Uhlobo lwesibindi: inkqubo, ukuchithwa kwemigaqo kunye nemigangatho

I-Palpation - enye yeyona ndlela yokufundisa ukuxilongwa, eyenziwa ngugqirha kwinqanaba lokuhlolwa kweprayimari. Namhlanje siza kuthetha ngawo.

I-Anatomy yesibindi

Ngaphambi kokuba uqale ukufundisisa umbuzo wokubamba kwesibindi, kuyimfuneko ukucacisa indlela yokusebenza kunye nemisebenzi yelungu. Isibindi sifumaneka ngaphantsi kwesithsaba, kwicala lasekunene kwi-top top of the stoma, kwaye kuphela inxalenye encinci yelungu lomntu omdala elisekhohlo (ngokuhambelana nomgca ophakathi). Kwiintsana, isibindi sinesabelo esibalulekileyo sesigxina esiswini.

I-Topographically, isibindi sinemihlaba emibini kunye nemida emibini. Umgangatho we-anteroom (ongentla) uqhotyoshelwe kumphezulu wesithsaba kwaye uqhutywe ngokuhambelana nokugoba kwawo. Inxalenye ephantsi ikhona emva nangaphantsi, inemifanekiso emininzi evela kwizitho eziseduze. Imihlaba engaphantsi nephezulu ihlukaniswe ngumgca ophantsi ophantsi, omnye umgca (ubuso obusemva), ngokuchaseneyo, bukhuni kakhulu, kwaye ngoko ke kunokuthiwa kubangelwa kwithuba elingasemva kwesigqeba.

Kukho iinxalenye ezimbini kwisibindi: ilungelo elikhulu kunye nekhohlo encinci, ehlukaniswe yeligenti yecrescent, kwinxalenye yamahhala enokuthi ilinegamenti enomthamo onamandla-into ebizwa ngokuba yi-circular ligament esukela kwintonga kwaye ayikho into engaphezu kwe-vebilical vein.

Isabelo esifanelekileyo sahlula ngeendlela zomlambo kwii-lobes eziliqela. Kweminye yale milambo ikhona i-gallbladder kunye ne- vein deep (engaphantsi), eyahlula isiqwenga sesibindi sesibindi, esibizwa ngokuba yinkqubo ye-caudate.

Enye yezona ndawo zibalulekileyo zeli candelo yimijelo ejikelezayo, ebizwa ngokuba yi-portal yesibindi. Ngalolu lwakhiwo, ilungu liquka imitha ephezulu ye-hepatic, i-veal veins kunye neentsholongwane, kwaye iyishiya ithwele i-hepatic conduit (ukukhutshwa kwe-bile kwi-gallbladder) kunye neempahla zellymatic.

Kwinqanaba elungileyo lebhunga , iqhekeza lesikwere liyabonakala, elinqunywe ngamasango esibindi, i-ligament ejikelezayo kunye nomgodi ovela kwi-gallbladder, kunye ne-lobe ye-caudate ephakathi kwamasango e-portal kunye ne-portal vein.

Imisebenzi yesibindi

• I-Metabolic (lawula ukutshintshisiswa kwamanzi, iifayile kunye namavithamini, amahomoni, amino acids, lipids, iiprotheni, i-carbohydrates).
• Ukuhlamba (emzimbeni uqokelela i-BZHU, iivithamini, ukulandelela izinto, i-hormone).
• Imfihlo (ukuveliswa kwe-bile).
• Ukuxhatshazwa (okwenziwa ngecebo lokusondeza kwesibindi - macrophage ye-hepatic).
• I-excretory (ngenxa yokubopha i-glucuronic kunye ne-sulffu acid acids: intodole, tyramine, scotol).
• I-homeostatic (ukubandakanywa kwesibindi ekulawuleni i-hemostasis ye-antigenic kunye ne-hemostasis yomzimba).

Ngenxa yeempawu zokuziphatha kunye nokusebenza, isibindi sisoloko sithinteka kwiintlobo ezahlukeneyo zezifo ezingenasifo kwaye zisulelayo. Kungoko okokuqala unyango lwesigulane kuyimfuneko yokwenza isalathiso salo lungu.

Ukutshatyalaliswa kunye neengcambu zesibindi

Ngaphambi kokuqhuba isalathiso sesibindi, kucetyiswa ukuba uchaze imida yayo usebenzisa ingqungquthela. Oku kuya kuvumela ukuba kungabikho nje ukuphakamisa ukwanda kwilungu, kodwa kwakhona ukuqonda ngokucacileyo apho i-palpation ifanele iqale. Ngomngxubevange, izicubu ze-hepatic zenza isandi esilumkileyo, kodwa ngenxa yokuba inxalenye engezantsi yomphunga iyayifaka, iyakwazi ukuchaza imida emibini: ukunyaniseka okwenyaniso kunye nongqongqo, kodwa ngokuqhelekileyo ukubeka umda kuphela (umzantsi nephezulu) wobungenangqondo.

