1. Tohu o te reflux hepatojugular
Ina pupuhi te ate me te ngenge o te ngākau matau, ka taea te pēhi i te ate ki ngā ringaringa kia nui ake te pupuhi o ngā uaua o te huha. Ko ngā tino take ko te ngoikore o te ventricle matau me te mate hepatitis.
2. Te tohu a Cullen
E mōhiotia ana hoki ko te tohu a Coulomb, ko te ecchymosis papura-kikorangi i runga i te kiri huri noa i te umbilicus, i te pakitara o raro rānei o te puku, he tohu ia mō te toto nui i roto i te puku, he mea e kitea nuitia ana i roto i te toto retroperitoneal, te pancreatitis necrotizing hemorrhagic acute, te aneurysm aortic abdominal ruptured, me ētahi atu.
3. Tohu Grey-Turner
Ina pāngia te tūroro e te pancreatitis whakapeka, ka maringi te wai repeure ki roto i te kiko o raro o te hope me te taha, ka memeha te ngako o raro, ka pakaru, ka toto ngā uaua toto, ka hua ake he ecchymosis kikorangi-papura i runga i te kiri i ēnei wāhi, e kiia nei ko te tohu Grey-Turner.
4. Tohu Courvoisier
Ina pēhia te awaawa au e te mate pukupuku o te pane o te repe taiaki, ka āraihia rānei te awaawa au e te mate pukupuku o ngā wāhanga waenga me raro o te awaawa au, ka kitea te kiri māwhero. Ka taea te pā atu ki te puku au e pupuhi ana, he kikokore, kāore e ngawari, he maeneene te mata, ā, ka taea te neke, e kiia ana ko te tohu Courvoisier, e mōhiotia ana hoki ko te ārai haere o te awaawa au.
5. Tohu riri o te peritoneal
Ko te kitea o te ngawari, te ngawari hoki o te puku, me te pēhanga o te uaua puku i roto i te puku i te wā kotahi, e kiia ana ko te tohu riri peritoneal, e mōhiotia ana ko te peritonitis triad. He tohu noa iho tēnei o te peritonitis, inā koa te wāhi o te whara tuatahi. Ko te haere o te pēhanga o te uaua puku e whakawhirinaki ana ki te take me te āhua o te tūroro. He rerekē te āhua whānui, ā, ko te pikinga o te puku he tohu nui o te kino haere o te āhua.
6. Te tohu a Murphy
Ko te tohu Murphy pai tētahi o ngā tohu nui i roto i te tātaritanga haumanu o te cholecystitis whakapeka. I te pā atu ki te rohe o te pūkahukahu i raro i te tawhē o te ihu matau, ka pāngia te pūkahukahu pupuhi, ā, ka tonoa te tūroro kia manawa hōhonu. Ka neke te pūkahukahu pupuhi me te mumura ki raro. I rongo te tūroro i te kaha haere o te mamae, ā, ka pupuri ohorere i tōna manawa.
7. Te tohu a Mcburney
He mea noa te ngawari me te ngawari hoki ki te pito o McBurney i te puku o raro matau (te hononga o te pito me te hautoru o waenganui me waho o te tuaiwi iliac o mua matau) i roto i te apendicitis whakapeka.
8. Te tokotoru o Charcot
Ko te cholangitis purutive aukati whakapeka ka puta mai i te mamae o te puku, te makariri, te kirika nui, me te jaundice, e mōhiotia ana ko te Chaco's triad.
1) Mamae puku: Ka puta i raro i te tukanga xiphoid me te quadrant matau o runga, ko te nuinga he colic, me ngā whakaekenga paroxysmal, he mamae tonu rānei me te kaha haere o ngā paroxysms, ka horapa ki te pakihiwi matau me te tuara, me te whakapairuaki me te ruaki. He maha ngā wā ka puta i muri i te kai i ngā kai hinuhinu.
2) Te makariri me te kirika: Whai muri i te aukati i te awaawa o te ate, ka piki ake te pēhanga i roto i te awaawa o te ate, ka hua ake he mate tuarua. Ka taea e ngā huakita me ngā paitini te hoki ki roto i te toto mā roto i ngā awaawa o te ate me ngā sinusoid ate, ka hua ake he whēwhe ate ate, he sepsis, he ohorere septic, DIC, me ētahi atu, ka puta ko te kirika dilatant, me te pāmahana tinana tae atu ki te 39 ki te 40°C.
3) Te kiriuhi waikura: Whai muri i te aukatinga o te awaawa o te ate e ngā kōhatu, ka puta pea he mimi kōwhai pouri ki ngā tūroro me te tae kōwhai o te kiri me te sclera, ā, ka pāngia pea ētahi tūroro e te mākūkū o te kiri.
