消化系统诊断学部分的PPT整理：使用说明：1、略去了PPT中的图片，但是文字部分全部保留。
顺序同PPT。
2、橙色与红色标注的文字基本与PPT上一致，具体到个别字句会有出入。
3、中文系本人参照大绿书手工翻译，个别地方在内容上稍作了补充，仅供参考。
Abdominal Examination:1.Sequence：inspection, auscultation, percussion, and palpation望、听、叩、触原因：（1）convenient to perform the auscultation after the auscultation of the heart.便于在心脏听诊后进行腹部听诊（2）avoid the negative impacts of palpations on auscultation of bowel sounds （←alteration of peristalsis）避免触诊对听肠鸣音的影响（改变了肠蠕动）2、Anatomic Landmarks：解剖标志（1）xiphoid (ensiform) process(剑状突起) of sternum(胸骨)（2）costal margin肋弓缘（3）umbilicus脐（4）anterior superior iliac spine髂前上棘（5）inguinal ligament 腹股沟韧带（6）superior margin of os pubis耻骨上缘（7）anterior midline/midabdominal line 腹中线（8）lateral border of rectus muscles 腹直肌外缘（9）symphysis pubis (耻骨联合)3、Zones of abdomen：4 quadrants , 9 sectionsThe anterior surface of the abdomen is divided into four quadrants by two intersecting lines前腹面经两条相交线分为四个区(1) one extending vertically from the xiphoid, through the umbilicus, to the symphysis pubis一条由剑突垂直向下经过脐，到达耻骨联合(2) the other extending horizontally across the abdomen at the level of the umbilicus.另一条在脐处水平横贯腹部所以分为了4个区：Right upper quadrant 右上腹部Left upper quadrant 左上腹部Right lower quadrant 右下腹部Left lower quadrant 左下腹部Two imaginary, parallel, horizontal lines 两条互相平行的假想水平线（1）across the lowest border of the costal margin 经过两侧肋弓下缘的连线（2）across the anterior superior iliac spine 经过两侧髂前上棘的连线Two imaginary, parallel, vertical lines 两条互相平行的假想垂直线（1）across the middle point of linking line formed by left anterior superior iliac andmidabdominal line 经过左髂前上棘至腹中线连线的中点（2）across the middle point of linking line formed by right anterior superior iliac and midabdominal line 经过右髂前上棘至腹中线连线的中点所以分为了9 sections：Right hypochondrial region右季肋部Left hypochondrial region 左季肋部Right lumber region 右腰部Left lumber region 左腰部Right iliac region 右髂部Left iliac region 左髂部Epigastric region 上腹部Umbilical region 脐部Hypogastric region下腹部4. Question : What are the distinct benefits and disadvantages in Four-quadrant and Nine-section methods? 四区法和九区法的明显优缺点？Four-quadrant :(1) simple, practical 简单实用(2) rough, imprecise 粗糙不精确(tenderness of epigastric region) （上腹部压痛）Nine-section(1) elaborates more clearly and more exactly 更清晰精确(2) inconvenient 不方便(3) limited scope of left or right hypochondrial region, left or right iliac region左、右季肋部，左、右髂部范围局限5. Inspection: General preparation 望诊的一般准备（1）urinate completely: bladder is empty 膀胱排空（2）relax abdominal muscles: lie on back with a pillow under head and knees bent 放松腹部肌肉：低枕仰卧位，双腿屈曲（3）expose abdomen completely: from xiphoid process to pubis 充分暴露腹部：上至剑突，下至耻骨联合（4）breasts should be covered: female 遮盖乳房：女性6. Inspection: major contents望诊的主要内容abdominal contour 腹部外形respiratory movements 呼吸运动abdominal veins 腹壁静脉gastral or intestinal pattern(胃型或肠型)peristalsis(蠕动波)abdominal rash（皮疹）, hernia(疝), striae(纹), etc.7. Inspection: Abdominal Contour 视诊whether the abdomen is symmetrical 腹部是否对称whether it is bulged or retracted 是否膨隆或凹陷whether it is indicative of ascites or enclosed mass(包块) 是否提示有腹水或包块Normal :(1) abdominal flatness(腹部平坦) :√ abdomen at the same level or lower as between costal margin and symp hysis pubis前腹面处于肋弓缘与耻骨联合平面，或略微凹陷√ ask the patient to sit, the lower part of umbilicus can become more or less protruded or bulged要求病人坐位，脐以下部位可稍膨出(2) abdominal fullness(腹部饱满) :√ very fat or a child, the abdomen is a little bit round 肥胖者或小儿（尤其餐后）腹部外形饱满或膨隆√The level of the abdomen higher than that of the surface between costal margin and symphysis pubis 前腹面超过肋弓缘至耻骨联合平面(3) abdominal lowness(腹部低平):√ very thin or slender, the level of the abdomen lower than that of the surface between costal margin and symphysis pubis (← little subcutaneous fat)消瘦者前腹面低于肋弓缘至耻骨联合平面（由皮下脂肪少导致）abdominal flatness, fullness, and lowness (normal cases)√ abdomen obviously protruded or bulged, or exceedingly retracted or depressed(abnormal and usually pathologic) 腹部明显膨隆或过分凹陷（异常，通常为病理）8. Pathologic conditions 病理情况: abdominal protuberance (bulge) 腹部膨隆I. Overall/generalized abdominal protuberance/bulge 全腹膨隆√ ← several pathologic factors besides overly obesity or physiologic pregnancy除了肥胖、妊娠等生理状况外，还有多种病理因素i. Peritoneal fluid 腹腔积液a large amount of free fluid within the abdomen (ascites 腹水) → abdominal wall can be lax in supine position仰卧位时腹壁松弛→ fluid can deposit at both lateral sides (the contour just like a frog belly) 液体下沉于腹腔两侧（外形如蛙腹）√ lies on one side or sits 侧卧或坐位→ the lower part of abdominal wall will be bulged ( ← movement of free fluid) 腹下部膨出（由腹腔积液移动引起）√ commonly found in ascites complicated by portal hypertension (liver cirrhosis) 见于肝硬化门脉高压症→in long-term ascites, the appearance of the umbilicus is protruded or everted (umbilical hernia) 在长期腹水中，脐外形凸出或外翻（脐疝）√ (obesity) the umbilicus is usually deeply inverted（肥胖）脐通常下凹Apical belly尖腹← peritonitis腹膜炎or invasion of cancer cells癌细胞侵袭(abdominal muscle: tense, usu. with the apical shape) （腹肌：紧张，通常呈尖凸形）Peritoneal air 腹内积气√ ← a large amount of air accumulating in the cavity of stomach. 胃腔内大量积气√ globular shape ( two sides of lumber region is not obviously protrudent.) 球形，两侧腰部膨出不明显√ ask the patient to move or change the position → the shape of abdomen remains globular要求病人移动或改变体位，腹部仍然呈球形√ commonly found in intestinal obstruction肠梗阻or enteroparalysis(肠麻痹)Pneumoperitoneum气腹√ ← air accumulating in the abdominal cavity 腹腔内大量积气√ commonly found in perforation of gastrointestinal diseases or artificial pneumoperitoneum meant to treat 常见于胃肠穿孔，或者治疗性人工气腹Huge abdominal enclosed mass 腹内巨大包块usually found in full-term pregnancy足月妊娠, huge ovarian cyst(卵巢囊肿), teratoma畸胎瘤, etc.For any generalized abdominal bulge, circumference of abdomen should be measured in centimeters at the level of the umbilicus with a soft tape measure during normal abdominal breathing.对于所有的全副膨隆情况，应该以厘米为单位，测量腹围。