Nhengo ye spleen: algorithm uye nzira

Iyo spleen inhengo isina kubhadharwa inenge iri kuruboshwe rwechidziro chemuviri. Ikoko chikamu chemuviri chinosungirirwa kumudumbu, uye chikamu chechikamu chinopinda kune inso, adrenal uye matumbo.

Nhengo yepleen

Kuumbwa kwepleen kunotarisa serosa uye iyo capsule, iyo yekupedzisira inoumbwa nekubatanidzwa kwezvigunwe, mavara uye elastic fiber.

Iyo capsule inopinda mumucheto wechiri, ichiparadzanisa mapira (parenchyma) muzvikamu zvakasiyana "zviwi" nemubatsiro we trabeculae. Mumapurp (pamasvingo eArterioles) kune mazamu akazara kana oval ye lymphoid tissue (lymphoid follicles). Pamwoyo wepurp rinoshandisa mavara akasiyana-siyana , ayo azere nemasero akasiyana-siyana: erythrocytes (kunyanya kuora), leukocytes uye lymphocytes.

Mabasa emuviri

• Iyo spleen inobatanidzwa mu lymphopoiesis (kureva kuti, ndiyo inokonzera lymphocytes).
• Inobatanidzwa mune hematopoietic uye maitiro ezvirwere zvemuviri.
• Kuparadzwa kweaishandisa maplatelets uye erythrocytes.
• Kuderedza ropa.
• Mune matanho ekutanga embryogenesis inoshanda sechikamu che hematopoiesis.

Izvi zvinoreva kuti muviri unoita mabasa mazhinji anokosha, uye naizvozvo nokuda kwekutsanangurwa kwehutachiona pamatanho ekutanga ekuongororwa, ndiko kutanga kwezvose zvakakosha kuita marpation uye kuputika kwepleen.

Kunyanya kugadzirisa nhengo dzomukati

Mushure mekutora zvikwangwani, anamnesis uye kuongorora kukuru, chiremba, sekutonga, kunowedzera nzira dzepanyama dzekutsvakurudza, dzinosanganisira palpation uye kuputika.

Kusiyanisa:

• Simba palpation, iyo inoratidzira kusuruvara kweimwe kana imwe nzvimbo, kukanganiswa kwemisungo yemudumbu, kuzvikudza, zvisimbiso zvakasiyana-siyana uye maitiro (hernias, tumor, nodes). Inogadzirwa nekumanikidzwa kwemaoko neminwe inopinza-kubva, kubva kumucheto wekeri nechepamusoro-soro.
• Kubata kwakadzika, kunoitwa mumutsara unotevera: cecum, iyoum (iyo inogadzirisa chikamu), yekoloni (yakakwira uye ichidzika zvikamu), iyo yakanyanyisa kubuda mumukumbo, mudumbu, chiropa, pancreas, spleen, mafungiro, inoitwa nekudzika kwekupinza kweminwe Chiremba mumudumbu wepamuviri.

Kana zvichikanganisika kuvapo kwezvirwere zvepleen (kana kuwedzera kwayo nemhaka yezvirwere zvechiropa) zvinodiwa kuita chirwere chepachiviri , palpation yechiropa uye spleen.

Gara mitemo ye palpation

Chikamu chepleen ndechimwe chezvinyorwa zvekutsvakurudza zvakagadzirwa nachiremba. Kana zvichiwedzera kuwedzera munhengo, apo chirwere hachisi nyore kuongorora, chiremba anonyatsokurudzira kupera kwe ultrasound kugutsikana / kupokana nehutachiona hunonzi mumwana kana munhu mukuru.

Nzvimbo yemurwere:

• Kutsigira kumashure (mune iyi nzvimbo, palpation yechiropa uye spleen inoitwa).
• Kutenderera kuruboshwe rwake. Ruoko rworudyi rwuri pasi pemusoro, uye ruoko rworuboshwe runofanira kunge rwakanamatira pahota ndokuisa pachipfuva (iyi nzira inonzi palpation ye spleen maererano naSali). Uye musoro wemurwere unofanirwa kunge uchida kusvika pachifuva, rutsoka rworudyi rwakarurama, uye rutsoka rworuboshwe runofanira kunge rwakanamatira muhudyu nepamabvi.

