Ngokucofa-udakada: algorithm kunye nobuchwepheshe

Udakada - ilungu unpaired iqhele kwicala lasekhohlo lwe esiswini. Inxalenye umzimba ngaphambili nemelene kokwesisu, ngasemva - ukuya kwizintso, adrenal kunye emathunjini.

Ubume udakada

Ukubunjwa spleen echazwe inshorensi serous kunye capsule zabucala, le yokugqibela ezenziwa indibanisela kwizicwili, izihlunu kunye imicu elastic.

Le philisi ludlulele amathambo umzimba, yahlukanisa yintlama (i parenchyma) zibe "iziqithi" hlukanisa trabecular. Xa yintlama (iindonga arterioles) zicwangciswe ngeenxa okanye maqhuqhuva embhoxo izihlunu lymphoid (lymphoid zoboya). Xa intliziyo yintlama na eli laphu reticular leyo izaliswe ezahlukeneyo iiseli: iiseli ezibomvu egazini (ikakhulu uhageleyo), leukocytes lymphocyte.

umsebenzi zomzimba

• Le spleen libandakanyeka lymphopoiesis (okt njengomthombo lymphocyte).
• Ngenela kwi hematopoietic kunye nezifo nemisebenzi eziphilayo.
• Ukutshatyalaliswa qeda of zegazi kunye neeseli ezibomvu zegazi.
• Ukukhutshwa kwe-gazi.
• Kumanqanaba okuqala embryogenesis usebenza ilungu hematopoietic.

Oko kukuthi, umzimba wenza imisebenzi ebalulekileyo, yaye ke ngoko ukufumanisa ukungaqheleki xa nisaqala zophando kufuneka ukuphunyezwa yokuqala Ngokucofa yesandi le udakada.

Umyalelo Ngokucofa ngamalungu angaphakathi

Emva ukuqokelela izikhalazo, imbali yezonyango kunye noviwo jikelele, ugqirha luqala iindlela emzimbeni isifundo, eziquka Ngokucofa yesandi.

ahluke:

• Umphezulu Ngokucofa apho ibhaqwe ukuqaqamba nelula ombane intsimi kwizihlunu esiswini, ukudumba, kunye neentlobo ngeentlobo itywina Ukwakheka (Ithemba, nangezilonda, nodes). Bawuthwale uxinzelelo gentle iminwe isiqingatha-kruthu, ukuqala ukusuka kummandla iliac ekhohlo ebalwa.
• Ngokucofa Deep kwenziwa ngokulandelelana ilandelayo: iimfama , ileum (isiphelo inxalenye), ikholoni (zinyuka macandelo zisihla), ezinqamlezayo colon emathunjini, isisu, isibindi, injeke, udakada, izintso, ikhutshwa phandle usebenzisa iminwe Ukungena olunzulu ugqirha kwisisu.

Kwimeko urhano kwezifo splenic (okanye ungeniselo lwayo ngenxa isifo kwesibindi) ephethe zibuphekhashini ngokuyimfuneko, a Ngokucofa isibindi kunye udakada.

imithetho jikelele Ngokucofa

Ngokucofa (Ngokucofa) loMthetho udakada - yenye yeendlela ezininzi ulwazi uphando elibonakalayo, olwenziwe ngugqirha. Kwimeko ukunyuka okungephi emzimbeni, xa udakada akukho lula ukuba iphande, qiniseka ugqirha ukuba usebenzise indlela ultrasound ukuqinisekisa / aphikise leengxaki wabanga ukuba umntwana okanye omdala.

isimo yesigulane:

• Lisalele (kule ndawo ibanjwa Ngokucofa isibindi kunye udakada).
• Elele ecaleni kwakhe. Isandla sokunene siphantsi kwentloko yam, nangasekhohlo kufuneka maxa kwi engqinibeni, wambeka esifubeni sakhe (le ndlela kuthiwa Ngokucofa-udakada ka Sali). Ngaphezu koko, intloko isigulane kufuneka ithambeke kancinci esifubeni, umlenze ngqo ekunene kunye nomlenze ekhohlo kufuneka maxa kwi inyonga nedolo amalungu.

