Percussion and palpation of the spleen, diagnostic value. Size of the spleen: the norm in adults, area, size in mm Degree of palpation of internal organs

The spleen is removed in the glybin of the subcostal region lateral to the slug. It is located beside the middle under the dome of diaphragms, and so it is, like a stove, volodya dizzy and crumbling. Selezinka can project an ovoid shape on a lava bichnu surface breast cancer mіzh IX and XI ribs, and the additional organ is approximately visible to the course of the X rib.

The method of palpation of the spleen is basically analogous to the method of detection of the liver. Palpate to carry out the spatula in the position of the patient lying on the back. palpate right hand The flanks of the abdomen should be raised in the left flanks, called the edge of the straight meat, in such a rank, while the bottom of the valley is directed towards the pubis, and the little knuckles of those three curved fingers were located on one edge at the edge of the second rib. At the same time, the tip of the middle finger is guilty of lying in the cuff between the lower edges of the X rib and the strong tip of the XI rib. Great finger Do not take care of the right hand in the palpation of participation. Put a little of your left hand in a crosswise direction on the child's side of the other half of the breast, on the side of the costal arch, before the hour of palpation is to be interconnected and on the other side of the family for the purchase of washing for Before the hour of palpation, the car regulates the dichotomy of a sick person.

A sprinkle of liquor should be inhaled to a sick person with a "belly", and at the same hour, with the fingers of his right hand, a 3-4 cm shkiru of the black wall in a straight valley, to the side, against the costal dusi. In such a rank, the stock of shkiri with your fingers is opened, so that you can put it away further down into the glybin. black empty... The idea is to rob the sight of others, and the drug, following the dropping of a black wall, smoothly curling the fingers of the right hand into the abdominal cavity and fixing in such a placed hand until the end of the offensive breath.

Between the costal arch and the strong surface of the fingers, there is enough space to miss the lower pole of the spleen. Let the sick know smell well and inhale with the "belly". At the end of the hour, the lіkar lіvіyu dolonei onslaught on the lіva costal arch, wrap around її looseness, and the fingers of the right hand wipe out unruly in the bite of the abdomen, repairing the support to the wickedness of the black wall (Fig. 61).

The diaphragm descends on the inhale and the dome of the spleen moves down. When the spleen is accessible for palpation, the lower pole is lowered when it is lowered, penetrating between the fingers and the costal arch into the gut, making the grip of fingers on the black wall, and then bypassing the fingers like this,

Innocent spleen is not consumed in the queen, but rather deprived of sticking its lower pole on the fingers. For many people, in order to swirl, you need to put your right hand forward on the inhale, stick your fingers straight in the closed phalanges, and then pat them from above or go to the bottom. However, the palpation of the spleen is further safeguarded, and it is not poskoditi її.

Until the end of the day, repeat the development, and besides, to hold the palpation in the position of the sick person on the right boat (according to Sali). With a full right, the leg of the sick person is guilty, but it is straight, and the liva is bent in a circle and slightly brought to the tulub. Offended by their brushes, folded at once, ailments put on the right side. Likar descend on the right side of the sled and carry out palpation of the spleen, and when palpating the patient is lying on the back (Fig. 62).

With the appearance of spleen, the appearance of the steps of improvement, consistency, the nature of the surface, the manifestation of ailments begin.

The normal spleen is not palpable. Yaksho f її to be lost, it means won’t. When there is a severely swollen spleen (splenomegaly), the part of the rib arch is significant and can be readily visible to superficial swelling without the described method of palpation.

In order for the spleen to grow backwards, it is possible to make a palpation in the standing position: the spleen when going backwards and the palpation of the age is difficult, but downwards In addition, with splenomegaly, characteristic virality is palpated on the front edge of the spleen, at that time it is a nirka when it is coated with its own specific features.

Pislya palpation of the spleen is shown as a percussion analysis according to Kurlov. For a whole lot of people to know the upper and lower borders of the spleen, and then the front and back edges. To carry out the pre-treatment in the position of a sick person lying on the right boat, yak at palpation on Sali. Put the finger-plessimeter in parallel to the pummeled cordon organ. Percussion to carry out in the area of a clear (tympanic) sound to a very dull, stagnant quiet percussion strikes. Pislya dermal bet of strokes in the finger-plessimeter to compensate for 0.5-1 cm. To the knowledge of the cordon it means along the edge of the finger-plessimeter, beaten into a clear (tympanic) sound.

Slid mother on uvaz, when normal sizes the spleen over it does not appear stupid, but along with dullness, the percussion sound from the tympanic vidtinkom as a result of the close rosetting of the little "bulb" of the slunk (Traube's space) and to remove the gas of the intestines.

The upper and lower borders of the spleen begin. For a whole finger-plessimeter, place it in a transverse straight line on the left side of the breast plate on the edge of the V rib. The middle phalanx of the finger is guilty of lying on the middle groin line and perpendicular to it. Percussion of the line of lines along the ribs and intercostal spaces, the crosswise position of the finger-plessimeter, right across the edge of the left club brush, until the transition of the clear legendary sound into dullness is revealed. The border of the upper border of the spleen and in the norm is rosetted on the IX ribs (the ribs lead to the normal end of the XII rib).

Having identified the cordon by the dermograph for fixing the middle of the left hand, insert the finger-plessimeter without the middle edge (proximal) of the krill of the other club chain and percussion along the middle of the groin. The cordon transitions from tympanic to bluntness, the sound appears to lie on the lower edge of the spleen and normally lie on the XI rib. Vimіryuyut stand between the upper and lower boundaries of the spleen. In the norm, it becomes 4-7 cm and is called the width of the bluntness.

When the anterior edge (anterior-lower pole) of the spleen is visible, place the finger-plessimeter later along the anterior middle line of the abdomen so that the middle phalanx of the finger is umbilical lineі the bulla is perpendicular to the їy. Percussion in the right direction of the spleen along the line, from the bottom of the navel and the point of the overflow of the X left rib to the middle groin line (Fig. 63a). Cordon the transition of the tympanic sound in the bluntness of the anterior edge of the spleen. The normi vin does not go beyond the boundaries of the front groin line.

To mark the posterior edge (posterosuperior pole) of the spleen, it is necessary to match the X edge and to know the posterior edge at the ridge. Then, set the finger-plessimeter of the left paravertebral line so that the middle of the phalanx was lying on the X edge and the bulla was perpendicular to it. Percussion along the X edge in the right direction of the spleen, taking the same position of the finger-plessimeter (Fig. 63b). The transition of the tympanic sound into the dullness of the posterior edge of the spleen. This is indicated by a dermograph.

In the norm, the posterior edge of the spleen does not protrude beyond the line between the left scapula. If you look between the front and back edges of the spleen, you know that it is dulled, which is 6-8 cm in the norm. In such a way, I will add a part of the spleen.
The size of the spleen according to Kurlov is restructuring in the history of ailments in the viglyadi fraction, for example: for example, the number of sizes goes beyond the edge of the costal arch of a part of the spleen, the number is dull, and the banner is dull.

You can also choose one simple way of developing the growth of the spleen. So, as if in the position of a sick person on the right side (according to Sali) with a percussion in the movement of the X left rib with the middle groin line, a dull sound appears, similar to the sound of a percussion over the liver, meaning it should be noted

The improvement of spleen growth is an important diagnostic knowledge of a whole series of pathological processes. The withering, the growth of the spleen in the days of the growth of the liver and of the peripheral lymph nodes in the infectious endocarditis, Hemoblastosis and systemic immunopathological diseases. One hour, the increase in the size of the spleen and liver is caused by chronic active hepatitis, liver cirrhosis, hemolytic anemia, accumulated ailments (Gaucher, Nimana-Pika).

Isolation of the spleen can be caused by thrombosis of the spleen or thrombosis of the spleen, development in the spleen of swelling, bristles and other local pathological processes. at gostrich Infectious diseasesі septic processes of consistency її meat, dough, and also in case of chronic infections, liver cirrhosis, leukemia, and especially in case of amіloidosis, you are prone to damage. A certain increase in the spleen is more likely to develop in the case of a special form of chronic chronic leukemia - osteomyelofibrosis. With a lot of sickness, the spleen has been loaned a large part of the black empty.

The ailment of the spleen can be tied to the quick fixes, to make the capsule unstretched, or with perisplenitis. The tuberosity of the surface is most often indicative of the transfer of splenic infarction, however, in some cases, the inherited echinococosis, syphilis, abscess, cystic or swollen lesions.

Palpation of the liver and spleen with ascites is not very difficult. In general, we will describe the stove milling by the method of palpation, followed by a good palpation in the position of the sickly lying on the left boat and standing with a small nagging of the tulub forward, and the spleen is more beautiful than palpation on the right side of the bed on the right side. In case of swollen ascites, for the development of hepato- and splenomegaly, the method of balancing palpation is used. To carry out the pre-treatment in the position of the ailing lying on the back.

Likar by small knuckles and three knocked fingers of the right hand, not pulling out from the sides, giving short, frequent jolts to the anterior cranial stance perpendicularly to the forward edge of the hip Fix the application of such a rank of items along the half of the abdomen on the back of the line of the comb and step by step changing the fingers in the right edge of the costal arch until it looks like a blow on the hardness, as if floating kryzhinka "). At the same time, the surface of the organ can be faked.

In the process of severe palpation of organs in the black emptying, some pathological statements are revealed, the sprinkling of the pukhlin or the cyst. In many cases, the exact localization of the palpable illumination in the worms, its shape, size, consistency, the manifestation of fluctuations, the nature of the surface, lumpiness (senility, organs, ligaments) Osvita, bezposeredno tied with an anterior cranial wall, tinker as well when you look around. It is palpable when the yak is relaxed, so it squeezes the mucus of the cranial press, and when the abdominal dysfunctional excursions are carried out, it moves in the anterior-posterior right at once from the abdominal wall.