9. Ngā tohu rima a Reynolds (Renault)
Kāore te mauheretanga kōhatu e whakamamaetia, ka kino haere te mumura, ā, ka whanake te mate hinengaro me te ohorere i runga i te triad a Charcot, e kiia nei ko te pentalogy a Raynaud.
10. Te tohu a Kehr
Ka whakaoho te toto i roto i te kōhao puku i te diaphragm maui, ka mamae te pakihiwi maui, he mea noa tēnei i te pakaru o te whēkau.
11. Tohu obturator (obturator internus muscle test)
I takoto takoto te tūroro, me te hope me te huha matau e piko ana, kātahi ka hurihuri haere ki roto, ka mamae te puku matau o raro, e kitea ana i te appendicitis (e tata ana te appendicitis ki te uaua obturator internus).
12. Te tohu a Rovsing (whakamātautau pupuhi koroni)
Kei te takoto takoto te tūroro, ko tōna ringa matau e pēhi ana i te puku maui o raro, ko tōna ringa maui hoki e pēhi ana i te koroni proximal, ka mamae te puku matau o raro, e kitea ana i te apendicitis.
13. Tohu riri o te hihi-X o te barium
Ka whakaatuhia e te barium ngā tohu o te riri i roto i te wāhanga whekau mate, me te tere o te takoto kau me te kore e pai te whakakī, engari he pai te whakakī i roto i ngā wāhanga whekau o runga me raro. Ka kiia tēnei ko te tohu riri barium hihi-X, he mea noa i roto i ngā tūroro e pangia ana e te mate kohi whekau ulcerative.
14. Tohu āwhiowhio takirua/tohu ūnga
I te wāhanga kaha o te mate a Crohn, e whakaatu ana te CT enterography (CTE) kua whakapaitia kua tino matotoru te pakitara o te puku, kua tino kaha ake te kiriuhi o te puku, kua papatahi tetahi wāhanga o te pakitara o te puku, ā, kua tino kaha ake te mowhiti kiriuhi o roto me te mowhiti serosa o waho, e whakaatu ana i te tohu āwhata takirua, te tohu ūnga rānei.
15. Tohu heru rakau
I te wāhanga kaha o te mate a Crohn, ka whakaatuhia e te CT enterography (CTE) te pikinga o ngā oko toto mesenteric, ka piki ake te kiato me te pōuri o te ngako mesenteric, me te whakanui ake i te kōpū lymph mesenteric, e whakaatu ana i te "tohu heru rakau".
16. Te mate pāwera o te tinana
I muri i te toto nui i te ara kai o runga, ka mimitihia ngā hua nakunaku o ngā pūmua toto ki roto i ngā whekau, ā, ka piki ake pea te kukū o te hauota urea i roto i te toto mō tētahi wā poto, e kiia nei ko te enterogenic azotemia.
17. Te mate Mallory-Weiss
Ko te whakaaturanga haumanu matua o tēnei mate ko te pikinga ohorere o te pēhanga o roto i te puku nā te whakapairuaki nui, te ruaki me ētahi atu take, ka puta ai te haehae roa o te mucosa me te submucosa o te cardia cardiac distal me te esophagus, ā, ka puta ai te toto o te puku o runga. Ko ngā whakaaturanga matua ko te hematemesis ohorere, i mua i te ruaki, i te ruaki rānei, e kiia ana hoki ko te esophageal and cardia mucosal tear syndrome.
18. Te mate Zollinger-Ellison (gastrinoma, te mate Zollinger-66Ellison)
He momo pukupuku neuroendocrine gastroenteropancreatic e tohuhia ana e ngā mate pukupuku maha, ngā wāhi rerekē, te ngāwari ki ngā raruraru mate pukupuku, me te kore urupare pai ki ngā rongoā ārai-mate pukupuku auau. Tērā pea ka puta te korere, te nui o te waikawa o te puku, me te nui haere o ngā taumata gastrin i roto i te toto. Ka piki ake pea.
He iti noa iho ngā gastrinoma, ā, tata ki te 80% kei roto i te tapatoru "gastrinoma" (arā, te hononga o te pūkahukahu me te awa aukume noa, te tuarua me te tuatoru o te duodenum, me te kaki me te tinana o te pancreas). I roto i te tapatoru i hangaia e te hononga), neke atu i te 50% o ngā gastrinoma he kino, ā, kua horapa ētahi tūroro i te wā i kitea ai.
19. Te mate tukunga taonga
I muri i te tangohanga iti o te puku, nā te ngaronga o te mahi whakahaere o te pylorus, ka tere rawa te whakawātea o ngā ihirangi o te puku, ka hua ake he raupapa o ngā tohu haumanu e kiia nei ko te dumping syndrome, he mea e kitea whānuitia ana i roto i te PII anastomosis. E ai ki te wā e puta ai ngā tohu i muri i te kai, ka wehea kia rua ngā momo: te wā wawe me te wā mutunga.
