การตรวจร่างกายระบบทางเดินอาหาร

FIST TEST ff PERCUSSION TENDERNESS
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FIST TEST ff PERCUSSION TENDERNESS

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fiH*D `"'

ก fi` : HIffi)(ff
CG'ก"\ (tenderness) : localized ff generalized
กก\!กfiffl& fffflffl&*$กก" (guarding) +nกC"!n I"fl (voluntary) ff&fl (involuntary) :
fi#fi voluntary guarding &&' &` B
 involuntary guarding
"&'ก ก! parietal peritoneum

ก
!\ก\!กfiffl& fffflffl$fi"fi (rigidity)
$fflnก\&&ก"

fifflfiI"\ (rebound tenderness) : &'กก! parietal peritoneum CG  & `I"&` ก\&ก
ก fi` E ก"ffl&'H ffกfflflffi ffl'$  E "ffl ก fi` : HIffi)(ff

ก fi`
C& fi`กfffflffl"ffl!fi
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flffifflCa' fi`finกE I"flffiffl&ff hooking technique

ก fi`

ก fi`

ก fi`

!ffl&$fiกก fi` 1. !" (size) : liver span ffกIffl"ก Rt costal margin +C& 2. #C (surface) : ' (smooth) !D!H (nodular) 3. ! (edge) :  (thin), & (blunt) ff & (sharp) 4. &
 (consistency) : D& (soft)
 (firm)
!\ (hard) ff
!\&ก (stony hard) 5.กก"\ (tenderness) : point of tenderness

fiกFGH!fl กC  fi`"ffl  !"H&G 1-2 +C& กflfflffiI ! #C', !, D&
fiHก"& \

ก fi`&ffl&
flffiffl&+ffl""fflfffi!#$ffl% &!flfffflC   "ffljกกffiI +ffl
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ก fi`&ffl&

ก MURPHY ’S sign
fl&'*D `"'กj'(fi I"flffiffl&+ffl!ffiI ! flffiffl C ff
&&ก"CG*D `"' &#$ffl%fffl!ffl
fiffl&'ก\'ก Murphy ’s sign ก
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fiffl

ก MURPHY ’S sign

ก fi`
flffiffl& ( Bimanual ) I"&+ffl"ก"fflfffi CG &!ก"ก"fflffffl&
 flfffflfiC $fi!!กfiffl&  rectus abdominis fi\กffl
flffffl#$ffl%fffl!fflกfinก E flffffl& !ffl!fflffiC" ก H$fflnก fi!ffl&$fl& !ffl I"j(H&+ffl+n fi`ก"fflfffi H$fflnก$ flกfiffl&กก&!

ก fi`กfflflffl
ffl
fifflก : location, size, shape, surface, edge, consistency, tenderness, pulsation, mobility ( fix or move with respiration )

กI"Ca' Ballottement
flffifflfiC '
ffiC"กC &ffก"\ E (  (dipping ff ballottement) ( กfflffH'I#C"กC fl'&' `&กfl ffl `flffffl fi`&"ffl
ก#fiกflffffl `flffiffl
กก `flffffl &* fi`กfflffH  E "ffl!n 

ก Acute appendicitis
Localized tender at Mc Burney ’ spoint
Rovsing ’s sign: \fffflffl"ffl!fi !GH'ก"ffl"ffl+fflfi
fiHfi& I"\ (referred rebound tenderness)
Psoas test
fiH Obturator test

กffก
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C&I"ก"$
fifflnflffกI"flffiffl& !+nfl*D& flffifflC ffi' +n€fiC"!ffl ffก(`ก

&#C"กC'fflff กก"$ fiกFGH#Cff$กffl ffi ก กก !#Cff
fiH skin tag C"'" (external hemorrhoid) *D ` (cyst)
fiHqx $"! sinus, fistula
fiH fissure Prolapse ! rectum (&flffffl#$ffl%
DH)

กก fi` tone ! anal sphincter &fi$กff&ก : กC, BPH, &H\ff&fi$กff&กก กก fi`ff!" &
 fiกFGH#C
fiHกก"\ ก&"fi$ก กD" ก\กDffifflกffi fflCกff\ กqx กffl : polyp, CA rectum (

fiH!D!H) ff rectal shelf ( ff Blummer’s shelf fi`"ffl"fflffffl! rectum )