Intra-vascular office visually start only at the same time as it is necessary to finish great razmіrіv... With a strong pressure of the muscles of the cranial press, palpation of the inner-chest illumination is complicated, and with the weakening of the muscles of the abdomen, the looseness of such illumination and the shift to the upper-lower right is possible. However, it is a matter of vrahovuvati, that the wisdom of the inner-diabral illumination lies in the form of natural decay to the organ, from which it goes, and, as it is approved by the puffiness, then it is the manifestation of the growth in the suspect. The retroperitoneal illumination appears to be very loose in the black empty and in a tight ring from the back wall. Vono is inactive і, as a rule, cover the organs of the abdominal emptying, for example, with the intestine or a slag.

Methodology for the awareness of the patient's status Methods for the implementation of the ob'ective status Zagalny oglyad Mistsevii oglyad Sertsevo-sudinna system

When diagnosing patients with an increase in the size of the organs of the herbal system, palpation of the spleen is performed. The whole organ grows in the ribs from the left side. As far as the spleen is slightly increased in size, and it is easy to miss, it is possible to recognize the ultrasound preliminarily, to confirm it or to easily diagnose it in children and adults.

There is a lack of methods of tactile detailing, but they do not carry an obvious shkodi of patients.

Zovnіshnіy look around the abdomen

When there is an age of symptoms of ailments, he is guilty of being killed. Before the examination, I will look at the health of the sick and the periodicity, intensity and nature of the pain. It is important to brothers to respect, chi bully at the patient with injuries and operations. Pislya tsyo mendayut look around live. Such a glance will allow the visibility, the degree to which the curvature of the curmudgeon is, and the result is improved.

superficial palpation

If there is no norm or difference between an organ, then it is easy to start after an hour of superficial palpation. The whole type of palpation is called organic. For the additional cost of the technique, it is possible to reconsider the muscular tone of the black emptying in older adults and children, the opiate of prominence, sore muscles, the looseness of the mucous, rosted around the navel, Before carrying out the treatment of ailments, he is guilty of lying on his back, resting his hands and straightening his legs. Visually, the diameter of the organ is also possible for additional palpation. You know about the camp of the longest and the diameter, people look around, if they lie on their backs or on the boats.

At the same time, it is important, that it was not too soft and not too soft for the lowly uzgoliv. The specialist is guilty of the order with the patient and turn to the new ruling sideways(Left side of the system from the left side to the recumbent). At the same time, it is necessary, just a stiletto, on which to sit a lykar, approximately on one level from the tazostegnovy slope of the ailing one. At his own cherry, the height of the seat is guilty of being the same with the height of the seat. It is necessary that your hands will be fired for an hour to palpate the spleen, or if the liver will be warm, you should be briefly educated. For rosіgrіvu brushes lіkar can be rubbed їх or mash with warm water.

As a rule, it is empty and the liver is palpated on a hungry slunk. When the whole intestine is guilty, let’s be empty. When the procedure is carried out for the patient with a dichati mouth, he will not overload the abdominal wall at the same hour. Bezposeredno before the closure of the liver, or the spleen, the car can put your hand on the empty wood of the sick person, - you can also change the muffs. One hour it will be necessary to make respect for those who are equally equal to take on the fate of the small waste in the process of development. Krym, later to reconsider, when in the middle of the patient's dichati, having touched the diaphragm: when inhaling, a full fakhivtsya, rots to the front abdomen, to fall, when seen - to fall.

Gliboka methodical palpation according to Obraztsov-Strazhesko

Palpation is stagnant when diagnosing an illness of the shlunkovo-intestinal tract

Qia methodology for fixing ailments in organs shlunkovo-intestinal tract... In the course of carrying out an additional palpation, there is a pidshlunkov, a spleen. One of the intestines (sigmoid) should be promoted in the club area from the left side, the slit should be reversed from the right side, and the transverse rim should be inserted a couple of centimeters below the navel. The intestines may have a solid consistency, the stench is painless, not guilty of gurgling. The appendix cannot be felt for an hour. The curvature of the black emptying should be adjusted during the procedure. Vona makes the shape of the fold, її to become 1 centimeter of the navel. Mesenterial limfouzli do not see it for an hour.

spleen bleeding

In the course of the robotic blood-circulatory system and percussion of the spleen (prostration), there is not an important role: it is only necessary to make the approximate development of the liver and spleen in children and adults. Oskilki spleen to feel the empty organisms of the slunk-intestinal tract, in which there is food, with the percussion of the stench, they see mucky sounds. It is not possible to precisely establish the measurement and percussion between the spleen for the preparation of the method. To carry out an illness for an additional percussion, if the patient is standing or lying on the boat. To achieve a shorter result, I use the method of V.P. Obraztsov more quickly.

Draining spleen according to M.G. Kurlov

The patient slides onto the right side. Specialist percussion down the intercostal space and ribs (repair from V). For an additional percussion, the upper boundary (in the area of dullness) arises. When I play the car, I will put my finger on the analogous lines and percussion up the hill, by themselves fixing the lower boundaries. We'll help you to keep the gap between the edges. If it is necessary to know the X edge in the norm of the cordon, the body needs to know it. For this, it is necessary to perpendicularly to the line of the navel at right angles to the rib and eye. I want to know the back and front cordon. At your own cherga, the repair of the liver needs to be repaired from the designated upper border of the organ.

The pechinka with percussion gives a dull sound - quiet (non-voiced), short (non-trivial) and high for its timbre. Navkolishnі organi - from the top of the lungs, from below the slunker and the intestines - to avenge the gut and when percussion they give a thick, trivial and low sound behind the timbre, which is recognized from above as a legenevian, and below it is a tympanic one.

To that, the stove on top has two cordons - admirable and absolutely stupid. At the bottom, the anterior-lower edge of the stove, being even thinner and close to the gasy air of the slunker and intestines, can also take revenge from one's own enlightened gas, asserting absolute dullness, as it is possible to preserve with an even quiet percussion.

It is practical to start only with the absolute stupidity of the stove, that is, that part, which lies down to the inner surface of the black emptying at the right edge and the epicranial delight for whom the vicious percussion is quiet. The definition of the upper liver is carried out behind three lines: the right peri-sternal (L. parasternalis dextra), mid-clavicular (L. medioclavicularis dextra) and anterior groin (L. axillaris anterior). On the right side of the groin, it grows along the upper edge of the second rib, on the right mid-clavicular - along the lower edge of the second rib, and on the right anterior groin line - along the lower edge of this rib.

Small. 67. Percussion viznachennya

between absolute pechinkovo stupidity

The lower boundary of the stove, except for the visceral lines, also appears along the anterior middle line (L. mediana anterior) and in the middle of the middle line (L. parasternalis sinistra). Along the anterior groin line of the lower border of the liver, it grows along the lower edge of the tenth rib, along the right mid-clavicular line - along the lower edge of the costal arch, on the right near the middle of the middle line - by 2 cm below the border of the rib line, scho from the sword-like outgrowth and navel, along the lower edge of the left costal arch (pic. 67).

For the duration of the growth of the upper and lower between the stoves, see the right anterior groin, the right mid-clavicular and right mid-sternum lines, the height of the stove dullness, see the warehouse, 9-10

The development of the ovens is carried out for M.G. Kurlov. For the whole, start along the middle-clavicular line the upper boundary of the pechinka (the first point of Kurlov), the lower (2 point of Kurlov), then the upper boundary along the front middle of the line (the third point of Kurlov). The mice of rosetting the cordon must be cleverly started, behind the rosetting of the upper border along the right middle-clavicular line, and the lower border also along the front middle line (fourth point of Kurlov). Let's start the lower edge of the liver along the edge of the ribs (point Kurlov's point) for whom the finger-plessimeter should move perpendicularly to the edge of the ribs on the edge of the VIII-IX ribs and percussion along the edge of the front ... It is seen between the first and other points of Kurlov, which means that the vertical size of the stove is on the right of the middle-clavicular line, in the norm one in the middle 9 ± 1-2 cm. The appearance between the third and fourth points indicates the vertical size of the stove along the front middle line, which in the norm becomes at the middle 8 ± 1-2 cm. The appearance between the third and the fifth points is indicated as an oblique size of the stove according to Kurlov, which in the norm is 7 ± 1-2 cm.

Palpation of the liver is carried out up to the principles of glib, coy, methodical, topographic palpation by the method of V.P. Obraztsova, a zagalny zmіst like a polyag, in that, vikoristovuyuyuyuyuyu dikhannya ailing, fingers palpate to open for an hour vidihu on the front cherevnіy stіntsі swarmed, in what kind of use the stove before I breathe in.

The ailment is guilty of lying horizontally on the back with twisted legs and low-lying narrow-minded people, those who are guilty of being bent in the licks and folding on the front part of the chest wall, so that such a camp surrounds the crumbling of the ribs on the sides, sick (pic. 68).

The first moment of palpation: with the left hand gnaw the right half of the breast plate of the sick person in the lower sides, so that the great finger of the left hand is folded in front, and the chotiri іnshi - behind the breast plate. The process is flanked by ruffleness, by the loss of diaphragms and stoves. Put the right hand on the right side of the edge with the plasma on the right side of the edge, so that the other fingers were on the same line, so that the boules were slightly bent, they went out between the right mid-clavicular and near-sternum lines. with percussion. Another and the third moment is the illumination of the crease and the path of the path downward and downward and downward movement of the finger in the glide of the right edge. The fourth moment is palpation of the stove: if you put your right hand in the cleft of the right edge, who is ailing to ask for a quick breath, before the hour you can palpate your fingers slightly to curl up and shake off a small ruin, burn down to the bottom of the stove for an hour. Stay, podralyuchi in pretending to be a swarm, to go out from ny in the faraway Russian stoves, making a tactile grip on the fingers of the fingers of the right hand.

