J腹部检查B.ppt

physical examination腹部腹部(f b)(f b)检查检查(2)Abdominal Examination palpate mass palpate mass 腹部腹部腹部腹部(f b)(f b)包块触诊包块触诊包块触诊包块触诊 percussion and auscultation percussion and auscultation 腹部叩诊和听诊腹部叩诊和听诊腹部叩诊和听诊腹部叩诊和听诊 signs of common diseases signs of common diseases 腹部常见疾病征象腹部常见疾病征象腹部常见疾病征象腹部常见疾病征象第一页，共五十二页。1Abdominal Masses腹部腹部(f b)(f b)包块包块Physical massn nIn abdominal walln nIn abdominal cavityPathological massn nswelling of organ n nInflammatory massesn nTumor生理生理(shngl)(shngl)包块包块n n腹壁包块腹壁包块n n腹腔包块腹腔包块病理包块病理包块n n脏器肿大脏器肿大n n炎性包块炎性包块n n肿瘤肿瘤第二页，共五十二页。2Physical Masses生理性包块生理性包块n nAbdominal wall:venter musculi or Abdominal wall:venter musculi or tendinous intersections of tendinous intersections of musculus rectus abdominis musculus rectus abdominis n n腹壁腹壁腹壁腹壁:腹直肌肌腹及腱划腹直肌肌腹及腱划腹直肌肌腹及腱划腹直肌肌腹及腱划n nAbdominal cavity:lumbar Abdominal cavity:lumbar centrum,sacral promontory,centrum,sacral promontory,abdominal aorta,inferior pole abdominal aorta,inferior pole of right kidney,transverse of right kidney,transverse colon,sigmoid colon,cecumcolon,sigmoid colon,cecumn n腹腔腹腔腹腔腹腔:腰椎体腰椎体腰椎体腰椎体 骶骨岬骶骨岬骶骨岬骶骨岬 腹主腹主腹主腹主动脉动脉动脉动脉(dngmi)(dngmi)(dngmi)(dngmi)右肾下极右肾下极右肾下极右肾下极 横结肠横结肠横结肠横结肠 乙状结肠乙状结肠乙状结肠乙状结肠 盲肠盲肠盲肠盲肠第三页，共五十二页。3Pathological Masses病理性包块病理性包块n nShifting or swelling of parenchymatous organShifting or swelling of parenchymatous organ 实质性脏器肿大实质性脏器肿大实质性脏器肿大实质性脏器肿大n nDistension of hollow viscusDistension of hollow viscus 扩大的空腔脏器扩大的空腔脏器扩大的空腔脏器扩大的空腔脏器n nInflammatory masses(abscess or adhesion)Inflammatory masses(abscess or adhesion)炎性包块炎性包块炎性包块炎性包块(脓肿或粘连脓肿或粘连脓肿或粘连脓肿或粘连(zhnlin)(zhnlin)(zhnlin)(zhnlin)n nTumor or cystTumor or cyst 肿瘤与囊肿肿瘤与囊肿肿瘤与囊肿肿瘤与囊肿n nLymphadenectasisLymphadenectasis 淋巴结肿大淋巴结肿大淋巴结肿大淋巴结肿大第四页，共五十二页。4Characteristics of Palpation 触诊触诊(ch zhn)(ch zhn)要点要点n nLocation:relation to organsLocation:relation to organsn nSize:diameter in long,wide Size:diameter in long,wide and thickand thickn nContour:shape,margin and Contour:shape,margin and surfacesurfacen nTexture:soft,firm and hardTexture:soft,firm and hardn nTenderness:inflammation,liver Tenderness:inflammation,liver swelling swelling n nPulsation:Pulsation:dilative and conductive dilative and conductive n nMovability:shift by respiration Movability:shift by respiration or handor handn n部位部位部位部位:所在部位与该处脏所在部位与该处脏所在部位与该处脏所在部位与该处脏器多相关连器多相关连器多相关连器多相关连n n大小大小大小大小:纵长纵长纵长纵长 横宽横宽横宽横宽 深厚深厚深厚深厚 可可可可用实物比喻用实物比喻用实物比喻用实物比喻n n轮廓轮廓轮廓轮廓:形状形状形状形状 边缘边缘边缘边缘 表面表面表面表面n n质地质地质地质地:柔软柔软柔软柔软 中等硬度中等硬度中等硬度中等硬度 质硬质硬质硬质硬n n压痛压痛压痛压痛:炎症炎症炎症炎症 肝肿大肝肿大肝肿大肝肿大n n搏动搏动搏动搏动:膨胀性和传导性膨胀性和传导性膨胀性和传导性膨胀性和传导性n n移动度移动度移动度移动度:随呼吸随呼吸随呼吸随呼吸(hx)(hx)(hx)(hx)移移移移动动动动 用手推动用手推动用手推动用手推动第五页，共五十二页。