, which does not support malignancies, but rather to provoke splenomegaly's malpractice).
• The appearance of a rotated splenomegaly is a pathological increase in spleen growth.
• Incorrectly shaped body.

Finding minor changes from standard parameters is more important diagnostic value, Scho vimag of obov'yazkovo ї konsultatsії qualified fakhіvtsya.

The spleen is removed in the glybin of the hypochondrium, lateral to the slug. It is located beside the middle under the dome of diaphragms, and so it is, like a stove, volodya dizzy and crumbling. The spleen can form an ovoid shape to be projected onto the lithic surface of the chest wall between the IX and XI ribs;

The method of palpation of the spleen is basically analogous to the method of detection of the liver. Palpate to carry out the spatula in the position of the patient lying on the back. Long palpate the right hand, spread the flanks of the abdomen at the left edge of the abdomen, called the edge of the straight meat in such a rank, but when the valley is pointed towards the pubis, and the knuckles of the closed ones and the three closed fingers were known at one edge of the left side. At the same time, the tip of the middle finger is guilty of lying in the cuff between the lower edges of the X rib and the strong tip of the XI rib. The thumb of the right hand in the palpation of participation is not taken care of. Put a little of your left hand in a crosswise direction on the other side of the village on the other half of the breast, on the side of the costal arch, until the hour of palpation is to be interconnected and on the other side of the family for the purchase of washing for Before the hour of palpation, the car regulates the behavior of a sick person.

A sprinkle of liquor should be inhaled to a sick person with a "belly", and at the same hour, with the fingers of his right hand, a 3-4 cm shkiru of the black wall in a straight valley, to the side, against the costal dusi. In such a rank, the stock of shkiri with your fingers is opened, so that you can lay it down further down the slope of a black empty space. For all the ailments to rob vidih, and the likar, then go down black wall, Smoothly curling the fingers of the right hand into the abdomen and fixing in this position until the end of the offensive breath.

Between the costal arch and the strong surface of the fingers, there is enough space to miss the lower pole of the spleen. Let the sick know smell well and inhale with the "belly". At the end of the hour, the lіkar lіvіyu dolonei onslaught on the lіva costal arch, wrap around її looseness, and the fingers of the right hand wipe out unruly in the bite of the abdomen, repairing the support to the wickedness of the black wall (Fig. 61).

The diaphragm descends on the inhale and the dome of the spleen moves down. When the spleen is accessible for palpation, the lower pole is lowered when it is lowered, penetrating between the fingers and the costal arch into the gut, making the grip of fingers on the black wall, and then bypassing the fingers like this,

Innocent little spleen doesn’t eat it in the swish, but it’s deprived of sticking its lower pole on the fingers. In order to swirl, you need to put your right hand forward on the inhale, stick your fingers straight in the closed phalanges and pat them from above, or go to the bottom. However, the palpation of the spleen is further safeguarded, and it is not poskoditi її.

Until the end of the day, repeat the development, and besides, to hold the palpation in the position of the sick person on the right boat (according to Sali). With a whole right, the leg of the sick person is guilty, but it is straight, and the liva is bent in a circle and slightly brought to the tulub. Offended by their brushes, folded at once, ailments are put on the right side. Likar descend on the right side of the sled and carry out palpation of the spleen, and when palpating the patient is lying on the back (Fig. 62).

With the appearance of spleen, the appearance of the steps of improvement, consistency, the nature of the surface, the manifestation of ailment.

The normal spleen is not palpable. Yaksho f її to be prompted, it means won’t. When there is a severely swollen spleen (splenomegaly), the part of the rib arch is significant and can be readily visible to superficial swelling without the described method of palpation.

In order for the spleen to grow backwards, it is available from the growing nirka, it is necessary to additionally hold the palpation in the standing position: In addition, with splenomegaly, characteristic virality is palpated on the front edge of the spleen, at that time it is nirka when it is coated with its own specific features.

The palpation of the spleen is indicated by the percussion analysis according to Kurlov. For a whole lot of people to know the upper and lower borders of the spleen, and then the front and back edges. To carry out the pre-treatment in the position of a sick person lying on the right boat, yak at palpation on Sali. Pull the finger-plessimeter in parallel to the pummeled cordon organ. Percussion to carry out in the area of ​​a clear (tympanic) sound to a more dull, stagnant quiet percussion strikes. Pislya dermal bet striking the finger-plessimeter to compensate for 0.5-1 cm. Knowing the cordon is indicated along the edge of the finger-plessimeter, turned into a clear (tympanic) sound.