Fig. 68. Palpation of the lower edge of the liver

In healthy people, the liver is palpable in 88% of the vapors, and the lower edge, on the right of the middle-clavicular line, is located on the equal costal arch, on the right near the edge of the chest - 2 cm below the rest. In hepatitis, cholangitis, amyloidosis, liver cancer, leukemia, hemolytic anemia, the lower edge of the liver appears significantly lower.

The design of the localization of the lower edge of the stove results in its shape, consistency, cut and soreness. Behind the shape of the edge of the stove at healthy people Gostry abo rounding, soft, yak consistency mov, simple and painless. With hepatitis, we become older, more sensitive and more sensitive, with cirroses of the liver, we will become more aggravated (especially with Micronodular cirrhosis); With metabolic liver disorders (fatty hepatosis, amyloidosis and in.) The edge of the liver is rounded, tight-elastic consistency and painless.

At the norm is the edge of the stove. In case of hepatitis, it is also more common to become indifferent, but rather to shrink in case of liver cirrhosis and cancer, if the edge of the disease becomes unstable. A similar rank changes the surface of the stove, like assessing the palpation of the lower edge. For the sake of touching the fingers of the right hand, lay a plisk on the area of the right edge in such a rank, so that the valley of the surface of the kintsev phalanges, which will be the most sensitive, rose up over the surface of the oven, like a rose-colored moth. Then, by and large, they whirled the wrapped ruffs over the pechinka, assessing the entire accessible surface. In healthy people and with diffuse liver diseases by an ignition process (hepatitis) or metabolic nature (fatty hepatosis), the liver surface is smooth, with macronodilary liver cirrhosis, echinococosis, syphilis and malignant neoplasms, with micronodular cirrhosis, the tuberosity is small (from 1 to 5 mm), but with a great widening of irregularities.

With a significant bought-up time in the black empty, or flatulence, palpation of the liver is carried out in vertical position a sick person who is guilty of standing, heaving forward, i gliboko dikhati. The technique of palpation of the liver is also used in the supine position. In case of ascites, for the visualization of the microscopy of the anterior edge of the liver, it is stashed by jerky palpation. Technically, you won’t be victorious: the knuckles of the other-fifth fingers should be palpated into the slightly bent stanch, and I’m set up between the right middle-clavicular and near-sternal lines of the troche at the lower edge of the rib arch and the light jerking. in the ochіkuvanni "common reaction of the stove". With a significant accumulated line in a black empty furnace, being fixed with a diaphragm, it is floated into the viglyadi kryzhina. When shipping, if the edge of the stove is located on the fingertips of the hand, the stove goes back, and then turn and the front edge into the fingers.

The jerky palpation can be seen in the horizontal position, or the symptom of "floating kryzhinka" is more likely to appear in the vertical position of the sick person.

The change in the size of the stove with її wrinkling is not allowed to miss, since it is hooked behind the rib edges, but with percussion it is possible to evolve by the change in the height of the liver’s dullness.

When palpation of the liver, it is necessary to respect the beasts and for the sickness at the moment of obmatsuvannya. The sickness of the liver during palpation is most often spared during stagnation in the blood, the appearance of firing changes in the furnace, at the internal or lateral chewing moves, during attacks gum ailment And also in case of urazhennye nerve end with a neoplastic abo perivisceral process. There is also a pain in chronic active hepatitis, macronodular, primary and secondary bilious liver cirrhosis, with syphilic lesions and ecinococosis. In men in the world, there is a soreness in case of obstruction of the liver in ailments for chronic persistent hepatitis and mycronodular liver cirrhosis.

Palpation of the zhovchny michur

The position of a sick person during palpation of a zhovny mikhur is also the same as when palpation of a liver. The "projection zone" of the chewing michur is located on the anterior cherevniy stintsi, on the point where the last edge of the right straight abdominal meat is crossed from the right costal arch (this is the name of the michurna point). The palpation of the ruminant mikhur is carried out on the basis of the vicars of the dichny rukhiv great finger right hand, like at my own ordered meat at right angles to the right edge. The installation of the great finger of the right hand in the michurovo point before the costal arch is rotated before the hour of the vidihu. Then the ailing one can ask for a glimpse of a big breath, and at the same time the stove sinks, and the gummy little thing sticks out with a finger. Palpation with one great finger is proponated by Glenar, but a similar palpation can be carried out at once with two "great" fingers, the tops of the two "great" fingers, one by one.

Until the number of non-standard methods of palpation of the female mikhur, it can be seen that the rest of the patient is in the right position on the other side, if the car rots behind the back of the patient, the hair is filled with bent fingers of the right hand in the middle of the right hand. At the same time, the part of the hand is located on the lower part of the breast plate, and the tips of the fingers are on the right side of the rib (Chiray). If the malleable mink is not palpable when the ailing person is placed on the back and not in the standard position on the other boat, then you can try to pinch it from the ailing one in the standing position with a light old finger on the back of a person. under the costal arch (Glouzal).

In case of a wide palpation of the liver, the lower edge of the last one begins to increase the malleable pear-shaped form, elastic consistency with a significant pendulum-like displacement along the distance to the axis of the sensed organ. It can be used in case of cancer of the head of the podshlunkovaya zalozi (symptom of Kurvuaz), dropsy of the olecranon with occlusion of the remaining stone, or the rotation of hypotonic dyskinesia of the beetle michur.

Hanging of the liver is carried out in the zone of absolute dullness, so that there is L. L. axillaris anterior, medioclavicularis dextra, parasternalis dextra, mediana anterior and parasternalis sinistra. With muscular peritonitis, post-traumatic perihepatitis, there is a noise of rubbing the neck in the central zone.

To make the spleen and spleen rosetting (transverse and late) percussion, percussion determine the following points: 1 - upper, 2 - lower, 3 - front and 4 - back (pic. 69). The first point is to start with a path of percussion from 3-4 mid-ribs along the middle groin line of evil (L. axillaris media sinistra) from top to bottom, going out from a clear legendary sound (along the intercostal spaces) to dull. In healthy people, the upper border of the spleen (1st point) grows along the lower edge of the IX rib, the lower (2nd point) - along the lower edge of the XI rib. A little bit of rooting for the rest of it starts with a quiet percussion so it goes along the middle groovy line of evil, ale, down the hill, up the crest of the club line, until a dull sound appears. Visible between the 1st and 2nd points - the diameter of the spleen, the length of the spleen is 4-6 cm. mіzh navel і lіvіyrebernoy arches). Straight percussion from the navel to the X edge and far along the new one until a dull sound appears. At the norm, the third point is expanded by 2 cm, called from the front groin line. To mark the 4th point, the finger-plessimeter should also be moved perpendicularly to the X edge in the "area" of the scapula of the line. Percussion is carried out along the X edge straight up to the spleen until a dull sound appears. In a cool people, the 4th point grows along the rear groin line, and when it appears between it and the 3rd point (additional spleen) to become 6-8cm.

Small. 69. Scheme of percussion of selesinous dullness

The principle of palpation of the spleen is analogous to palpation of the palpation of the liver.

Small. 70. Palpation of the spleen.

The ailment is guilty of lying on the right boat with his left leg bent and brought forward with his left hand. Likar to sit on the stile, right-handed blya lizhka sick, denounced to the new. Palpation of the spleen is bimanual: the wrist of the left hand with a plasma is laid on the lower part of the breast cage on the left costal arch and slightly heals the area, so that the collapse of the breast cage is surrounded by the side for an hour. Kintsev_ phalanges of 2-5 fingers of the right hand, spread parallel to the anterior edge of the spleen by 3 cm lower than the thigh, which is known during percussion. The other third moment of palpation is the education of the skin folds and the "gut": for an hour you see, if the front row is loose, the fingers of your fingers are palpating the skin right up to the navel pіdreber'ya (confirmation of the kishenі). The fourth moment is the dressing of the spleen: upon completion of the education of the "kishena", as soon as you come to visit you, who is sick to ask for a glimpse of the spleen. One hand in a whole hour lightly squeezes on the lower part of the breast plate and the lil costal arch, and fingers palpate the hand, the spike expands and shrugs off a small, bright ruff right up to the spleen. As soon as the spleen is better, then it is consumed in the swarm and it is even more tactile to see (Fig. 70). At the time of palpation of the spleen, it means localization (in centimeters from the edge of the costal arch), consistency, shape and tenderness.

In a healthy person, the spleen is not palpable, the anterior edge is 3-4 cm apart from the costal arch, and the spleen can be palpated at the edge of the costal arch, which is already increased by 1.5 times.

Decreased spleen (splenomegaly) can be prevented in hepatitis, liver cirrhosis, cholangitis, typhoid fever, malaria, leukemia, hemolytic anemia, thrombosis of splenic vena and in. In case of hospitable infectious diseases, for example, typhoid fever, or in case of gross stagnation of blood in the village, it takes its own consistency, and in case of chronic diseases, from those who have been diagnosed in the pathological process -.

The edge of the spleen is most often slightly rounded in the case of an increase, and in the case of a large number of symptoms, it is painless. Most of the messages appear when state-of-the-art development pathological process in viglyadi traumatic spleen disease or thromboembolic process.

The palpation of the surface of the large spleen is vibrated with light, oozing, overturned, or folding-rocking ruches over the surface. The surface of the spleen is smooth, but sometimes it is uneven through the scar from colic infarctions or traumatic ears.