5Fluid Thrill液波震颤液波震颤(zhn chn)(zhn chn)n nTechnique:move flank wall by Technique:move flank wall by handhand 检查方法检查方法检查方法检查方法:用手推动一侧腹壁用手推动一侧腹壁用手推动一侧腹壁用手推动一侧腹壁n nPositive:the other hand feels Positive:the other hand feels liquid waveliquid wave 阳性征象阳性征象阳性征象阳性征象:对侧手掌感到液体波对侧手掌感到液体波对侧手掌感到液体波对侧手掌感到液体波动动动动n nMeaning:largeMeaning:large volume of volume of ascites,usually 3000mlascites,usually 3000ml 临床意义临床意义临床意义临床意义:大量腹水大量腹水大量腹水大量腹水(fshu)(fshu)(fshu)(fshu)在在在在3434升升以上以上以上以上第六页，共五十二页。6Percussion of Abdomen 腹部腹部(f b)(f b)叩诊叩诊 organs in the abdomenorgans in the abdomen 脏器叩诊脏器叩诊脏器叩诊脏器叩诊(ku zhn)(ku zhn)fluid in the abdomen fluid in the abdomen 腹水叩诊腹水叩诊腹水叩诊腹水叩诊第七页，共五十二页。7Organs Percussion脏器脏器(zn q)(zn q)叩诊叩诊Percussion notes:indirect percussionPercussion notes:indirect percussion 叩诊音叩诊音叩诊音叩诊音:间接叩诊间接叩诊间接叩诊间接叩诊n nTympany:hollow viscus as Tympany:hollow viscus as Traubes area,intestineTraubes area,intestine 鼓音鼓音鼓音鼓音:空腔脏器空腔脏器空腔脏器空腔脏器 胃泡鼓音区胃泡鼓音区胃泡鼓音区胃泡鼓音区 肠腔肠腔肠腔肠腔n nDullness or flatness:parenchyma viscus as liver or Dullness or flatness:parenchyma viscus as liver or spleen,enlarged bladder or uterusspleen,enlarged bladder or uterus 叩音或实音叩音或实音叩音或实音叩音或实音:肝脏肝脏肝脏肝脏(gnzng)(gnzng)(gnzng)(gnzng)和脾脏实质脏器和脾脏实质脏器和脾脏实质脏器和脾脏实质脏器 增大的膀胱或子宫增大的膀胱或子宫增大的膀胱或子宫增大的膀胱或子宫Knock pain:indirect knock impress inflammationKnock pain:indirect knock impress inflammation 叩击痛叩击痛叩击痛叩击痛:间接叩击间接叩击间接叩击间接叩击 提示炎症提示炎症提示炎症提示炎症n nOrgans:liver,Organs:liver,gallbladder,gallbladder,kidneykidney 脏器脏器脏器脏器:肝脏肝脏肝脏肝脏 胆囊胆囊胆囊胆囊 肾脏肾脏肾脏肾脏第八页，共五十二页。8Abnormal Area of Tympany鼓音范围鼓音范围(fnwi)(fnwi)异常异常n nEnlarged area:Enlarged area:intestinal obstruction,intestinal obstruction,perforation of gastrointerstinal tract perforation of gastrointerstinal tract 范围增大范围增大范围增大范围增大:胃肠高度胀气胃肠高度胀气胃肠高度胀气胃肠高度胀气 胃肠穿孔胃肠穿孔胃肠穿孔胃肠穿孔n nReduced area:Reduced area:swelling of parenchymatous organ,swelling of parenchymatous organ,tumor,ascites tumor,ascites 范围缩小范围缩小范围缩小范围缩小:肝脾等脏器极度肝脾等脏器极度肝脾等脏器极度肝脾等脏器极度(jd)(jd)肿大肿大肿大肿大 腹腔肿瘤腹腔肿瘤腹腔肿瘤腹腔肿瘤 大量腹水大量腹水大量腹水大量腹水第九页，共五十二页。9Traubes Area胃泡鼓音胃泡鼓音界界n nLocation:left Location:left hypochondriumhypochondrium 位置位置位置位置:左季肋部左季肋部左季肋部左季肋部 n nUpper border:left lung,diaphragmUpper border:left lung,diaphragm 上界上界上界上界:左肺下缘左肺下缘左肺下缘左肺下缘 膈膈膈膈 n nLower border:RibLower border:Rib 下界下界下界下界:肋弓肋弓肋弓肋弓n nRight border:liverRight border:liver 右界右界右界右界:肝脏肝脏肝脏肝脏(gnzng)(gnzng)(gnzng)(gnzng)n nLeft border:spleenLeft border:spleen 左界左界左界左界:脾脏脾脏脾脏脾脏第十页，共五十二页。