诊断学学习资料：腹部检查E.docx

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1、1. Please state the percussion method of shifting dullness and the clinical significance of shifting dullness. (50)With the patient supine, percuss left from the umbilicus until the dullness is encountered (2.5). Fix the pleximeter finger on the skin (2.5). Ask the patient to lie in a right lateral

2、position (2.5). Percuss the same place again and notice if there is change of the percussion notes (5). Keep the patient lie in a right lateral position (5), then percuss to the right side until the dullness is encountered (5). Fix the pleximeter finger (5). Ask the patient to turn to a left lateral

3、 position (2.5). Percuss the same place again (5). A change from dullness to tympany indicates the presence of shifting dullness (5), which means that the area of dullness shifts with the alteration of position. Shifting dullness cannot be elicited in normal person. The positive shifting dullness us

4、ually indicates more than 1000 ml of ascitic fluid (10)Please explain the definition of rebound tenderness and its clinical meanings. (25)Press the approximately finger tips gently into the abdomen, and then suddenly withdraw them. Pain worsened after withdrawal is rebound tenderness.(15) Rebound te

5、nderness is a reliable sign of peritoneal inflammation.(lO)Please explain the definition of hepatojugular reflux and its clinical meanings. (25)In the presence of congestive heart failure, pressure applied to the liver causes a sustained rise of the venous pressure that is prominently reflected by d

6、istention of the superficial, and elevation of the pulsating level of the deep, neck veins (15). The impaired heart is unable to respond to an increase in venous return by an increase in its output; therefore, the venous pressure rises. This is an important sign of right heart failure, pulmonary hypertension and pericardial effusion.(lO)