The hanging of the spleen is carried out over the zone of the projection, as a form of beginning for an additional percussion. At the same time, in some drops over the area of the spleen, there may be a lingering noise of rubbing the oleoresin, which appears when a muscle is fired up in patients with splenic infarction in cases of thromboembolic lesions of the spleen.

Percussion and palpation of the spleen

The spleen, being an organ lymphatic systems and vikonuyu function of the organ of blood, antibody formation, ruinous erythrocytes and thrombocytes, not to be referred to the herbal system. However, until the end of the reception of the organs of the black emptying of the percussion and palpation of the spleen, it is carried out for the delay of the liver and the chirp.

· The position of the sick person on the right boat.

· Visually start diameter of spleen dullness (in the norm - 4-6 cm). For the whole on the middle groin lines, percussion from the groin fossa down to the transition of a clear Legendary sound to dull (blunt) and from bottom to top until the transition of the tympanic sound to dull. With normal sizes of the spleen, the upper inter-gap is drawn on the IX ribs, and the lower - on the XI ribs.

· Visually start longitudinal spleen dullness (in the norm - 6-8 cm). For tsyogo percussed along the X edge to the right and left from the middle groin line to the transition of a dull sound into a tympanic one.

Palpation of the spleen (bimanual)

Gliboka methodical spleen palpation is carried out in the patient's position on the back or on the right side. Good mind for the palpation of the situation, if the ailment doesn’t have to turn to the right side, but it’s like it’s sideways. Ailments lay your hands on your head. The right leg of the patient is vily, and liv leg zginaє in a colonic and tazostegnous loam, which can be reached more beautifully than the weakening of the mucous membranes of the anterior cervical stinka.

Doslidzhu sida on the style of the right-handed man from the sick and put his hand on the area VII-X of the ribs along the groin lines. For the additional help of such a fixation of the half of the breast ailment of the ailing one, there is a diversified excursion.

Palpation of the spleen is carried out with the help of slightly bent fingers of the right hand (II-V) with slightly bent fingers of the right hand, as they are close to the X ribs 3-4 cm lower than the left costal arch (if percussion does not show the paralysis).

· The skin of the anterior abdominal wall is slightly pulled straight up to the navel.

· Finger palpate your hands to zanyuyuyutsya in the middle of the black empty, making a kind of "swelling" (similar to the fact that there is little time when palpation of the liver).

When palpation of the spleen (as you miss it), assess the size, shape, consistency, shape of the surface, looseness, soreness.

In the norm, the spleen is not palpable, so the front edge does not reach approximately 3-4 cm to the edge of the costal arch. Splenomegaly (enlargement of the spleen) is prevented with ailments of the blood, hepatitis, cirroses of the liver, and in. The drooping of the spleen develops even more rarely.

Percussion and palpation of the spleen

Zovnіshnіy look around the abdomen

superficial palpation

At the same time, it is important, that it was not too soft and not too soft for the lowly uzgoliv. The specialist is guilty of the system of the order with the patient and turns to the right side (the left side of the system from the left side of the recumbent). At the same time, it is necessary, just a stiletto, on which to sit a lykar, approximately on one level from the tazostegnovy slope of the ailing one. At his own cherry, the height of the seat is guilty of being the same with the height of the seat. It is necessary that your hands will be fired for an hour to palpate the spleen, or if the liver will be warm, you should be briefly educated. For rosіgrіvu brushes lіkar can be rubbed їх or mash with warm water.

Gliboka methodical palpation according to Obraztsov-Strazhesko

The qia method is used for the identification of ailments in the organs of the intestinal tract. In the course of carrying out an additional palpation, there is a pidshlunkov, a spleen. One of the intestines (sigmoid) should be promoted in the club area from the left side, the slit should be reversed from the right side, and the transverse rim should be inserted a couple of centimeters below the navel. The intestines may have a solid consistency, the stench is painless, not guilty of gurgling. The appendix cannot be felt for an hour. The curvature of the black emptying should be adjusted during the procedure. Vona makes the shape of the fold, її to become 1 centimeter of the navel. Mesenterial limfouzli do not see it for an hour.

spleen bleeding

Draining spleen according to M.G. Kurlov

spleen production

Palpation of the upper and lower between the organ must be carried out, if the ailment lies on the back or on the boss (from the right side). If the patient is lying on his back, he is guilty of twisting his arms and legs. With a tsom uzgoliv'ya lizhka maє but low. If you look at the ailing one at the right boat, then you can take your head forward and your left arm is closed. At the same hour, the left leg slid downward, and the right leg slid downward. This is the position to allow the desire to maximize the weakness of the press, the three of them wince the spleen forward. With such a rank of a doctor it is easier to pay more attention to an organ for an additional palpation, and there are only a few improvements. Specialist sits from the right side of the patient. Lіva wrist lykar on the chest on the left side with two ribs (X і VII) and trochies huddle the breast cage, encircling the ruff for an hour.

Norms and pathology

The norm is based on respect for the unholiness of the production of the spleen. The organ becomes visible at palpation only when it is lowered and when it is clearly increased. In the development of infectious ailments, the power of the body decreases. Win sta m'yakim, as lyudin is sick with sepsis. at chronic forms Infectious ailments, liver cirrhosis, leukemia, the spleen's capacity to move. With the development of a large ailment, palpation is not a disease of ailments. Bil z'appear in cases of infarction and perspective.

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Palpation of the spleen: zavdannya zovnіshny gaze, methodology vikonannya, norms

The spleen is an unpaired parenchymal organ, which has a small ovoid form and an inflamed lower pole.

It is located in the very bottom of the lithium, the front side of its shlunkovaya (visceral) surface of the von lies down to the shlunk, and the posterior-lower dilenkoy (nirkovy surface) - up to the adrenal gland. At the bottom of the tsikavii for us, the organ sticks to the vigom of the intestine.

Being roztasovanoy іd lіvim a dome of diaphragms (between the nine and eleventh ribs), the spleen is overwhelmed by a dichotomous looseness. Її dovga hang (so the title of "long-length") stand in the norm with the course of the tenth rib.

In people with asthenic statues, the spleen grows lower and more vertically, while in volodar hypersthenic statues, it grows more and more horizontally.

zavdannya look around

The palpation of the spleen is transferred to the spleen immediately. With help you can:

make a form to the body;
assessment of the stance of the surface structures;
set the consistency of the fabric;
assess the steps of decay to the body;
detect the manifestation of ailments and іnshih key manifestations, Scho vkazuyut on vіdhilennya vіd norms.

Zovnishniy oglyad

The first croc in the pre-sledged spleen є the last look of the abdomen, which includes:

assessment of its value;
the establishment of symmetrical right and left halves;
assessment of the degree of turn of death, apparent in the region of the edge-edge arc.

Have a great people zovnishniy viglyad belly (th form і size) depending on the type of statues, type physical development and the level of growth.

The presence of pathological processes in the draining will inevitably provoke an increase, both insignificant and colossal (in most cases, the organ can reach the level of the club hole).

Overwhelming growth of the spleen with the growth of abdominal growth, with any wine becoming asymmetric (for the obvious vibration of the other half).

In a sick person, as if sowed horizontally, it is possible to draw a pathologically abnormally enlarged spleen across the black wall. A large world is typical for women with ailments in the region, who suffer from cachexia.

Zbіlshennya abdomen supravodzhutsya zgladzhuvannyam or signs of death, like at the skin healthy people є from the left edge of the costal arch. In children with ailments, you can wind up the lower part of the chest wall (on the left side).

percussion

Kozhen fakhivets, who is a vicon of percussion (fooling) of the spleen, knows about the small size of the organ, which is grown in the lavage of the ribs of the glibo, so that there can be a third of the lactation on top of the breast.

Oskilki dilyanka of spleen, available for puffing, excretion with organs, and to avenge disgust (lungs, intestines, slurry), we shorten the option of її preliminaries є without a mediocre quiet percussion according to Yanovskiy, but the results are absolutely dull.

In the case of an average percussion percussion (the whole option is full of mobility), fachivets should only consider dullness, an increase in the amount of air-containing tissues in the percussion zone, which is given in case of a thumping sound.

For the additional quiet percussion, you can see the approximate size of the spleen. For an hour, you can see the management of ailments:

Take an upright position with your arms straight forward.
Lie on the right side, bending your left hand in liktyovy loam and poklavi її on the surface of the breasts (the right hand is guilty of perebuvati under the head). The right leg of the patient is guilty, but the left leg is bent in the colony and in the tazostegnous slope. This is the posture for maximum relaxation of the muscles of the anterior abdominal wall.

Itself in the ciches of the position of the preliminaries, the change of the small cinder is brought up to the right, or downward towards the spleen, which means that you can see the results of palpation.

In order to increase the upper boundary between the organ, the finger, the viscous role of the plessimeter, set in the middle of the middle groin line and the level of the high-pitched intercostal space and start to the percussion, moving down the intercostal space.

To set the lower border of the spleen, the finger-plessimeter is guilty of being placed on the middle groin line in a straight line, parallel to the ochikuvano cordon (trochus below the costal arch). Directly the percussion is going from bottom to top: from a clear sound to the cob of dullness. A message about passing the cordon to shy away from the side of a clear sound.

By starting the front cordon to trick us to the organ, put the finger-plessimeter on the front wall of the abdomen (above the navel, at the level of the tenth mid-ribbed cordon) parallel to the front cordon. Perkutate slid, letting through to the transverse axis of the spleen dullness until the first signs of dullness appear.

The front view is placed on the other side, a clear sound can be heard. The front border of the spleen normally passes one to two centimeters from the front groin line (livish).