10Traubes Area Abnormal胃泡鼓音范围胃泡鼓音范围(fnwi)(fnwi)异常异常n nPathology:content variation of stomach and Pathology:content variation of stomach and compression of neighbor organcompression of neighbor organ 机制机制机制机制:胃内含气量变化胃内含气量变化胃内含气量变化胃内含气量变化 邻近器官邻近器官邻近器官邻近器官(qgun)(qgun)(qgun)(qgun)扩大压迫扩大压迫扩大压迫扩大压迫n nEnlarged:gastric dilatation,pylorus obstructionEnlarged:gastric dilatation,pylorus obstruction 扩大扩大扩大扩大:见于胃扩张见于胃扩张见于胃扩张见于胃扩张 幽门梗阻幽门梗阻幽门梗阻幽门梗阻n nReduced:swellings of liver or spleen,left pleural Reduced:swellings of liver or spleen,left pleural effusion,pericardial effusioneffusion,pericardial effusion 缩小缩小缩小缩小:见于肝脾肿大见于肝脾肿大见于肝脾肿大见于肝脾肿大 左侧胸腔积液左侧胸腔积液左侧胸腔积液左侧胸腔积液 心包积液心包积液心包积液心包积液第十一页，共五十二页。11Dullness Area of Liver肝脏肝脏(gnzng)(gnzng)浊音界浊音界n nMethod:percussion along the lines of right Method:percussion along the lines of right midclavicular,midaxillary and scapular linemidclavicular,midaxillary and scapular line 方法方法方法方法:沿右锁骨中线沿右锁骨中线沿右锁骨中线沿右锁骨中线 右腋中线右腋中线右腋中线右腋中线 右肩胛右肩胛右肩胛右肩胛(jinji)(jinji)(jinji)(jinji)线叩线叩线叩线叩诊诊诊诊n nSuperior border:relative dullness margin between liver and Superior border:relative dullness margin between liver and lung,its from resonance to dullness,correspond to top of lung,its from resonance to dullness,correspond to top of liver.liver.,肝上界肝上界肝上界肝上界:由肺区向下叩出肝与肺清音变浊音的由肺区向下叩出肝与肺清音变浊音的由肺区向下叩出肝与肺清音变浊音的由肺区向下叩出肝与肺清音变浊音的 相对浊音界相对浊音界相对浊音界相对浊音界 相当于被肺遮盖的肝顶部相当于被肺遮盖的肝顶部相当于被肺遮盖的肝顶部相当于被肺遮盖的肝顶部n nInferior border:from abdomen tympany up to liver dullness Inferior border:from abdomen tympany up to liver dullness marginmargin 肝下界肝下界肝下界肝下界:由腹部向上叩由腹部向上叩由腹部向上叩由腹部向上叩 鼓音变浊音鼓音变浊音鼓音变浊音鼓音变浊音第十二页，共五十二页。12Percussion ofPercussion of Superior and Inferior borderSuperior and Inferior border肝上下肝上下(shngxi)(shngxi)浊音界叩诊浊音界叩诊n nSuperior border:Superior border:intercostal space of 5 intercostal space of 5thth in in right midclavicular,right midclavicular,7 7thth in midaxillary and 10 in midaxillary and 10thth in scapular line in scapular line 肝上界肝上界肝上界肝上界:右锁骨中线第右锁骨中线第右锁骨中线第右锁骨中线第 5 5 肋间肋间肋间肋间 右腋中线第右腋中线第右腋中线第右腋中线第 7 7 肋间肋间肋间肋间 右肩胛右肩胛右肩胛右肩胛(jinji)(jinji)(jinji)(jinji)线第线第线第线第1010肋间肋间肋间肋间n nInferior border:Inferior border:costal margin in costal margin in right midclavicular lineright midclavicular line 10 10thth rib level in right midaxillary line rib level in right midaxillary line 肝下界肝下界肝下界肝下界:右锁骨中线右季肋下缘右锁骨中线右季肋下缘右锁骨中线右季肋下缘右锁骨中线右季肋下缘 右腋中线相当于第右腋中线相当于第右腋中线相当于第右腋中线相当于第1010肋骨水平肋骨水平肋骨水平肋骨水平第十三页，共五十二页。