Like mothers on uvaz, when with normal sizes of the spleen above it there is not a dull sound, but along with dullness, a percussion sound with a tympanic appearance as a result of a close rosette of a small intestine.

The upper and lower borders of the spleen begin. For the whole finger-plessimeter, place it in a transverse straight line on the left side of the breast plate on the edge of the V rib. The middle phalanx of the finger is guilty of lying on the middle groin line and perpendicular to it. Percussion of the line of lines along the ribs and intercostal spaces, the crosswise position of the finger-plessimeter, right across the edge of the left club brush, until the transition of the clear legendary sound into dullness is revealed. The border of the upper border of the spleen and in the norm is rosetted on the IX ribs (the ribs lead to the normal end of the XII rib).

Having identified the cordon by the dermograph for fixing the middle of the left hand, insert the finger-pessimeter without the middle edge (proximal) of the krill of the other club chain and percussion along the middle of the groin. The cordon transitions from tympanic to bluntness, the sound comes from the lower border of the spleen and normally lies on the XI rib. Vimіryuyut stand between the upper and lower boundaries of the spleen. In the norm, it becomes 4-7 cm and is called the width of the bluntness.

When the anterior edge (anterior-lower pole) of the spleen is visible, place the finger-plessimeter later along the anterior middle line of the abdomen so that middle phalanx the finger has passed on the umbilical line and the bull is perpendicular to the umbilical line. Percussion in the right direction of the spleen along the line, from the bottom of the navel and the point of the overflow of the X left rib to the middle groin line (Fig. 63a). Cordon the transition of the tympanic sound in the bluntness of the anterior edge of the spleen. The normi vin does not go beyond the boundaries of the front groin line.

To mark the posterior edge (posterosuperior pole) of the spleen, it is necessary to match the X edge and to know the posterior edge at the ridge. Then the finger-plessimeter was installed on the left paravertebral line so that the middle of the phalanx lay on the X edge and the bulge was perpendicular to the line. Percussion along the X edge in the right direction of the spleen; The transition of the tympanic sound into the dullness of the posterior edge of the spleen. This is indicated by a dermograph.

In the norm, the posterior edge of the spleen does not protrude beyond the line between the left scapula. If you look between the front and back edges of the spleen, you can see that it is dull, which is 6-8 cm in the norm. In such a way, I will add a part of the spleen.
The size of the spleen according to Kurlov is used to restructure the spleen in the history of ailments in the viglyad, for example: for example, the number of sizes goes beyond the edge of the costal arch of a part of the spleen, the number is dull, and the banner is dull.

You can also choose one simple way to improve the size of the spleen. So, as if in the position of a sick person on the right boat (according to Sali) with a percussion in the middle of the X left rib with the middle groovy line, a dull sound appears, similar to a percussion sound over a liver, meaning it should be noted

Improving the size of the spleen is important diagnostic knowledge a whole series of pathological processes. Growth, growth of spleen in the same period of growth of liver and peripheral lymphatic universities to start in case of deyakyh hospitals and chronic infections, sepsis, infectious endocarditis, Hemoblastosis and systemic immunopathological diseases. One hour an increase in the size of the spleen and liver in patients with chronic active hepatitis, liver cirrhosis, hemolytic anemia, accumulated ailments (Gaucher, Nimana-Pika).

Isolation of the spleen can be caused by a thrombosis of the spleen or thrombosis of the spleen, development in the spleen of the swelling, bristles and other local pathological processes. In case of hospitable infectious diseases and septic processes of the consistency of myak, dough, and also in case of chronic infections, liver cirrhosis, leukemia, and especially in case of amyloidosis, you have a problem. The most common form of chronic spleen disease is osteomyelofibrosis. With a lot of sickness, the spleen has been loaned a large part of the black empty.

The ailment of the spleen can be tied to the quick fixes, to make the capsule unstretched, or with perisplenitis. The tuberosity of the surface is most often in the case of transfers of splenic infarction, however, in some cases, hereditary echinococosis, syphilis, abscess, cystic or swollen lesions.

Palpation of the liver and spleen with ascites is not very difficult. In general, we will describe the stove milling by the method of palpation, followed by a good palpation in the position of the sickly lying on the left boat and standing with a small nagging of the tulub forward, and the spleen is more beautiful than palpation on the right side of the bed on the right side. In case of swollen ascites, for the development of hepato- and splenomegaly, the method of balancing palpation is used. To carry out the pre-treatment in the position of the ailing lying on the back.