To reveal the rear cordon to the organ, the finger-plessimeter is positioned perpendicular to the tenth rib (directly percussion can be parallel to the cordon). Collapsing between two lines (rear and shoulder blades), go to percussion until the sound is dull (back to front).

Having installed the upper and lower boundaries of the organ that is already visible, we become visible between them, as a result of which we can see the difference in diameter, which is located between the ninth and eleventh ribs. Normally, it is used for dinner, warehouses are up to six centimeters.

When you go out, you see the front and back cordon of the spleen, you get the value of the longest (in healthy people, it’s about six to eight centimeters).

Increased significance of the transverse and long axis of the spleen dullness to the non-transferable evidence of an increase in the organ, which is found in the patients who are watching:

ailments of blood-forming organs (hemolytic anemias, thrombocytopenic purpura, leukemia, lymphogranulomatosis);
by the broken exchange of words (amiloidosis, diabetic diabetics);
infectious ailments (painter, cranial, viscous and rotary typhus, sepsis, brucellosis);
blood circulation (thrombosis of the glandular or splenic veins);
pechinki ailments (cirrosis, hepatitis);
lesions of the spleen (echinococosis, ignition process, chubby, traumatic problems).

With the presence of hospitable infectious ailments (especially with sepsis), the spleen swells up a consistency. Damage to the body is susceptible to amyloidosis, chronic infectious processes, blood problems, oncological disorders, portal hypertension.

In addition to cysts, infarctions, syphilic hums, echinococosis, the surface of the spleen swells with irregularities. Ailment to the body of a vein as a result of a thrombosis, infarction, as well as thrombosis of the splenic vein.

Percussion of the spleen is carried out, it will be displayed in this video:

Norms for children and adults

In the protocol of ultrasound examination of the spleen, it is necessary to indicate the specific value of three linear changes (information about those, which the organ of growth, is not given in numbers, in the notice).

Normal size of the spleen (in the middle) in older patients are presented in the list below:

її dzhina can range from eight to chotiirteen centimeters;
width - from five to seven centimeters;
tovschina - from three to five centimeters.

It is necessary to be reasonable, so that the values are averaged, and the magnitude of any internal organs Individual in skin people.

The parameters of a healthy spleen in children change all hour (in general, in terms of size and size of continuously growing body).

Average indicators of the size of the body for children, which can be applied to different categories, indicated in the list:

In newborns, the size of the spleen is 40 mm, the thickness is 20 mm, and the width is 38 mm.
For children from one rock to three rocks, the organ becomes 68 mm, thickness - 30 mm, width - 50 mm.
Up to seven rocks of the spleen can be increased up to 80 mm, thickness - up to 40 mm, width - up to 55 mm.
For children of eight or twelve rocks, the organ becomes 90 mm, thickness - 45 mm, width - 60 mm.
Up to the fiftieth century, the length can be from 100 to 120 mm, the thickness is 55 mm, and the width is too large.

Based on the list given, it is possible to establish, by measuring the spleen, eliminating it in the course of ultrasound diagnostics, according to the applicable standards.

In case of inconsistency of indicators in a car, it is possible to detect in a small patient the following:

Methods of palpation of the spleen

Palpation (industrialization) is one of the main methods of spleen detection.

When you see the surface palpation of the abdomen, the lingering area of the left ribs needs to come with special respect, and some help the body will allow you to make the most of the cone-shaped baby.

As well as a sick person is susceptible to splenomegaly (as a result of a large swelling of the spleen), as well as provoking the vibrations of a larger part from the edge of the costal arch, at the end of the costal arch, because of the need for a large amount of palpation.

Oscillations of palpation of the spleen, healthy with a vertical position of the sick person, in a large amount of vomiting can be seen twisted through strong strains of the muscles of the abdomen, її good:

in the position of the sick person on the back;
in the first diagonal (45 degrees) position on the right side.

At the same time, the situation is tied with deyakie non-hands for a lykar. I’m guilty of the production of the spleen, I’m guilty of something else at the couch, or to stand on one of her handles.

A lot of bimanual palpation in the patient's position is to lie on the back on a soft slick on a low pillow. Yogo feet are guilty of butyahnut, and hands are laid by the bridle of tuluba. Having approached the sled from the right side, the doctor borrowed a special order from her.

The right hand (palpate) the hands with a plasom laid on the left part of the abdomen in such a rank, which is flared towards the pubis, and the end phalanges are closed and three of the ribs of the ribs were fluttered on one edge of the edge.

Kintseva phalanx of the middle finger is guilty of roztashovuvatsya in the cuff, fixed by the lower edge of the tenth rib and the tip of the eleventh rib. The great finger of the right hand does not take care of the manipulation of participation.

The hand of the left hand is placed on the left part of the breast plate of the sick bridle of the tenth-tenth ribs on the equal front axillary (pahvovy) line. Guilty fingers are thrown into the side of the ridge stop.

For an hour after the dying of the spineless ruffs, the doctor's hand is guilty of the triples between the spine of the costal arch, letting go to increase the spirited excursion of the diaphragms, so that the spleen goes down. In the process of palpation, the vicon has a glimpse of the regulation of the patient's behavior.

Even in the course of percussion or superficial palpation of the bullet, information about the localization of the lower border of the spleen is taken out, fingers palpate the brushes to become one or two centimeters lower. When you try to break the crease of the skin, make the crease of the front abdomen by three centimeters straight to the front of the rib dusi.

The staff of the whole reception of the drug will open with their fingers a supply of shkiri, which will lay down without any problems in the livogo pidreber'ya. Likewise, the patient robs the vid, and the vison palpates the fahivets at once from the lowering of the abdominal wall, carefully curling the fingers of the right hand in the middle of the black emptyness (down to the end of degrees), unnecessary hand in all the next steps.

The space, lacking a thin surface of the hand and costal arch, is sufficient for passing the lower pole of the spleen. Proponuvavshi to the patient, it is glibky and non-volatile dikhalne rukh belly, lykar with the fingers of the left hand pushing on the left costal arch, the splinter is surrounded by ruffleness.

For a moment, fingers palpate the hands, being unruffy, get lost in the blood empty, nudging the anti-vyshtovuk ruch of the abdominal wall.

Innocent spleen may not be consumed in the quest, all deprived of their lower edges with the fingernose phalanges of the fingers. In such vipadas, the fachіvets, which pragmatically pinch the organ, is guilty for an hour to inhale, lightly stick the brush forward, straighten the fingers, shuffle them or stroke it (from above), or push it (from below) to the ruch.

It is necessary to memorize, so that the palpation will not be protected by the obscurantism of the body, which is suspiciously infuriating.

After repeating the last bit of development (beckon with a stretch of two or three dichal cycles), go to the palpation in the position of the patient on the right boat, named in honor of the proponent of the Swiss diagnostician Salon of Germany.

Laggy on the bik, the patient is guilty of turning to right side(From the cot 45 degrees) to the surface of the couch, folded at once to the right to the right. The right leg of the sick person is guilty but it is twisted, and the liva is to loosen up the muscles of the abdomen - it is half-bent in a knee-joint, and the trocha is brought to the tulub.

The specialist can take a particular position, however, if the low couch is evident, and the lack of numbness of the exchange of soft slopes, you will be able to see the palpation of the seated one at a time, or sinking in front of the post on the right. The same position is given the ability of the right hand to flatten out on the patient's belly.

The given method of palpation of the spleen according to Sali is practically not related to the generalized method of bimanual dosage, which is used in the patient's position, but to lie on the back.

In order not to get rid of the bad spleen from the bad nirkoy, it will be necessary to carry out the palpation in the position of the sick person. The price of a provocation of the spleen from one side, in connection with which the procedure of palpation appears to be difficult, and from the second, the lowering of the nirka and lays down the production of the organ.

Splenomegaly allows namatsati on the front edge to tell us to the body the manifestation of characteristic viral patterns, which are present in the nirka, over a number of authorities and specific features.

When there is a palpation of the spleen (the purchase of a new age in a black empty), palpation of the spleen can be complicated. In such vipadkas її promatuvannya zdіysnyuyut in the position of the sick person, lying on the right boat (yak when advised on Sali). It is possible to establish the manifestation of splenomegaly in patients with ascites swelling by using the method of palpating palpation, in the position of lying on the back.

Specialist, like a healthy manipulation, with the help of the phalanges of the knuckles at once and three of the knuckle fingers, palpate his hands with a series of short, frequent and jerky blows on the anterior wall of the abdomen (none

Straightly applied pochtovhіv, scho vzhivayutsya with the mark of natrapiti on the organ, but perpendicular to the ochіkuvannyy lower edge.

The price of the change is trivial to quiet pir, until the end of the day we repeat it It’s like to come in with a lot of black empties, and then when you’re futile and know about the end phalanxes of the glider’s fingers.

Dana's manifestation will be called a symptom of "floating kryzhinka". Itself at the moment of such zitknen obmatsuyut the surface of the organ before it.

Video showing the technique of palpation of the spleen:

Norms and pathology

Selezinka, yak take care of the fate of the form immune system, In the fight against pathologies cystic brain In blood, in all types of carbohydrate and lipid metabolism, the role in the body of people is even more important.

It is the very fact that insignificant troubles in the robotic organ (and even more growth) can be found, by way of serious concern.

In cich vipadkah the patient is guided by ultrasound to the patient. Indicator norms є:

Growing the spleen from the left side, pid lower part diaphragms. The middle of a healthy organ is guilty of lying down to the shlunk, and the tail of the lump of the spleen is localized at the center of the spleen (this is the name of the entry into her nerves and arteries and the way of lymph vessels and veins).
The appearance of parenchyma, which has a single-grain structure.
The diameter of the splenic vein, which does not overlap, is 0.5 cm.
Evidence of a homogeneous ecostructure.
There are some blotches on the surface.
Evidence of new outlines, how to make a mistake.