13Area of Liver肝界范围肝界范围(fnwi)(fnwi)n nSuperior border:12 inter-costal Superior border:12 inter-costal spaces higher than inferior lung borderspaces higher than inferior lung border 肝上界肝上界肝上界肝上界:肺下界的上肺下界的上肺下界的上肺下界的上1212肋间肋间肋间肋间n nInferior border:12 cm higher than Inferior border:12 cm higher than detected by palpationdetected by palpation 肝下界肝下界肝下界肝下界:较触及的肝界高较触及的肝界高较触及的肝界高较触及的肝界高1212厘米厘米厘米厘米n nLiver span in right midclavicular line:Liver span in right midclavicular line:911 cm911 cm 肝上下径肝上下径肝上下径肝上下径(右锁骨中线右锁骨中线右锁骨中线右锁骨中线(zhngxin)(zhngxin)(zhngxin)(zhngxin):):):):肝上下肝上下肝上下肝上下界间的距离约界间的距离约界间的距离约界间的距离约 911911厘米厘米厘米厘米第十四页，共五十二页。14Abnormal Findings肝浊音肝浊音(zhuyn)(zhuyn)界异常界异常n nEnlarged:hepatic congestion,hepatitis,liver abscess,liver Enlarged:hepatic congestion,hepatitis,liver abscess,liver carcinomacarcinoma 增大增大增大增大:肝淤血肝淤血肝淤血肝淤血 肝炎肝炎肝炎肝炎 肝脓肿肝脓肿肝脓肿肝脓肿 肝癌肝癌肝癌肝癌(n i)(n i)(n i)(n i)n nDiminished:liver cirrhosis or necrosisDiminished:liver cirrhosis or necrosis 缩小缩小缩小缩小:肝硬化肝硬化肝硬化肝硬化 肝坏死肝坏死肝坏死肝坏死 n nDisappeared:perforation of gastrointestinal tract,abdominal Disappeared:perforation of gastrointestinal tract,abdominal surgerysurgery 消失消失消失消失:代之以鼓音代之以鼓音代之以鼓音代之以鼓音 胃肠穿孔胃肠穿孔胃肠穿孔胃肠穿孔 腹部手术后腹部手术后腹部手术后腹部手术后n nUpward shifting:fibrosis or atelectasis of right lung,Upward shifting:fibrosis or atelectasis of right lung,large volume of air or gas in the gastrointestinal tractlarge volume of air or gas in the gastrointestinal tract 上移上移上移上移:右肺纤维化右肺纤维化右肺纤维化右肺纤维化 右肺不张右肺不张右肺不张右肺不张 胃肠胀气胃肠胀气胃肠胀气胃肠胀气n ndownward shifting:emphysema,right side pleural downward shifting:emphysema,right side pleural effusion,hepatoptosiaeffusion,hepatoptosia 下移下移下移下移:肺气肿肺气肿肺气肿肺气肿 右胸腔积液右胸腔积液右胸腔积液右胸腔积液 肝肝肝肝下垂下垂下垂下垂第十五页，共五十二页。15Dullness Area of Spleen脾脏脾脏(pzng)(pzng)浊音界浊音界Normal space Normal space 正常状况正常状况正常状况正常状况n nLocation:9th11th ICS alongside left midaxillary lineLocation:9th11th ICS alongside left midaxillary line 位置位置位置位置:左腋中线左腋中线左腋中线左腋中线911911肋间肋间肋间肋间n nDiameter:superio-inferior 47 cmDiameter:superio-inferior 47 cm the anterior border not exceed anterior axillary line the anterior border not exceed anterior axillary line 范围范围范围范围:上下径上下径上下径上下径4747厘米厘米厘米厘米(l m)(l m)(l m)(l m)前界不超过腋前线前界不超过腋前线前界不超过腋前线前界不超过腋前线Abnormal findings Abnormal findings 叩诊异常叩诊异常叩诊异常叩诊异常n nEnlarged:splenomegalyEnlarged:splenomegaly 范围增大范围增大范围增大范围增大:脾肿大脾肿大脾肿大脾肿大n nDiminished:too much gas in surrounding organsDiminished:too much gas in surrounding organs 范围缩小范围缩小范围缩小范围缩小:胃扩张或肠胀气胃扩张或肠胀气胃扩张或肠胀气胃扩张或肠胀气第十六页，共五十二页。