Ngokucofa-udakada: algorithm

1. ugqirha sesandla sasekhohlo sakhe kufuneka ibekwe ukuze elala phezu kwicala lasekhohlo esifubeni lwesifundo, lekhefu phakathi 7 kunye ubambo 10 ngokungqinelana kunye nemigca axillary, kunye nokubonelela xi okungephi. Xa iminwe yesandla sasekunene kufuneka enesiqingatha uzimisele kwaye ibekwe kwi arch costal ngasekhohlo ukuze ngomnwe ophakathi ezikufutshane ubambo-10.
2. Xa isigulane usezela, isikhumba ishenxiselwe ezantsi ukwenza likriwa yesikhumba.
3. Emva isandla Umphunga ngugqirha ingena isisu (esisu).
4. Isigulana ngesicelo ugqirha uthatha ukuphefumla nzulu, ngoxa phantsi kwempembelelo uvalo udakada ihambisa phantsi. Kwimeko yokwandisa ugqirha iminwe ziya nazo kwipali awo. Isenzo esinjalo kufuneka uphindaphindwe amaxesha amaninzi.

nokutolikwa iziphumo

Phantsi kweemeko eziqhelekileyo (kubantu abasempilweni), lo udakada ayikho uvalo. Ngaphandle ke asthenics (ikakhulu abafazi). Palpate i spleen kwezinye iimeko zibe kokushiywa uvalo (pneumothorax, unepleurisy) kunye splenomegaly, oko kukuthi, ukwanda ubukhulu emzimbeni. Yimeko efanayo ixhaphake kakhulu lithi zilandelayo:

• Izifo igazi.
• ezimbi sesibindi (splenomegaly apha luphawu lwegazi portal okanye hepatolienal syndrome).
• Acute kunye neenkqubo ezingapheliyo ezasulelayo (usulelo endocarditis, imalariya, yicesina, nokudumba).
• Izifo kwizicwili.
• Infarctions okanye amathumba le udakada.

Amaninzi, nkqu Ngokucofa udakada elula ziphangalalisiwe. Ngaphandle ke infarcts omzimba, njengezingxobo eqine ekhawulezileyo episplenitis. Kule meko, i udakada uba ethe kakhulu (oko kukuthi, kabuhlungu Ngokucofa).

Xa kwesibindi kunye nezinye izifo ezingapheliyo of udakada ngohlangothi kwintsunguzi iinkqubo, etsolo efanayo - ezithambileyo.

Ukungaguquguquki idla okuphakathi izifo ezihlasela zosulele, izifo ezingapheliyo kunye zesibindi kwesibindi iba ashinyeneyo.

Ngako sikrini iviwe isahlulo umzimba inokuba ixabiso elincinane okanye ezinkulu, nendlela udakada basonta ngaphandle zinongqameko asenokubonisa ubungakanani lokwenyaniso umzimba enkulu. Ngenxa yoko, ukonyuka encinci ibonisa ngohlangothi umzimba output le arch costal kwi 2-7 cm, nto leyo uyaqapheleka izifo ezihlasela zosulele (icesina, meningitis, nokudumba, lobar inyumoniya, njalo njalo) okanye izifo ezingapheliyo (isifo sentliziyo, ukuqina kwesibindi, erythremia, wegazi, igazi) kunye umyalezo engaziwayo eyenzeka ngamaxa amaninzi kubantu abatsha (ekusenokwenzeka negcushuwa ilifa, yamathambo)

Ngako mninzi spleen uvalo edge (ukuba ukwanda) kunokwenzeka ukuba bafikelele kwizigqibo malunga nenkqubo imithi. Oko kukuthi, ixesha elide komtshiso langoku emzimbeni, ukuba luthe nzima ngaphezu parenchyma wayo, ukusuka apho kulandela ukuba soft ngakumbi kwaye bhetyebhetye kunokuba udakada ezingapheliyo edge kwiinkqubo bukhali.

Xa umzimba mkhulu kakhulu, xa ungqameko olungezantsi ichazwe kwisisu zangasese, ukuba aqhube Ngokucofa-udakada lulula kakhulu kwaye ayifuni izakhono ezizodwa.