Signs of pathology can be presented:

The emergence of a heterogeneous structure (as a rule, to produce good poohlini).
Due to malignancy (a blame for oncological ailments of blood, which does not support malignancies, but rather to provoke splenomegaly's malpractice).
The appearance of a rotated splenomegaly is a pathological increase in spleen growth.
Incorrectly shaped body.

Finding insignificant indications of standard parameters is less important in diagnostics than in the form of a comprehensive consultation of qualified functions.

spleen percussion

The percussion of the spleen is stagnated for the purpose of making a difference. Vikoristovuєtsya quiet percussion. Ailment at any one can be found in a vertical position with arms stretched forward, or in a horizontal position, lying on the right boat, his left hand is guilty of being bent in a thin slope and lying on the front surface of his breasts, his right hand is twisted with his head, his right hand is twisted with his head bent in colline and tazostegnous slopes.

For the purpose of the upper intercostal space, the finger-plessimeter (Fig. 64, a) may be placed at its own rank along the middle groin lines in the VI-VII intercostal space and percussed down the intercostal spaces, as long as the clear, youthful sound does not change dull. Vіdmіtka cordon is carried out from the side of a clear sound.

Small. 64. Percussion of the spleen:

a - the position of the finger-plessimeter when the upper and lower between the spleen are indicated;

b - front and rear cordons.

To establish the lower border of the spleen, the finger-plessimeter (div. Fig. 64, a) is also inserted along the middle groin line, parallel to the cordon, below the costal arch. Draw the sign of the cordon from the side of the tympanic sound.

To mark the front of the spleen (Fig. 64, b), the finger-plessimeter is moved to the anterior cage of the umbilicus, parallel to the shukano cordon (approximately on the length of the X mid-ribs) Place the sign on the side of a clear sound. In the norm, the anterior border is located 1-2 cm more than the anterior groin line.

Small. 65. Growing normal spleen.

To determine the rear cordon of the spleen, the finger-plessimeter (div. Fig. 64, b) is placed on the X ribs, perpendicular to the new one, i.e.

The distance between the upper and lower borders of the spleen, that is, the diameter, which grows between the IX and XI ribs, and in the norm becomes 4-6 cm. back fringes spleen, that is, the length of the length, which normally becomes 6-8 cm (Fig. 65).

The increase in diameter and length of the spleen dullness is indicative of the increase in the spleen. Chemotherapy can be spasmodic in case of infectious diseases (chronic, visceral, rotten typhus, malaria, brucellosis, sepsis and in.), Ailments of the hematopoietic system (leukemia, hemolytic thromboembolism, cirrhosis) destructive exchange of words ( diabet, Amyloidosis and in.), Blood circulation (thrombosis of the splenic or vortic veins), when the spleen is affected (ignition process, traumatic ear, Pukhlina, echinokokoz).

In case of hospitality of infectious diseases, the spleen can reach a pulp of consistency (especially in case of sepsis). In case of chronic infectious diseases, blood ailments, portal hypertension, the disease may suffer, especially in case of amyloidosis, cancer. With ekhinokokozi, cysts, syphilic gummas, spleen infarctions, the surface of the їїє becomes nervous.

Spleen ailment is indicated in case of inflammation, infarction, as well as in thrombosis of spleen vein.

/ Palpation and percussion of liver and spleen / Palpation and percussion of liver and spleen

Superficial palpation in case of liver disease can develop a zone of ailment in the area of the right ridge and epigastric disease. Particularly strong local soreness to navit with a slight dot to the anterior cranial wall in the projection zone of the mothball is spared in case of gross cholecystitis and moth ring. at chronic cholecystitis It’s easy to start, for it’s easy to reconcile the soreness in the so-called point of the living room: there’s a projection of the bottom on the front black wall, and in the norm, in most cases, in the right direction, there’s no need to go to the right.

The palpation of the liver should be performed using the Obraztsov-Strazhesko method. The principle of the method of polarity is that, with a deep breath, the lower edge of the stove descends to be palpated with your fingers and then, when you come across them and see them, it becomes visible. Seemingly, the stove is in the middle of the middle empty organs to the diaphragms of the volodya. Otzhe, when palpating the liver, an active role is to lay down the power of the dichotomous collapse, and not to palpate with the fingers, as the hour of the intestinal obstruction.

The palpation of the liver of that zhivny wickedness to roam in the position of the sickly standing or lying on the back Promoting the liver and chirp michur to roam behind the gallant rules of palpation, and the most respect for the anterior margin of the liver, for the authorities (contours, shape, soreness, consistency) to judge about the physiology, the liver's form itself In bagatech vipadkah (especially with a lowered or abnormal organ), in addition to the edge of the liver, it is possible to palpate it often from the left edge to the right one, to protrude from the upper front surface of the liver.

Before the end of the day, the right-handed man pushed with a lazy on the stile, or on a stool with a special person until the end of the stool, put the dolon and some fingers of his left hand on the right across the area, and with the thumb of his left hand pushing to the side and in front of the right edge of the finger to the back quickened expansion of the breast cell for an hour to breathe, additional assistance to improve the strength of the excursion of the right dome with diaphragms. Put the platter of the right hand with a plasma, slightly bending your fingers, on the living of the ailing one without the middle of the costal arch along the middle-clavicular line and lightly pushing the fingers onto the black wall. For such an installation of the hands of a person who is already aware of the sound of a deep breath; the stove, descending, from the point to go to the fingers, then to bypass and hang from the fingers, that is, to be felt. The hand will go through the whole hour to become unruly, while repeating the cycle of development.

The position of the edge of the stove can be depleted by the depletion of the versatile furnishings, so that the nobility develops the fingers of the right hand, it is corny in front of the front because of the position of the lower edge of the stove by the way of percussion.

For V.P. Obraztsov, it is normal to feel the liver in 88% of cases. On palpation, one can see that it is captured from the lower edge of the stove, it is possible to see the significance of its physical power (soft, shy, nervous, hospitable, rounded, sensitive, etc.). The edge of an unassailable stove, adolescents in the end of a deep breath 1 2 cm below the costal arch, a soft, gostriy, easily tucked up and insensitive.

The lower edge of the normal liver is encouraged to be felt on the right mid-clavicular line; the right-handed person does not let the liver miss out on it, so it’s caught by the subcostal arch, and malice is not easy to palpate through the twisting of the sinews. If the ovens are increased or damaged, they will be prompted for all the lines. The ailment from the abdominal pains to the point of delighting the heart for lightening the palpation. When buying a piece of empty space (ascites), palpation of the liver in the horizontal position of the sick person is not expected. In cich vipadkah, it is indicated by the indicated method, ale palpation is carried out at the vertical position, or in the position of the sick person on the left boat. With the purchase of even a great number of births, in front of them, they should be used for paracentesis. As in the black emptying є the great purchase of the house, the stove can also be poured behind the aid of a jerky pampering palpation. For the right hand, with slightly bent II IV fingers, stand in the lower right half of the abdomen, perpendicular to the perebachuvanuyu lower edge of the liver. With the closed fingers of the right hand, jerk strikes on the cranial points and overshoot straight from the bottom up the hill until you see the heart of the liver, like, when you hit the fingers, you can go into the depths of the old waste, and

Sickness is characteristic for the ignition of the stove with the transition ignition process on the capsule of the stove, or for stretching (for example, in case of stagnation of blood in the liver, in case of heart failure).

The liver is healthy people, as long as palpation is available, it has a soft texture, with hepatitis, hepatosis, heart decompensation, it is more severe. Particularly sensitive to the liver in case of cyrosis (with the whole edge of the liver), and the surface of the amniotic fluid is very small), plumpy severe metastases of cancer (in these types of cases, some of the surface of the liver is roughly humpbacked) In some cases, it is not very big for the size of fluff or brush.

The visibility of the lower edge of the larger liver starts from the period up to the costal dusa on the right anterior groin, right close to the sternal and left peri-sternal lines. Dani palpation to clarify the statement about the size of the liver, eliminated by the method of percussion.

Zhovchny mikhur in the norm it is not probable, as it’s soft and practically not at the edge of the stove. Ale with an increase in zhovchny mikhura (dropsy, reminiscent of stones, cancer, etc.) Win becomes accessible to palpation. Promatsuvannya mikhura leads in the same position of the sick, as well as palpation of the liver. To know the edge of the stove and without the middle before it at the last edge of the right straight meat, follow the rules for the promotion of the liver itself by palpation of the chewing meat. The easiest way can be found with the Russian fingers transversely to the axis of the beetle mikhura. Zhovchny mikhur palpably begins at the viglyadi pear-like mishmash of growing size, malnutrition and soreness in the fallowness due to the nature of the pathological process in the very same or in the other organs (for example, ; schilno-humpbacked michur with newly established in the yogo stage, with redevelopment of stones, with fired stinks and іn.). Improvement of the ruhlivy mikhur in case of dichanna and robbing the pendulum-like ruch. Lumpiness of the zhovchny mikhur is involved in the burning of the curvature of the pericholecystitis. With cholecystitis and gnawing ailments, there is a slight ailment and reflex tension of the musculoskeletal system of the anterior abdominal wall in the area of the right fissure to accelerate palpation.