●Te mate pūkahukahu wawe: Ka puta ngā tohu o te ngoikore o te toto i roto i te tinana mō te wā poto pēnei i te tere o te manawa, te werawera makariri, te ngenge, me te kiri mā i te hawhe haora i muri i te kai. Ka haere tahi me te whakapairuaki me te ruaki, te mamae o te puku, me te mate korere.
●Te mate o te kai tōmuri: ka puta i muri i te 2 ki te 4 hāora i te kai. Ko ngā tohu matua ko te whanoke, te kiri mā, te werawera makariri, te ngenge, me te tere o te pā o te manawa. Ko te tikanga, i muri i te urunga o te kai ki roto i te whekau, ka whakaohokia te nui o te insulin, ā, ka hua ake te hypoglycemia tauhohe. Ka kiia hoki ko te hypoglycemia syndrome.
20. Te mate pāwera mimiti
He mate haumanu tēnei e kore ai e whai kiko ngā matūkai nā te koretake o te mahi a te whekau iti ki te nakunaku me te mimiti i ngā matūkai, ā, kāore e taea te mimiti noa i ngā matūkai, te whakaputa atu rānei i roto i te paru. I roto i te haumanu, he maha ngā wā ka puta mai i te korere, te kikokore, te taumaha, te hinuhinu me ētahi atu tohu mimiti ngako, nō reira ka kiia hoki ko te steatorrhea.
21.Te mate PJ (te mate polyposis pigmented, PJS)
He mate pukupuku autosomal dominant onge tēnei e tohuhia ana e te tae o te kiri me te mucosal, he maha ngā polyp hamartomatous i roto i te ara kai, me te ngoikore ki te pukupuku.
Ka puta te PJS mai i te tamarikitanga. I te pakeketanga o ngā tūroro, ka piki haere, ka nui haere hoki ngā polyp o te puku, ka puta ai ngā raruraru maha, pērā i te intussusception, te aukati i te puku, te toto o te puku, te mate pukupuku, te kore kai pai, me te whakaroa i te whanaketanga o ngā tamariki.
22. Te mate puku o te puku
Ko te pēhanga o roto i te puku o te tangata noa he tata ki te pēhanga o te āhuarangi, 5 ki te 7 mmHg.
Ko te pēhanga o roto i te puku ≥12 mmHg he toto toto tiketike o roto i te puku, ā, ko te pēhanga o roto i te puku ≥20 mmHg me te ngoikore o ngā okana e pā ana ki te toto toto tiketike o roto i te puku he abdominal compartment syndrome (ACS).
Ngā Āhuatanga Hauora: Ka pāngia te tūroro e te kikī o te uma, te poto o te manawa, te uaua ki te manawa, me te tere o te tere o te ngakau. Tērā pea ka haere tahi te puku pupuhi me te taumaha nui me te mamae o te puku, te ngoikore, te ngaro rānei o ngā oro puku, me ētahi atu. Ka puta pea te Hypercapnia (PaCO?>50 mmHg) me te oliguria (te putanga mimi ia hāora <0.5 mL/kg) i te wā tōmua o te ACS. Ka puta te anuria, te azotemia, te ngoikore o te manawa me te iti o te putanga ngakau i te wā o muri mai.
23. Te mate o te uaua mesenteric superior
E mōhiotia ana hoki ko te benign duodenal stasis me te duodenal stasis, he raupapa tohu e puta mai ana i te tūranga rerekē o te uaua mesenteric o runga e pēhi ana i te wāhanga whakapae o te duodenum, ka hua ake he aukati wāhanga, he aukati katoa rānei o te duodenum.
He nui ake te kitea i roto i ngā wāhine pakeke e mate pōuri ana. He mea noa te hīkī, te whakapairuaki, me te ruaki. Ko te āhuatanga nui o tēnei mate ko te hononga o ngā tohu ki te tūnga o te tinana. Ina whakamahia te tūnga takoto, ka kino ake ngā tohu pēhi, engari ina whakamahia te tūnga takoto, te tūnga turi-uma, te tūnga taha maui rānei, ka taea te whakamama i ngā tohu.
24. Te mate pōro matapo
He mate puku korere, he mate toto koretake, he ngoikore te mimiti me te ngaronga taumaha i puta mai i te noho pūmau o ngā ihirangi o te whekau iti me te tipu nui o te huakita i roto i te lumen whekau. Ka kitea nuitia i roto i te hanganga o ngā koropiko matapo, ngā putea matapo rānei (arā, ngā koropiko whekau) i muri i te tango i te puku me te anastomosis gastrointestinal. Ā, i puta mai i te noho pūmau.