Uhlobo lomzimba (ubuchule)

Xa uvavanya isibindi, kufuneka ulandele imithetho ethile:

• Isikhundla sesihloko silele ngasemva, ngelixa ikhanda liphakanyisiwe, kwaye imilenze ayiguquki ngamadolo okanye aqondiswe. Izandla zilele esifuba ukukhawulela ukuhamba kwazo xa zifakwe ngaphakathi kwaye zikhulule izihlunu zesisu.
• Ugqirha usekunene, ejongene nesigulane.
• Ugqirha ubeka isandla esifanelekileyo esicatyiweyo kwisisu sesigulane kwimimandla ye-hypochondrium echanekileyo, ephantsi kweemitha ezintathu ukuya ezintlanu ngaphaya komda wesibindi, echazwe ngaphambili. Ngesandla sakhe sobunxele, ugqirha uyasibekela isifuba (inxalenye yayo esezantsi ngakwesokudla), kunye neminwe emine ukuba ibekwe ngasemva, kunye nomnye (omkhulu) ngomnwe ubeke kwi-arch ebiza. Le ndlela izakuqinisekisa ukungahambi kakuhle kwesifuba ngexesha lokuphefumlelwa kwaye kuza kwandula isithintelo sitshintshe phantsi.

• Xa isigulane sigxininisa, ugqirha unogqirha ngaphandle kwesikhumba kwaye, ngokufakela iminwe yesandla sakhe sokunene kwisigxina esiswini, ubuza isiguli ukuba siphefumle. Ngeli xesha, umda (inxalenye engezantsi) yeedonsi zequmrhu, ungene kwiipokethi ezidaliweyo kunye neeslayidi kwiminwe. Ngexesha elifanayo, ingalo enesibindi kufuneka ihlale ihleli. Ukuba, ngenxa yesizathu esithile, isibindi sasingenanto, inkqubo iphindaphindiwe, kodwa iminwe ifakwe emithamitha amaninzi phezulu. Ukuvelisa ukunyanzelisa, ukunyuka phezulu nokuphakama kude kubekho isandla sokunene sikhubekiso kwi-arch ebiza imali, okanye kude kube yinto enqabileyo.

Izixhobo

• Ukubethelwa kwesibindi kuvame ukuqhutyelwa kwi-muscle ye-rectus esiswini (umda wayo wangaphandle) okanye umgca we-clavicular. Kodwa ukuba kunesidingo esinjalo, ukuphonononga kuqhutywe kumigangatho emihlanu (ukusuka kwi-axila yangaphakathi ukuya ngasekunene esifubeni sasekhohlo).
• Kwimeko yokuqokelelwa kwemimandla emikhulu yomkhuhlane kwisisu, i-palpation iba nzima. Emva koko batyelela kwi-balloting sensation of organ. Ukwenza oku, iminwe yesibini, yesithathu neyesine yesandla sokunene yenza ukutshwenyeka kwindonga yangaphambili yesisu, kuqala ukusuka ngasezantsi kwaye kuphelile ngombambo wenamba kuze kufikelelwe isinyithi esininzi-isibindi. Ngethuba lexesha lomzimba, ilungu lokuqala libuyela ngaphakathi, kwaye libuye likhubekise iminwe (uphawu lubizwa ngokuthi "i-ice floating").

Ukuchazwa kweziphumo (eziqhelekileyo)

Ziziphi iziphumo kufuneka ukuboniswa kwesibindi?

• Ngokuqhelekileyo, kwi-88% yezigulane, umgca ongezantsi welilungu usekufuphi kwinqanaba elibi, ngokuhambelanayo nomgca we-median-clavicular ngakwesokudla.
• Ngomntu onempilo, umda welilungu unzima okanye unqabile. Kuthambile, kubuhlungu, kulula ukujika xa uvakalelwa, nokuba.

Uvavanyo lwezinto ezifunyenweyo (ukugula)