Chikamu chepleen: algorithm

1. Chiremba anofanirwa kuisa ruoko rwake rworuboshwe kuitira kuti rwuri kuruboshwe rwechifukidzo chechidzidzo, mukati pakati pemiti yechinomwe uye yegumi nematanhatu maererano nemitsetse ye axillary, uye ivai nekumanikidzwa kuduku. Muchiitiko ichi, minwe yoruoko rworudyi inofanira kunge yakapetwa hafu uye yakasara kuruboshwe rworuboshwe nenzira yakadai kuti munwe wepakati unonamatira kune nharo yegumi.
2. Kana murwere achizununguka, ganda rinodonhera pasi kuti risike ruvara rweganda.
3. Mushure mokunge mhepo inoputika, ruoko rwechiremba runopinda mukati-kati mudumbu (mimba yemimba).
4. Murefu pakukumbira kwachiremba anotora kufema kwakadzika, asi pasi pesimba rerafrag the spleen inowira pasi. Kana ikanyanya kuwedzera, zvigunwe zvechiremba zvichasangana nepasi rezasi. Ichi chiitiko chinofanira kudzokororwa kazhinji.

Kutsanangurwa kwemigumisiro

Pasi pemamiriro ezvinhu akaenzana (mune vanhu vane utano), chirwere hachigoni kumira. Kusiyanisa ndiko asthenics (kazhinji kacho vakadzi). Kuti uchinzwe kuti spleen mune dzimwe mamiriro ezvinhu inokwanisika nekudzika kwechirafu (pneumothorax, pleurisy) uye splenomegaly, kureva, kuwedzera kwehukuru hwechirongwa. Hurumende yakadaro inowanzoonekwa pasi pemamiriro ezvinhu anotevera:

• Zvirwere zveRopa.
• Chirwere chisingaperi Chirwere chepachiviri (pano splenomegaly chiratidzo chehutachiona hwehutachiona kana hepatolenal syndrome).
• Zvirwere zvisingagumi uye zvinotapukira (endocarditis inotapukira, malaria, typhus, sepsis).
• Zvirwere zvehutano hunobatana.
• Infarits kana mapfupa emupleen.

Kazhinji kazhinji, ruzha rwepleen yakakura harupenzi. Kusiyanisa kune nhengo inoparadzanisa, nekukurumidza capsule kutambanudza, perispenitis. Muzviitiko izvi, chirwere chinova chinonyanya kunzwisisika (kureva, chinorwadza pamarpation).

Ne cirrhosis yechiropa uye zvimwe zvirwere zvisingagoneki, rutivi rwepleen rwakanyanyisa, asi muhutachiona hutano hunyoro.

Kuwirirana kunowanzova munyoro mune zvirwere zvakanyanya, uye zvirwere zvisingaverengeki uye cirrhosis zvinowedzera.

Maererano nechiyero chekuwedzera kwechigadziko, chikamu chinoputika chinogona kuva chiduku kana chikuru, uye chikamu chakaita kuti chirwere chacho chibude kubva pasi pemibvu chinogona kuratidza chidimbu chechokwadi chemugadziri wegunhi. Nokudaro, kuwedzera kwechidiki kunoratidza kubuda kwemucheto wechirongwa kubva pasi pechitsiko chemari kusvika ku 2-7 masentimita, iyo inowanikwa mune zvirwere zvakanyanya (typhoid, meningitis, sepsis, croupous pneumonia nezvimwe zvakadaro) kana chirwere chepfungwa (chirwere chemwoyo, cirrhosis, erythremia, Leukemia, anemia) uye eticology isina kutsanangurwa, iyo inowanzoitika kune vechidiki (zvichida ine syphilis,

Maererano nehuwandu hwomukati unoputika wepleen (pamwe nekuwedzera kwayo) zvinokwanisika kutsvaga mhedziso pamusoro pemirairo yegadziriro yacho. Icho chikonzero, nguva refu kupisa mukati momuviri, ndiko kunopisa uye kunowedzera parenchyma yake, iyo inotevera kuti mumatauriro akaipisisa kumucheto kwepleen yakanyanyisa uye yakasununguka kupinda pane zvisingaperi.

Kana ukama hwenhengo hukuru kwazvo, apo rutivi rwakadzika rwuri kurondedzerwa mumusana wepelvic, zviri nyore kwazvo kuita marpation wepleen, uye hapana unyanzvi hunokosha hunodiwa.

Muchiitiko che splenomegaly, sechikonzero chekweoplasm, palpation ye spleen (kunyanya, margo crenatus yayo) inotora notches (kubva 1 kusvika 4). Chiratidzo chakadaro chekuongorora chinoratidza kuvapo kweAmyloidosis, leukemia (myelogenous chronic or pseudo-leukemia), malaria, cysts uye endothelium.