Likar by small knuckles and three knocked fingers of the right hand, not pulling out at the same time, giving short, frequent jerking blows to the anterior cranial stance perpendicularly to the forward edge of the knuckle Fix the application of such a rank of items along the half of the abdomen on the back of the line of the comb and step by step changing the fingers in the right edge of the costal arch until it looks like a blow on the hardness, as if floating kryzhinka "). At the same time, the surface of the organ can be faked.

In the process of severe palpation of organs in the black emptying, some pathological confirmation appears, the sprinkling of the pukhlin or the cyst. In many cases, the exact localization of the palpable illumination in the worms, its shape, size, consistency, the manifestation of fluctuations, the nature of the surface, lumpiness (senility, organs, ligaments) Osvita, bezposeredno tied with an anterior cranial wall, tinker as well when you look around. It is palpable when the yak is relaxed, so it squeezes the mucus of the cranial press, and when the abdominal excursions are spontaneous, move in the anterior-posterior right at once from the abdominal wall.

Intra-vascular office visually start only at the same time as it is necessary to finish great razmіrіv... With a strong pressure of the muscles of the cranial press, palpation of the internal diabetic illumination is difficult, and with the weakening of the muscles of the abdomen, the looseness of such illumination and change in the upper right direction may appear. However, it follows that, as a matter of fact, the wisdom of the inner diabral illumination lies in the natural decay of the organ, from which it goes, and, as it is confirmed by the pudding, then it is in the form of the manifestation of sprouting in the plant. The retroperitoneal illumination appears to be very loose in the black empty and in a tight ring from the back wall. Vono is inactive і, as a rule, cover the organs of the abdominal emptying, for example, with the intestine or a slag.

the position of the sick on the right boat, liva leg zignut in the colony. Liva hand is bent in a lithic loam and lie on the chest plate.

the position of the lykar... Likar sit right-handed bіlya lіzhka sick, denounced to the new.

first moment... Put the right (palpable) hand with the plasma with slightly bent fingers on the area of ​​the left edge so that middle finger they were located approximately at the place of attachment of the tenth rib to the costal dusi. Put your hand on the lion's half of the sick man's breast, pushing a grip on her.

another moment... With the upper arms of the fingers of the right hand, the skirting is brought down by 3-4 cm.

third moment... Hanging the fingers of the right hand on the mice, ask the ailing one to make a big breath. Spleen's edge

go down for an hour, breathe down, go around palpate fingers. At tsei moment vynikak is more tactile in vidchuttya. If the spleen is palpable, then it means consistency, form and ailment.

Palpation of the slurry

Palpation of the slurry zone is carried out;

Have a sick person lying on his back

At the position on the right boat

At the position of standing

first moment... Place the crotch of the fingers of the right hand horizontally by 2-3 cm.

another moment... With the top of the fingers of the hand, we destroy the skirting up the mountain so that a crease is created in front of the nigta's surface of the fingers.

third moment... Clown to the weakness of the abdominal muzzles when you see it, step by step to rub your fingers into the stomach, if the stench does not reach the back wall.

quarter moment... Do not pick up your fingers from the back of the black wall, wiggle the ruffs with your hand upside down. If the result is positive, then the approval appears at the view of the transversely roasted cylinder close to 1.5-2 cm. In the diameter.

Methods for the detection of organs of the sechovidlennya Oglyad

look around the belly

Inspection of the suprapubic region

Inspection of the transverse area

The appearance of symmetry, the appearance of vibuhne, hyperemia of shkiri, pulsation, cicatrix.

palpation

1. Palpation of nirok when lying down(Obraztsov-Strazhesko technique):

The position of the sick person - lying on the back with stretched legs, the head on a low uzgoliv, the black press of relaxation, the hands are laid on the breasts;

Liva hand across the bottom of the XII rib;

The right hand is 2-3 cm lower than the costal arch, called from straight lines, parallel to them;

On the phase of the vidihu, the right hand is drawn into the black empty space, and the left hand is embossed on the transverse area right up to the fingers of the right hand;

For the sake of the ailments' hands to rob the gale of deep breaths with the "belly";

Having seen the dotted line from the nirko, the fingers of the right hand press down to the rear end, and then go down the front surface, bypassing the lower pole of the nirka. When palpation characterize: shape, size, nature of the surface, consistency, soreness, displacement.