16Dullness Area of Bladder or Uterus 膀胱膀胱(png gung)(png gung)或子宫或子宫浊音区浊音区n nBladder dullness area:pBladder dullness area:physical signs in retention hysical signs in retention of urine,a smooth,firm,and regular swelling of urine,a smooth,firm,and regular swelling arising out of the pelvis which one cannot“get arising out of the pelvis which one cannot“get below”and which is dull to percussion.below”and which is dull to percussion.膀胱浊音区膀胱浊音区膀胱浊音区膀胱浊音区:判断膀胱膨胀程度判断膀胱膨胀程度判断膀胱膨胀程度判断膀胱膨胀程度(chngd)(chngd)(chngd)(chngd)耻骨上方圆形浊音区耻骨上方圆形浊音区耻骨上方圆形浊音区耻骨上方圆形浊音区 排尿或导尿后消失排尿或导尿后消失排尿或导尿后消失排尿或导尿后消失n nUterus dullness area:estimate enlarged uterus Uterus dullness area:estimate enlarged uterus superior margin of pubis,not disappear after superior margin of pubis,not disappear after micturation or urethral catheterizationmicturation or urethral catheterization 子宫浊音区子宫浊音区子宫浊音区子宫浊音区:判断子宫增大程度判断子宫增大程度判断子宫增大程度判断子宫增大程度 耻骨上方浊音区耻骨上方浊音区耻骨上方浊音区耻骨上方浊音区 排尿或导尿后不消失排尿或导尿后不消失排尿或导尿后不消失排尿或导尿后不消失第十七页，共五十二页。17Percussion of Ascites腹水腹水(fshu)(fshu)叩诊叩诊Shifting dullness:Shifting dullness:移动性浊音移动性浊音移动性浊音移动性浊音n nfree fluid causes air-containing gut to float up to the most superior free fluid causes air-containing gut to float up to the most superior positionposition 液体流动使含气脏器位于液体流动使含气脏器位于液体流动使含气脏器位于液体流动使含气脏器位于(wiy)(wiy)最高位置最高位置最高位置最高位置n nvolume of ascites usually exceeds 1000ml if detectablevolume of ascites usually exceeds 1000ml if detectable 腹水量在腹水量在腹水量在腹水量在1000ml1000ml以上以上以上以上Puddle sign:Puddle sign:水坑征水坑征水坑征水坑征n nfree fluid in the most inferior position in elbow-knee posturefree fluid in the most inferior position in elbow-knee posture 肘膝位腹水位于最低位肘膝位腹水位于最低位肘膝位腹水位于最低位肘膝位腹水位于最低位n na way to detect small amounts of fluida way to detect small amounts of fluid 用于发现少量腹水用于发现少量腹水用于发现少量腹水用于发现少量腹水第十八页，共五十二页。18Shifting Dullness due to Ascites移动性浊音移动性浊音(zhuyn)(zhuyn)(zhuyn)(zhuyn)n nDullness area in both side of abdomen with dorsal positionDullness area in both side of abdomen with dorsal position 平卧位时浊音区位于腹部的两侧平卧位时浊音区位于腹部的两侧平卧位时浊音区位于腹部的两侧平卧位时浊音区位于腹部的两侧n nDullness area moves to inferior when moved positionDullness area moves to inferior when moved position 变换变换变换变换(binhun)(binhun)体位浊音区移至下方体位浊音区移至下方体位浊音区移至下方体位浊音区移至下方n nDullness movement follows position movedDullness movement follows position moved 浊音部位随体位变动而变动浊音部位随体位变动而变动浊音部位随体位变动而变动浊音部位随体位变动而变动第十九页，共五十二页。19Puddle Sign due to Ascites水坑水坑(shu kn)(shu kn)征征n nIn elbow-knee postureIn elbow-knee posture 肘膝位肘膝位肘膝位肘膝位n nPercussion dullness in Percussion dullness in umbilical regionumbilical region 脐部叩诊呈浊音脐部叩诊呈浊音脐部叩诊呈浊音脐部叩诊呈浊音(zhuyn)(zhuyn)(zhuyn)(zhuyn)n nDullness disappear when Dullness disappear when position movedposition moved 变换体位浊音区消失变换体位浊音区消失变换体位浊音区消失变换体位浊音区消失 第二十页，共五十二页。