The method of palpation of the liver and chuck mikhura is very simple, manual and even the best results. Difficult palpations, and at the same hour, the evidence, as soon as it was allowed to correct the valuable data for diagnostics, was smacked by the most beautiful method of palpation. It is proponated that the position of the hands can be brought up to the position of the head until the position of the hands is changed or the position of the hands is changed according to the worn out to the sick. However, there are no doubts about the method when it comes to advanced liver and chewing michur. On the right, not in the rosmata of the emptying, but in the awareness of the preliminarily and systematic plan of the preliminaries of the emptying in whole.

The percussion method allows for the value of the boundary, the size and the configuration of the furnace. Percussion of the upper and lower boundaries of the furnace. They develop the upper boundaries of two types of liver dullness: common dullness, as there is a notice about the upper border between the liver and absolutely dullness, so that the upper between the sides of the anterior surface of the midsection, to the point where there is no In practice, there is no need to be confused between the absolute dullness of the liver, since the position of the upper boundary between the relative dullness of the liver is inappropriate and lie in the form of the size of the chest wall, while the standing of the right dome of the diaphragms. In addition, the upper edge of the stove is even more tightly gripped by the lungs, and the upper border of the apparent dullness of the stove is important. At the end, in all cases, the increase in the size of the stove goes all the way to the bottom, just to judge by the position of the lower edge.

To carry out the percussion of the stove in accordance with the rules of the topographic percussion. For the purpose of making the upper boundary of the absolute dullness of the stove, you will have a quiet percussion. Percussion from top to bottom along vertical lines, yak when the lower between right legends... We know by contrast between the clear, legendary sound and dull from the stove. I know the cordon by means of points on the screen along the upper edge of the finger-plessimeter along the skin vertical line. At the norm of the upper boundary of the absolute dullness of the liver, it grows along the right side of the hearth at the upper edge of the VI rib, along the right mid-clavicular line on the VI rib and on the right anterior corner of the E. legends. In the same way, it is possible to set the position of the upper boundary of the liver and to the back, protest to be interconnected only after the specified three lines.

The designation of the lower boundary of the absolute dullness of the stove represents the folding through the closeness of the empty organs (shlunok, intestines), which, when percussed, gives a high tympanic, concealing a stove sound. I will look at the price, go to the quietest percussion, and even more beautifully, vikoristovuvati without the first percussion with one finger according to the Obraztsov method. The percussion of the lower boundary of the absolute dullness of the stove according to Obraztsov is repaired by the guard in the area of the right half of the abdomen on the right of the front groin line in the horizontal position of the sick person. Place the finger-pessimeter parallel to the position of the lower edge of the stove, and on such a far-off edge, when a blow is applied, a tympanic sound is felt (for example, on the level of the navel or lower). Step-by-step peresuvayuy finger-plessimeter uphill, reaching the boundary between the transition of the tympanic sound into an absolutely stupid one. In the whole mice on the skin vertical line (right middle-clavicular line, right side-line line, front middle line), and with significant improvement of the liver and on the most robust edge of the bottom line

When the left borderline is absolutely stupid, the finger-plessimeter is placed perpendicularly to the edge of the left costal arch on the edge of the VIII IX ribs and percussion to the right without middle middle to the edge of the costal arch until the mimic transition

At the norm of the lower boundary of the absolute dullness of the liver in the horizontal position of the ailment with the normostenic form of the chest wall, pass in the right anterior groin line on the X ribs, along the mid-clavicular line along the lower edge of the right costal arc, on the lower edge of the right costal arc , along the front middle, line 3 6 cm from the lower edge sword-like sprout(At the boundary of the upper third of the line from the side of the xiphoid protrusion to the navel), in spite of not going to the back middle line. The position of the lower edge of the stove, and in the norm, can be low in the form of the breast cancer, the constitution of the human, but it can be mostly deprived of the same position on the anterior middle line. So, with a hypersthenic thoracic clit, the lower edge of the liver grows into a trochie of the designated rivn, and with an asthenic breast clump, it is lower, approximately in the middle of the appearance of the xiphoid protrusion to the umbilicus. Zsuv the lower edge of the stove down by 1 - 1.5 cm is indicated in the vertical position of the sick person. With an increase in the liver, the gap between the lower edge changes to the edge of the costal arch and sword-like outgrowth; Between the left parts of the liver, start on the right side of the labor line downward towards the edge of the costal arch and along the line of the costal arch (along the costal arch).

Otrimanie of the percussion of the stove allows the visibility of the stove's dullness. For the whole, along the vertical lines, we change the distance between two different points of the upper and lower between the absolute dullness of the stove. The height in the norm on the right anterior groin line is equal to cm. on the right mid-clavicular line 9-11 cm, and on the right around the chest. Behind the percussion zone of dullness of the stove, it is important (you won’t get angry with the zone of dull sound, made with a ball of muffs across, nirkas and a dull grove), and a little bit of the vyglyadya smog. quietly in the fall, if it is lowered and go to the left of the right costal arch, and also the spike is turned about its axis in front of the dark, dulled by the sound behind the back.

Percussion of the stove according to Kurlov. With the percussion of the liver according to Kurlov, three times start: the first one is on the right mid-key line from the upper to the bottom of the absolute dullness of the liver (in the norm 9 11 cm), the other mid-range on the front line 9 cm), the third size along the edge of the ribs of the noy arch (6 8 cm wide).

The value of percussion between the stoves and the development of the diagnosis is significant. However, the upper bounds (upward or downward) are often tied with post-pectoral snakes (high or low standing with diaphragms) the manifestation of subphrenic abscesses, pneumothorax, exudative pleurisy). Tilki with echinococosis and liver cancer of the upper and lower boundaries can be moved up the hill. Zsuv lower between the stoves up the hill to indicate a change in the changes in the temperature, but it can also be seen in case of flatulence and ascites, the stove appears up the hill. The lowering of the lower intestine downward spares, as a rule, with an increase in the body as a result of early pathological processes (hepatitis, cirrhosis, cancer, ecchymosis, congestion of blood in case of heart failure, etc.), Systematically cautioning for Percussion between vypikannya zmіnoy vysota pechinkovoy dullness allows you to judge about the change or the change in the body in the loss of illness.

Zhovchny mikhur percussion is not a percussion, however, with a significant improvement, it is possible for an additional quiet percussion.

The percussion is not just for the purpose of setting the size of the stove and the chewing mikhur (topographic percussion), but for the assessment of what I will become: the percussion (guard) on the surface of the stove, but above the zone of rosé mowing of the chewing ill-feeling with ignition processes (hepatitis, cholecystitis, pericholecystitis і іn.). Bittya (succusio) on the right costal dusi is also vicious in case of liver disease and gum disease, especially in case of gum disease (Ortner's symptom).

Palpation of the spleen should be carried out in the position of the patient lying on the back or on the right side. For the first person with ailments, lie on a slicker on a low pillow, his hands are tied with a bridle of a tulub, his legs are also tied. In another, the sick person's head is laid on the right side, the head of the child's knuckle is tied forward to the breast cage, the left hand is bent in a licky slope, it’s possible to lie on the front surface of the thorax, the right leg is tied, while the back is bent. Whoever is supposed to reach the maximum relaxation of the cranial press and the spleen closer to move forward. All the cases will be felt by palpation with slight improvement. Likar to sit right-handed from a sick person to a new one. my hand lykar maє on half of the breast plate of the sickly mіzh VII and X ribs along the groin lines and the corkscrews, flanking the ruch when dyhanna. To the right hand with slightly bent fingers, a likar can be found on the front surface of the village of the ailment at the edge of the costal arch, at the place of the end of the X ribs, because, as a result of the glance at the front of the village, Let the likar lightly press down the black wall with the right hand on the sick person's sight, making him swish; Dal a lykar proponu to a sick person a glib vidih. At the moment of inhalation, if the spleen is available to palpation and to be carried out correctly, the spleen, wriggling down, descends with a diaphragm, its antero-lower edges come close to the fingers of the lykar's right hand, to creep into them and when you push your way down. Tsei priyom repeat the kilka raziv, magayuchis until the entire accessible palpation edge of the spleen. At the same time, respect for size, soreness, thickness (consistency), shape, spleen decay, and visibility of virality on the front edge. The characteristic for the spleen is one or more of the virizoks on the front edge, which begin with the great victory. The stench allows you to see the spleen from the other dead organs of the black empty, for example, the livoy nirka. With a significant increase in the spleen, it also protrudes to the front surface, which goes from the edge of the costal arch.

The normal spleen cannot be felt. Wonderful palpation of lichen is available with significant omission (rarely with extreme step enteroptosis), most often with an increase. Decrease of the spleen should be promoted in the presence of deceased and chronic infectious diseases (cherevny and turn tifi, Khvoroba Botkina, sepsis, malaria and in.), Liver cirrhosis, thrombosis and abnormal splenic veni chronic leukozy). Significantly, the spleen is called splenomegaly (from the Greek. Splen - spleen, megas - great). Most reduction of the spleen is more likely to develop in the end of the stage of chronic myeloid leukemia, when it is not easy to occupy the entire left half of the abdomen, and its lower pole is in the malium pelvis.

In case of hospitalized infections, the density of the spleen is small; especially the pulp, doughy consistency of the spleen in sepsis. With chronic infectious diseases, liver cirrhosis and leukemias, the spleen becomes shy; even worse with amiloidosis.

With a large illness, palpation of the spleen is painless. You get sick with splenic infarction, persplenitis, and also in times of rapid expansion through the expansion of the capsule, for example, with stagnation in the venous blood with thrombosis of the splenic vein. The top of the spleen grows dull, the irregularity of the region and the surface begins to appear in case of persistent and elderly infarctions (may be drawn in), the hunchiness of the surface is susceptible to occur in case of syphilic gummas.