Kwimeko splenomegaly ngenxa yamathumba splenic ngu Ngokucofa (ngakumbi ngqo, margo crenatus yayo) iqondisiswa burr (1 ukuya kwi-4). Loo mqondiso zokuxilonga ibonisa ubukho amyloidosis, leukemia (esinganyangekiyo myelogenous okanye psevdoleykemii), isifo seengcongconi, cysts kunye endothelium.

Oko kukuthi, ngexesha Ngokucofa udakada ugqirha uyakwazi ukuhlola imeko ubuso bawo, ukuba ukubona fibrin nokufumba (njengaxa perisplenitah), lunamaqoqo ezahlukeneyo (oko kukuthi, umzekelo, amathumba, ukopha kunye cysts serous, echinococcosis) yaye zijongisise lexinene esikule. In amathumba rhoqo eyafunyanwayo kunye nokuya phambili. Yonke into imiselwe ulwazi Ngokucofa ibaluleke kakhulu ngenxa uxilongo izifo ezininzi udakada, kwaye inkcazelo sifo, nto leyo enokukhokelela splenomegaly.

Le spleen eqhelekileyo ise kwingingqi subcostal ngasekhohlo, axis yayo emide zihleli ubambo yeshumi. AbasemaGunyeni okweqanda (imbotyi) imilo.

Spleen kubantwana

Imilinganiso yalo udakada eziqhelekileyo, ngokuxhomekeka kubudala:

• Neonates: ububanzi - 38 omise ubude - up to ngemilimitha-40.
• minyaka 1-3: ubude - up to iimillimitha-68, ububanzi - up to 50 iimilimitha.
• 7: ubude - 80 mm, ububanzi - up to ngemilimitha 55.
• iminyaka 8-12: ububanzi - ukuya ku-60 omise ubude - up to ngemilimitha 90.
• kweminyaka 15: ububanzi - ukuya kwi-60 mm, kwaye ubude - 100-120 mm.

Kufuneka kukhunjulwe ukuba Ngokucofa-udakada ebantwaneni kwakunye abadala, kufuneka elingenabuhlungu, ukongeza, i udakada kuyinto eqhelekileyo ukuba umntwana uzimisele. Ubukhulu ngentla hayi obububo, oko kukuthi, izinto ezinxaxhileyo ezincinane indlela yokunciphisa / ukwandisa umzimba akukho mfuneko yokuba ithathwe ineenkalo zophendlo lwezifo.

spleen emgama

Le ndlela isetyenziswa ukuqikelela milinganiselo (imida) lomzimba.

Nomonde obekwe kwi polubokovoe kwindawo ekunene izandla ezibekwe phezu kwentloko, ngeenyawo zakhe ngokulambisa baphikele kwi inyonga nedolo amalungu. Percuss lulandelayo, ukuya kufikelela ekudambiseni sandi usebenzisa izithonga cwaka ngentlokomo.

emgama Ukufeza

1. Finger-plessimetr kufuneka ifakwe ngohlangothi arch costal kwicala lasekhohlo umzimba aa Incopho ubambo-10.
2. Chithani emgama buthathaka ubambo 10, ekuqaleni arch costal (ekhohlo) de isandi edakumbile (blunting). Xa ukusuka isandi wenze uphawu esikhumbeni. Emva koko percussing ukusuka kumgca axillary (ngasemva) anteriorly de isandi nokubulala kwaye wabeka uphawu esikhumbeni.
3. ubude ingxenye phakathi kwamanqaku - kuba udakada dlinnik (okanye ubambo 10). Ngokwesiqhelo, le salathisi iisentimitha 6-8.
4. Ukususela phakathi dlinnika i aa Incopho ubambo seshumi kwaye uvelisa yesandi phambili ukufumanisa ubukhulu be udakada, leyo ngokuqhelekileyo isusela ukusuka ngeesentimitha-4 ukuya ku-6.
5. Ngokwesiqhelo, le inxalenye ngaphambili udakada (okt udini lwalo) kufuneka ukuya umgca medial lebhokisi isiphelo simahla ubambo-11 kunye ilunga sternoclavicular. Kufuneka kuqatshelwe ukuba ekubaleni ubungakanani udakada usebenzisa zezihlokomiso - inani elisondeleyo kakhulu. ubukhulu zomzimba irekhodwa njengeqhezu, apho elingezantsi - yinto dlinnik, kunye nenani elingaphezulu - ubukhulu be udakada.