• Ukuba isibindi sandisiwe, xa siphucukisiwe, siya kufumaneka ngaphantsi kwesigqithiso seendleko, esinokubonisa kwakhona ukufuduka kwayo. Ukuxhasa le nto okanye loo ngxelo, i-percussion iyimfuneko ukwenzela ukuba imisele imida yelungu.
• Ukuba ubukhulu besibindi azingatshintshi, kodwa imida ye-hepatic dullness ishintshiswa phantsi - oku kuwuphawu lokushiywa kwelungu.
• Ukufuduka komda ongaphantsi kwembonakalo kubonisa ukunyuka kwesibindi, okwenzeka nge-stasis eneemvula, ukuvuvukala kwiphepha lebhiliyari kunye nesibindi, ukusuleleka kwezilwanyana (malariya, uklebhu, umkhuhlane we-typhoid, isifo somhlaza), i-cirrhosis (kwinqanaba lokuqala).
• Ukuba umda ongaphantsi ususelwa phezulu, kunokwenzeka ukukrokrela ukwehla kobunzima belilungu (umzekelo, kwizigaba zokugcina ze-cirrhosis).
• Ukutshintsha indawo yomda ophezulu we-hepatic (phantsi okanye phezulu) ubonakalisa ukulimala kwilungu ngokwalo (umzekelo, nge-echinococcosis okanye umdlavuza wesibindi). Ngokuqhelekileyo oku kubangelwa isikhundla esiphakamileyo se-diaphragm ekukhulelweni, kwi-ascites, kwi-flatulence, ngenxa yesimo esiphantsi se-diaphragm kunye ne-enteroptosis, i-pneumothorax, i-emphysema, kunye nakwiimeko zesithintelo esivela esibindi ngenxa yokuqokelela kwegesi.
• Ukuphazamiseka kompompo , ukuguqulwa kwesahlulo sawo saphantsi , imiphunga ye-pneumonia, ne-right-side pleurisy inokufanisa ukutshintsha umda ophezulu wequmrhu.
• Kwezinye iimeko, kungekhona nje ukutsalwa kwesibindi, kodwa nalo lonke iqumrhu likhoyo. Ngenxa yoko, iminwe ifakwe ngqo phantsi kwe-arch-right hand arch. Ugqirha, ucinezela ngokunyanisekileyo, uhlola isibindi ngokunyakaza, ngelixa uvavanya umgangatho walo (ubomvu, ubushelelezi, nokuba), ukuhambelana (ubuninzi, obuthambileyo), ubukho / ukungabikho kobuhlungu.

• Ubumnandi, obuqhekezayo, obuqhekekileyo bomhlaba kunye nolwaphulo olubuhlungu olusisigxina - iimpawu zeenkqubo ezivuthayo kwiqumrhu okanye ukubonakaliswa kwe-stasis yegazi eliphambili ngenxa yokuhluleka kwentliziyo.
• Umgubo ongekho, ongalinganiyo, onobunzima obonakalayo kwi-echinococcosis kunye ne-syphilis. I-dense kakhulu ("ukhuni") isibindi esinqunywe xa iqumrhu lilimala ngamaseli omhlaza.
• Umxhesho wenyama wesibindi ubonisa i-hepatitis, kunye ne-tuberosity - ye-cirrhosis.
• Ubuhlungu ngexesha lokubamba kwesibindi kungenzeka ngenxa yokuvuvukala okanye ngenxa yesigxina se-capsule yayo (sinesibindi esingapheliyo).

Uhlobo lwesibindi kubantwana

Ukubethelwa kwesibindi sesana esasisandul 'ukuzalwa kusenziwa rhoqo kwinqanaba le-clavicular kunye nomgca we-axilary wangaphakathi ngokugxotha i-palpation. Kule meko, isandla sonyango lwabahlengikazi besifundo sezingane sishiya emngceleni wesibindi, ukuze kungenakwenzeka kuphela ukuba kuqinisekiswe ubungakanani bequmrhu, kodwa kunye nokuhlolwa kobunzima. Isiqhelo seentsana ezisandul 'ukuzalwa kubonakala kwinqanaba elingaphantsi kwexabiso eliphantsi kweendleko ezimbini (kodwa ezingekho ngaphezulu). Uvavanyo luyenziwa kumgca ophakathi phakathi. Umgca womzimba kufuneka ungabi nabuhlungu, uphelele, uphawule kwaye uphelele.

Kubantwana abanobulungiseleleyo ukuya kufikelela kwiminyaka asixhenxe, umda wesibindi, njengomthetho, uhamba ngokusuka kwi-arch-right arch kwaye ufikeleleka kwi-palpation. Kubantwana abanempilo ukuya kwiminyaka emithathu, isiqhelo siyinkcazo yesibindi kwi-2 okanye 3 centimitha ngaphantsi kwe-hypochondrium enene. Emva kweminyaka eyisixhenxe, imida yesibindi iyahambelana nabantu abadala.

Ukufunda ngesibindi ngendlela yaseKurlov

Ukuqinisekisa ukuxilongwa kwe-pathology ethile, ekhokelela ekuphazamiseni ubukhulu belilungu, kuyimfuneko yokwenza i-palpation yesibindi ngokwe-Kurlov. Ukwenza oku, usebenzisa i-tapping (ingqungquthela) ukugqiba umda ophezulu, kwaye i-palpatory (okanye ingqungquthela) -ezantsi. Ngaphezu koko, ngokuhambelana nekhosi oblique yomgca wezantsi womda wayo, kunye nomda phakathi kwemida ephezulu naphantsi, iinqununu ezintathu. Iyokuqala ihambelana nomgca we-sredneklyuchichnoy, okwesibini-phakathi kwe-clavicular, kunye neyesithathu-i-arch ekhethiweyo. Kulo gumbi, ubukhulu bube ngu-9, 8, 7 cm, ngokulandelanayo.