25. Te mate puku poto
Ko te tikanga, i muri i te tango nui, te tango rānei i te whekau iti nā ngā take maha, ka tino heke te wāhi mimiti whai hua o te whekau, ā, kāore e taea e te whekau mahi e toe ana te pupuri i te kai a te tūroro, i ngā hiahia tipu rānei o te tamaiti, me ngā tohu pēnei i te korere, ngā mate waikawa-pūtake/wai/irahiko, me ngā mate e whakahaerehia ana e ngā mate mimiti me te pākia o ngā momo matūkai.
26. Te mate Hepatorenal
Ko ngā āhuatanga haumanu matua ko te oliguria, te anuria me te azotemia.
Kāore he whara nui i roto i ngā whatukuhu o te tūroro. Nā te toto toto tiketike o te tomokanga me te tohanga toto splanchnic hyperdynamic, i tino heke te rere o te toto pūnaha, ā, he maha ngā matū whakawhanui toto pēnei i te prostaglandins, te hauota hauota, te glucagon, te peptide natriuretic atrial, te endotoxin, me ngā peptide e pā ana ki te ira konupūmā kāore e taea te whakakore e te ate, ka whānui ake te moenga toto pūnaha; ka nui te wai peritoneal ka piki ake te pēhanga o roto i te puku, ka taea te whakaiti i te rere o te toto whatukuhu, inā koa te hypoperfusion cortex whatukuhu, ka arahi ki te ngoikore o te whatukuhu.
E 80% o ngā tūroro e tere haere ana te mate ka mate i roto i te rua wiki pea. Ko te momo e tere haere ana te mate he mea noa ake i te taha haumanu, he maha ngā wā ka puta mai me te rerenga toto puku uaua me te puhoi o te ngoikore o te whatukuhu.
27. Te mate ate pūkahukahu
I runga i te mate ate cirrhosis, i muri i te tango i ngā mate manawa tuatahi, ka puta te poto o te manawa me ngā tohu o te hypoxia pērā i te cyanosis me te karapu o ngā maihao (ngā matimati), e pā ana ki te whakanui i te toto o roto o te pūkahukahu me te koretake o te whakarato hāora ki te toto, ā, he kino te matapae.
28. Te mate Mirizzi
Te pakaru o te kōhatu i te kaki o te pūkahukahu, i te awa rānei o te pūkahukahu, te mumura rānei o te pūkahukahu, te pēhanga rānei
Ka puta tēnei mā te pēhi, te pā rānei ki te awa ate noa, ka puta te tipu o ngā kiko huri noa, te mumura, te whakatōtō rānei o te awa ate noa, ā, ka puta mai i te taha haumanu hei raupapa o ngā mate haumanu e tohuhia ana e te jaundice aukati, te kōroke biliary, te cholangitis rānei.
Ko te pūtake o te hanganga tinana mō tōna hanganga he roa rawa te awa cystic me te awa ate noa i te taha kotahi, he iti rawa rānei te tūranga e tū ai te awa cystic me te awa ate noa.
29. Te mate Budd-Chiari
Ko te mate Budd-Chiari, e mōhiotia ana ko te mate Budd-Chiari, e pā ana ki tētahi rōpū mate toto tiketike portal, te toto tiketike portal me te toto tiketike vena cava raro i puta mai i te aukati o te uaua ate, te vena cava raro rānei i runga ake i tōna whakatuwheratanga.
30. Te mate o Caroli
Te whānuitanga o ngā awaawa aukume i roto i te ate. Kāore i te mārama te tikanga. He rite pea ki te awaawa choledochal. He nui ake te maha o ngā mate cholangiocarcinoma i tērā o te taupori whānui. Ko ngā tohu haumanu tuatahi ko te hepatomegaly me te mamae o te puku, he rite ki te biliary colic, he uaua ake nā te mate awaawa aukume huakita. Ka puta te kirika me te jaundice i te wā o te mumura, ā, he ngawari te nui o te jaundice.
31. Te mate pukupuku o te puku
He mate tūtae tēnei e puta mai ana i te aukati i te putanga o te papa pelvic nā te kōpeketanga, te nui haere rānei o ngā uaua puborectalis.
32. Te mate o te papa pelvic
E pā ana tēnei ki tētahi rōpū mate e puta mai ana i ngā hapa io-uaua i roto i ngā hanganga o te papa pelvic tae atu ki te rectum, te uaua levator ani, me te sphincter anal o waho. Ko ngā tohu haumanu matua ko te uaua ki te tūtae, te kore e taea te pupuri i te mimi, me te pēhanga me te mamae o te papa pelvic. I ētahi wā ko ēnei ngoikoretanga ko te uaua ki te tūtae, me te kore e taea te pupuri i te mimi i ētahi wā. I ngā wā kino, he tino mamae.
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Wā tuku: Hepetema-06-2024