20Common Diseases腹水腹水(fshu)(fshu)的常见病因的常见病因n nHepatocirrhosis Hepatocirrhosis 肝硬化肝硬化肝硬化肝硬化n nTuberculous peritonitis Tuberculous peritonitis 结核性腹膜炎结核性腹膜炎结核性腹膜炎结核性腹膜炎n nCardiac dysfunction Cardiac dysfunction 心功能不全心功能不全心功能不全心功能不全n nNephropathy syndromeNephropathy syndrome 肾病综合征肾病综合征肾病综合征肾病综合征n nPrimary or metastasis tumorPrimary or metastasis tumor in abdominal cavity in abdominal cavity 腹腔内肿瘤或其他部位腹腔内肿瘤或其他部位腹腔内肿瘤或其他部位腹腔内肿瘤或其他部位(bwi)(bwi)肿瘤腹腔转移肿瘤腹腔转移肿瘤腹腔转移肿瘤腹腔转移第二十一页，共五十二页。21Compare Ascites and Ovarian Cyst腹水腹水(fshu)(fshu)和卵巢囊肿的鉴别和卵巢囊肿的鉴别SignsSigns 征征征征象象象象Ascites Ascites 腹水腹水腹水腹水Ovarian cyst Ovarian cyst 卵巢囊肿卵巢囊肿卵巢囊肿卵巢囊肿 Dorsal positionDorsal position仰卧位仰卧位仰卧位仰卧位 Umbilicus Umbilicus 脐脐脐脐Percussion Percussion sound sound 叩诊音叩诊音叩诊音叩诊音 Shifting dullness Shifting dullness 移动性浊音移动性浊音移动性浊音移动性浊音Ruler pressing test Ruler pressing test 尺压试验尺压试验尺压试验尺压试验 Side distension Side distension 侧腹膨隆侧腹膨隆侧腹膨隆侧腹膨隆Extrude Extrude 突出突出突出突出Middle tympany Middle tympany side dullness side dullness 中部鼓音两侧浊音中部鼓音两侧浊音中部鼓音两侧浊音中部鼓音两侧浊音Positive Positive 阳性阳性阳性阳性No jumpiness No jumpiness 无跳动无跳动无跳动无跳动 Middle distension Middle distension 中腹膨隆中腹膨隆中腹膨隆中腹膨隆Flat Flat 平坦平坦平坦平坦Middle dullness Middle dullness side tympany side tympany 中部浊音两侧鼓音中部浊音两侧鼓音中部浊音两侧鼓音中部浊音两侧鼓音Negative Negative 阴性阴性阴性阴性Rhythm jumpiness Rhythm jumpiness 有节奏跳动有节奏跳动有节奏跳动有节奏跳动第二十二页，共五十二页。22Difference of dullness sites between ovarian Difference of dullness sites between ovarian cystcyst andand ascitesascites 卵巢囊肿和腹水卵巢囊肿和腹水卵巢囊肿和腹水卵巢囊肿和腹水(fshu)(fshu)浊音区的不同浊音区的不同浊音区的不同浊音区的不同tympanytympanytympanytympanydullnessdullnessdullnessdullness第二十三页，共五十二页。23Percussion Pain in Liver Area肝区叩击肝区叩击(ku j)(ku j)痛痛n nTechnique:put left palm in liver area,right hand with boxing Technique:put left palm in liver area,right hand with boxing knock the left back of hand with middle force.knock the left back of hand with middle force.方法方法方法方法:将左手掌平放于肝区将左手掌平放于肝区将左手掌平放于肝区将左手掌平放于肝区 右手握拳用中等强度右手握拳用中等强度右手握拳用中等强度右手握拳用中等强度(qingd)(qingd)力量向左手背叩击力量向左手背叩击力量向左手背叩击力量向左手背叩击n nNormal:no pains feeling in liver area.Normal:no pains feeling in liver area.正常正常正常正常:肝区无叩击痛肝区无叩击痛肝区无叩击痛肝区无叩击痛n nAbnormal:Abnormal:the knock pain in lthe knock pain in liver areaiver area indicates indicates hepatitis hepatitis and liver abscessand liver abscess 叩击痛阳性叩击痛阳性叩击痛阳性叩击痛阳性:见于肝炎见于肝炎见于肝炎见于肝炎 肝脓肿肝脓肿肝脓肿肝脓肿第二十四页，共五十二页。24Percussion Pain in Gallbladder Area胆囊胆囊(dnnng)(dnnng)区叩击痛区叩击痛n nTechnique:kno