Izvi zvinoreva kuti, kana achiita chirwere chepleen, chiremba ane mukana wekuongorora mamiriro ezvinhu ayo, kuti aone fibrin deposition (sokuti, somuenzaniso, mu perisplenitis), zvakasiyana-siyana (izvo zvinowanzoitika, somuenzaniso, nemasumbu, hemorrhagic uye serous cysts, echinococcosis) uye kusarudza kuwanda kwehutano. Apo mabheji anowanzowanikwa uye achikurira. Zvose zvakagadziriswa ne palpation zvakakosha zvikuru, zvose pakuongorora chirwere chepleen pachako, uye kugadzirisa zvirwere zvinogona kutungamirira kune splenomegaly.

Kazhinji, chirwere chacho chiri munharaunda yekuruboshwe hypochondrium, nheyo yaro yakareba iri pedyo nemubvu wegumi. Nhengo yacho ine chando (yakagadzirwa nemhete).

Nyoka muhuduku

Tsora hukuru hwakajairika, zvichienderana nezera:

• Mucheche: upamhi - kusvika ku 38 millimita, urefu - kusvika kusvika mamita 40 mamita.
• 1-3 makore: kureba - kusvika pamabhirimita makumi matanhatu, kubhiti - kusvika pamamilimita makumi mashanu.
• Makore manomwe: urefu - kusvika pamamilimita makumi mapfumbamwe, upamhi - kusvika pamamilimita 55.
• Makore 8-12: upamhi - kusvika pamamilimita makumi matanhatu, kureba - kusvika pamamilimita 90.
• Makore gumi nemashanu: upamhi - kusvika pamamilimita makumi matanhatu, uye urefu - 100-120 millimeters.

Inofanira kurangarirwa kuti palpation yepleen muvana, pamwe nevakuru, inofanira kuva isina kurwadziwa, kuwedzera, chirwere chinowanikwa mumwana hachina kugadziriswa. Izvo zviyero zvinotsanangurwa pamusoro apa hazvisi zvachose, kureva kuti, kudarika kuduku kunotungamirira kuderedza / kuwedzera hukuru hwechirongwa haufaniri kuonekwa sechirwere.

Percussion of the spleen

Iyi nzira inoshandiswa kuongorora hukuru (miganhu) yechiganda.

Murwere anoiswa munzvimbo yakarurama yepakati-nechepamusoro nemaoko nemaoko ari pamusoro pemusoro wake, asi makumbo haana kunyengedzwa muhudyu nemabvi. Kuongororwa kunotevera, kubva kune zvakajeka kusvika kune zvisinganzwisisiki, kuisa runyararo runyararo.

Kufambisa mhirizhonga

1. Mwenje-plessimeter inofanira kuiswa pamucheto wechitema chinodhura kubva kurutivi rworuboshwe rwemuviri, zvakananga kusvika kumubvu wegumi.
2. Kufambisa kukanganisa kunokonzerwa nemubvuri wegumi, kutanga kubva pamutengo wemari (kuruboshwe) kusvika pakuonekwa kweshoko rakakomba (dullness). Munzvimbo yekushandurwa kwezwi rakaita pane chiratidzo chiratidzo. Zvadaro mhirizhonga kubva kumutsara we axillary (posterior) anteriorly kusvika pakuonekwa kwemavara uye kuisa chiratidzo pane peganda.
3. Kureba kwemukati pakati pemakadhi ndehurefu hwepleen (inoenderana nenyundo yegumi). Kazhinji, ichi chiyero 6-8 masentimita.
4. Kubva pakati pezvakareba, zvinyorwa zvese zvinokwevera kumucheto wegumi uye zvinowedzera kukonzera kuti uone hupamhi hwepleen, iyo inowanzosvika kubva pa4 kusvika ku6 masentimita.
5. Kazhinji, chikamu chepakati chepleen (kureva, chidimbu chayo) hachifaniri kunge chiri pakati pemuganhu, unobatanidza kuguma kwekusununguka kwembambo yegumi nemasere uye sridoclavicular junction. Izvo zvinofanira kuonekwa kuti kuverenga ukuru hwepleen nemapurisa ndeye chidimbu chekufungidzira. Izvo zviyero zvechirongwa zvakanyorwa sechikamu chiduku, apo nhambare iyo ndiyo yakareba, uye denominator ndiyo yakakura yepleen.