The lumpiness of the spleen will make you want to finish it; won’t be intertwined with perisplenite. Risko zbіlshena spleenka when dikhanna zalishatsya-ruhomiy, prote її invoke all the same to be pushed by hand before the hour of palpation. It is not common for leukemia to develop not only the spleen, but the liver (as a result of metaplasia), which can also be palpated.

With an advanced system blood-forming organs percussion can be used to change the meaning: you won’t be victorious for an out-of-the-box design of the spleen. In addition, the spleen is chipped away by empty organs (slunker, intestines), so it is impossible to take revenge on the percussion and give a dull tympanic sound at percussion, as if it is impossible due to the fact that it is not possible.

Percussion to carry out in the position of the sick, standing or lying on the right boat. It is necessary to perkutate even more quietly from a clear sound to a dull one; the best way to use the Obraztsov method. To designate the diameter of the spleen dullness, percussion along the line, so that it grows 4 cm lateral to the side of the costal-slope line (the whole line of the sternocleidomastoid joint of the child) In the norm, splenic dullness appears between the IX and XI ribs: її size 4 6 cm. percussion size of the dullness of the spleen longitudinal length 6-8 cm

To continue jumping, you need to take a picture.

Superficial palpation in case of liver disease can develop a zone of ailment in the area of the right ridge and epigastric disease. Particularly strong local soreness to navit with a slight dot to the anterior cranial wall in the projection zone of the mothball is spared in case of gross cholecystitis and moth ring. In case of chronic cholecystitis, it will appear that it’s easy to start, but for the right side of the right-hand side of the mothballs: you see the projection of the bottom on the front row of children, and in the norm in the locality there is a lot of life.

Sickness is characteristic of the ignition of the furnace with the transition of the ignition process to the capsule of the furnace, or for expansion (for example, with stagnation of blood in the liver due to heart failure).

Zhovchny mikhur in the norm is not palpable, as it is meek and practically not to be seen from the edge of the stove. Ale with an increase in zhovchny mikhura (dropsy, reminiscent of stones, cancer, etc.) Win becomes accessible to palpation. To know the edge of the liver and right next to it at the last edge of the right straight muscle, follow the rules of manufacturing the liver of the middle finger of the palm of the hand. mikhura. Zhovchny mikhur palpably appears at the sight of pear-shaped meat of a growing size, thickness and ailment in the fallow because of the nature of the pathological process in the new most or in the depleted organs (for 'Je;... schіlno -bugrіsty mіhur at novoutvorennyah in yogo stіntsі at perepovnennі kamіnnyam at zapalennі stіnki that іn) Zbіlsheny mіhur ruhlivy at dihannі i robit mayatnіkoobraznie Ruhu Ruhlivіst zhovchnogo mіhura vtrachaєtsya at zapalennі pokrivaє yogo ocherevini pericholecystitis at holetsistitі zhovchnokam i. 'yang ailment іnіy ailments nіst і refl The vector of tension in the muscles of the anterior cervical wall in the area of the right sidebar is to slow down the palpation.

Selezinka is an organ that grows in the area of the left edge. The spleen develops from the pulp, where it is reduced by a semi-tissue capsule, from which in the middle of the pulp trabeculi (heavy) enter, which changes the parenchyma.

In the case of histological Budova, the spleen has two balls: beliy and chervonia. At the base of the red pulp lie the supporting cells, where they are intertwined between themselves, and in the midst of them, there are cells, who glaze over the little erythrocytes and alien particles. Danish ball is thickly pierced by the hedgehog of the other capillaries, through the roof it goes up to the clitin of the pulp.

Bila pulp is a purchase of special blood cells (large blood cells - leukocytes) and blood cells from white blood cells on white worm capillaries. Besides, there are numerous lymphatic other universities in the large pulp.

for diagnostics developmental pathologies the body needs the nobility of the exact definition, as it starts percussion, or for an additional ultrasound scan. The growth of the spleen in the norm and in the case of illnesses is described in the data of the statute.

spleen topography

Ocherevina covers the organ to rise (crim vorit). The name of the area of the spleen lies up to the diaphragms (її costal part). The organ is designed on the left phrenic-costal sinus, between the 9th and 11th ribs along the groin middle line.

The posterior part of the spleen extends 4-6 cm from the ridge, at the level of the 10-11th ridges (thoracic). The shape of the organ is oval, abo dovgasta, it can be wide and short in children, or high and low in adults. The selezinka has two poles: curvatures of the posterior ones, scho of furrows to the ridge and bumps of the anterior ones, scho straightening to the ribs.

In addition, they develop two surfaces: diaphragmatic (external) and visceral (internal). On the visceral surface (in the center), the gates of the organ are expanded.

The growth of the body can change in the presence of pathologies, as well as the patient's condition. The size of the spleen in the adult population (norm): thickness 3-4 cm, width up to 10 cm, up to 14 cm.

The spleen can reach the ruchoma as long as it is tied with a slunk and a diaphragm (like ruhomie organs).

Growth of the spleen and other organs

The spleen is roasted under the lungs, it is charged with lіva nirkoyu, pіdshlunkovoy and intestines (tovstim), as well as diaphragm.

The visceral surface is tackled by the lack of inconsistencies that have been injected into these organs. These irregularities are the pits, named in the form of the organ, which is to mend the grip on the spleen:

avoidance of shlunkov;
intestinal fossa;
fossa nirkov.

Krym, the spleen is tightly tied to the other organs behind the aid of the blood-bearing vessels. The axis of what, with the appearance of pathological processes, for example, in the slurry hall, can be stored from the head, body, tail, with sizes, norms in grown-ups, the spleen can also be reduced.

The closeness of these organs to the diagnosis of the diagnosis, so for example, when the ultrasound examination is carried out, a comprehensive look at the diagnosis of the development of the liver, the last for someone else, for an additional percussion, designate the development of organs for the inclusion and change / change.

functions

The main functions of the offensive body:

Selezinka - rose. The norm for older adults and children

Splenic vein in the normal range of diameter 5-6 (up to 9) mm.

Growth of spleen in the norm in adults, the area for the maximum height of the road is 40-45 cm.

Obligate to the body vis-à-vis the Koga formula: 7.5 * area - 77.56.

Normal organ sizes

When the size of the spleen is used, the norm in older adults is meant for food, the mass of a healthy organ becomes 150-170 g (up to 250 g). In healthy people, the spleen will increase in size with the lower ribs and it may be deprived with a significant increase in the organ, if the mass grows up to 400 m

In case of insignificant improvement, special equipment is required for diagnostics of pathology, for such and it is carried out, for example, ultrasound.

The upper boundary of the size of the spleen (the norm in older adults) with ultrasound dosage becomes 5 * 11 cm (apparently - the size of the spleen). However, for an additional ultrasound scan, there is a measurement of the performance of the patient.

Diagnosis of pathologies of the spleen

Visually, the size of the parenchyma of the organ (and, apparently, the growth of the appearance / appearance of the disease) allows the offensive methods:

percussion, palpation;
roentgenologic doslidzhennya;

spleen percussion

For viznachennya razmіrіv body at to the first zasosovyut percussion. Percussion is guilty of being quiet. The patient grows vertically (hands are twisted forward) or horizontally (on the right side, with a bent in a lick, or it is free to lie on the breasts with his left hand, the right to stand before his head; the left leg is stretched out in the right hip)

Percussion between the spleen

When the doctor sees it, it appears between the lower and upper boundaries of the organ, so that the diameter, which is 4-6 cm in the norm, is located between the 9 and 11 edges. Likewise, it is necessary to make sure that there is a rear and front fringe, so that the spleen (in the norm is 6-8 cm).

Selezinka razmiri: the norm for grown-ups ultrasound

In addition to the fact that most often pathologies of the spleen are manifested in children, then the smut given doslіdzhennya polyagaє at the designated size of the body. After an hour of the ultrasound scan, the size, width and length of the body will start. So, the norm of spleen size in an older person: 12 cm in size, 5 cm in height, 8 cm in width.

Krym razmіrіv, the sonologist makes the shape of the organ, as can also be seen in children. As insignificantly higher visas start only for one size, then, as a rule, options are available. However, if the size is 2 or 3, the splenomegaly is suspected.

In addition, the ultrasound scan shows the growth of the spleen of other organs and the origin of the tissue structure (that is, the appearance / visibility of the cysts, new products and so far) and the diameter of the spleen: spleen veins (5-8 mm) and

In some cases, the ultrasound results show the area of the oblique maximum visibility to the organ. The Danish indicator is more accurately depicting the steps of improvement / change to the organ. Visually, it's easy to reach the area: the smallest size of the spleen multiplies by the smallest. The area of the spleen (size of the norm in adults) becomes 15.5-23.5 cm.

If necessary, calculate the amount of money to the body.

interpretation of results

Vіdhilennya in rozmіrah (zbіlshennya dovzhini i width) Body vkazuє on splenomegaly, yak Je naslіdkom rіznomanіtnih іnfektsіy (sepsis, rotary, visipny, cherevny typhi, brutseloz, malyarіya) patologіyah krovі (purpura trombotsitopenіchna, leukemia, Hodgkin's lymphoma, anemії hemolytic) patologіyah pechіnki (cirrhosis, hepatoses), obscenities (amiloidosis, diabetes mellitus), circulatory disorders (thrombosis or splenic veins), pathologies of the spleen (trauma, swelling, burning, echinococosis).

In case of infectious pathologies, the spleen swells up to a pulp of consistency (often with sepsis). In cases of chronic infections, blood problems, portal hypertension, new infections and amiloids, the organ is impaired. With the appearance of echinococosis, cysts, gum syphilitic, infarction of the spleen, the surface of the organ becomes nervous.

Spleen sore throat with infarctions, inflamed abnormal thrombosis of the spleen vein.