2. Palpation nirok in position on the boat:

The ailment is on the right side of the boat, the legs are slightly bent in the knees,

3. Palpation nirok in position standing(Methodology of S.P. Botkin):

The ailment is worth the accusations to the lykar, the tulub is slightly healed forward, the muzzles of the black press are relaxed,

Likar to sit on the stile,

The following steps are analogous to food descriptions.

In this given condition, the collapse of the nirka begins,

4. Palpation of cut points:

Upper - the edge of the straight abdomen on the navel,

The bottom is a cross-section of the basic line with a vertical line, which passes through the lumbar hump of the cystka.

5. Palpation of the cut michur:

Putting the sick on the back,

Palpate with the right hand from the navel straight to the pubic joint.

6. Palpation of the transverse area:

With the right hand, push the right-handed і lіvoruch at the costal-ridge points (kut mіzh XII with the edge and with the back muscles).

head physical spleen detection method insanely є promazuvannya. It should be carried out in the supine position of the sick person on the back, or, as a rule, in the right side abo diagonal position (Sahli, Schuster). Tsei priyom is also twisted with palpation of medium-sized children, albeit with majestic selets (leukemia, malaria, morbus Vaquez-Osler "a, motbus Banti and ін.) I will be happy.

Todi mi wedemo zvychaynisinke spleen production They can be resumed according to their fingertips, they can be felt by the edge in the region, and this rank is known not only because of the authorities of the region, but because of the nature of the consistency, the surface and the surface.

Accepted vvazati, scho normal The spleen cannot be felt, but once you pick it up, then it’s better. Tsia dumka tsіlkom uzgodzhutsya with our information about the encampment in the forefront - he beckon not to go far l. costoarticularis.

However, in case of inversion appear However, it is not right for all types of people to see a thought, and in some people, with a normal size, the organ still misses it. It should be carried out to quiet sub'ktsiv, in some of them even lower than in Budova, in most of them to women, which may be habitus asthenicus, in those who are more low, there will be more low-rise in front of them.

They have with glib dichny rukh you can wash the spleen. In the same way, a normal spleen is pushed into a normal spleen when the left dome is lowered with diaphragms under the infusion of pleurisy, exudate-pneumothorax, with significant enteroptosis, if it’s like a sick person has lower folds, smooth, thin, without obvious palpation chomu maє more aplomb; Anterior lower ribs are not felt in the area of ​​9-10 ribs, as with a small increase in spleen, but more in the area of ​​10-11-12 ribs.

If the spleen is felt more and more times, it means that it is won. At the same time, invoke the power of the lower front of the palpable end, become less of a normal organ, and in some cases the spleen can be felt to be sensitive.

V Falling from the step of the growth The whole organ will feel a part of it that is larger or smaller in size, and by the fact that the little spleen goes from the costal edge, one can judge before the singing world about those who have lost the whole organ.

Somewhat small increase spleens, If you go to your edge from the edge for 2-5-7 san. .), as well as with chronic stagnation in heart ailments and those suffering from cirrhosis of the liver, with chronic subversive blood (malignant anemia, leukemia, eritremia), with pseudo leukemic simple cases, often , de moody reason can be spadkovy syphilis, rachit or status lymphaticus. Behind the step of scholarship, the land of the great spleen, one can see the world of nobility about the old days. To improve the spleen it is trimmed more, the consistency of the parenchyma is firmer and shinier, so when the processes of the spleen are splendid, less in chronic ones.
In cichs in the fall, the spleen is already feel out not only for the hour of a large podikh, but at the middle dichal position of the diaphragms and the chest wall.

Great and overwhelmingly great spleens If one spleen with its lower pole descends into the empty pelvis, palpates all the hour. Here we will recognize a new diagnostic sign of a scherbini, in the number of types 1 to 4, in the middle edge (margo crenatus) for the recognition of the spleen in the palpable puffin.

Їx mi is known in vipadk splenomegaly with amiloid, with leukemia, especially chronic myelogenous, with pseudo-leukemia, with morbus Banti, with anemia splenica, with Gaucher ailment, Vaquez ailment, with chronic malaria, nares, adolescent cystitis palpation of the power of the surface of the spleen, permeation in the tissue of the fibrin during perisplenitis, to know the diagnosis, such as in case of echinococcus, serous and hemorrhagic cysts, and abscess (in case of some, dying, such cases) All the known signs are even more valuable for diagnosing the disease of the spleen itself, so, so, for the development of a quiet ailment, with such splenomegaly, it is spared.