Binciken ciki

**Binciken ciki,**wani yanki ne na gwajin jiki wanda likita ko ma'aikacin jinya ke amfani da shi don lura da cikin mara lafiya a asibiti don alamun cututtuka. Jarabawar ciki ta al'ada ta kasu kashi huɗu daban-daban: na farko, **duba** majiyyaci da abubuwan da ake iya gani na cikin su. **Auscultation (sauraron)** na ciki tare da stethoscope . **Palpation** na majiyyaci cikin ciki. A ƙarshe, **bugun** (tapping) na cikin majiyyaci da gabobin ciki.  Dangane da buƙatar gwaji don takamaiman cututtuka irin su ascites, ana iya yin **gwaje-gwaje na musamman** a matsayin wani ɓangare na gwajin jiki.  Ana iya yin gwajin ciki saboda likitan yana zargin cutar gabobin da ke cikin kogon ciki (ciki har da hanta, saifa, hanji babba ko karami), ko kuma a matsayin wani bangare na cikakken binciken jiki don wasu yanayi.A cikin cikakken gwajin jiki, gwajin ciki yana bin gwajin numfashi da gwajin jini na zuciya. 

## Matsayi da muhalli

Matsayin da aka ba da shawara shine ga masu haƙuri su kasance a kwance (a bayansu), tare da hannayensu zuwa ɓangarorinsu. Ya kamata a sanya majiyyaci a cikin yanayi mai haske mai kyau, kuma ya kamata a lullube shi da tawul ko zanen gado don kiyaye sirri da dumi. Ya kamata a lanƙwasa hips da gwiwoyi na majiyyaci (a cikin lanƙwasa) don tsokoki na ciki su kasance cikin annashuwa yayin binciken. Neman majiyyaci don nuna wuraren da zai iya zama mai laushi ko mai raɗaɗi an ba da shawarar don kauce wa tsanantawa zafi yayin dubawa kuma don ƙara jin daɗin haƙuri. 

Ko da yake likitoci sun damu da cewa ba wa marasa lafiya maganin jin zafi a lokacin ciwo mai tsanani na ciki na iya hana ganewar asali da magani, ra'ayi na yau da kullum ta hanyar Cochrane Collaboration  da kuma Rational Clinical Examination  karyata wannan.

## Dubawa
Likitan zai duba motsin ciki yana dubawa musamman don raƙuman ruwa ko sassauƙan yanayi.

## Auscultation
Auscultation yana nufin amfani da stethoscope ta mai dubawa don sauraron sauti daga ciki. 

Ba kamar sauran gwaje-gwajen jiki ba, ana yin auscultation kafin a yi bugun ko bugun zuciya, saboda waɗannan biyun na iya canza yanayin sautin hanji akai-akai. 

Akwai wasu rigima dangane da tsawon lokacin da ake buƙata don tabbatarwa ko keɓe sautunan hanji, tare da tsawan lokaci har zuwa mintuna bakwai. Ƙunƙarar hanji na iya kasancewa tare da sautin hanji mai guna-guni ko ƙarar hayaniya. Masu lafiya ba za su iya samun sautin hanji na mintuna da yawa  kuma ciwon hanji na iya yin shiru.  Za a iya haifar da sautin hanji mai yawan motsa jiki ta wani bangare ko cikakkiyar toshewar hanji yayin da hanjin da farko ke kokarin share toshewar. Rashin sautuna na iya haifar da peritonitis, ciwon gurguwar ƙwayar cuta, toshewar hanji a ƙarshen mataki, ischemia na hanji ko wasu dalilai.  Wasu mawallafa sun ba da shawarar cewa sauraron a wuri ɗaya ya isa kamar yadda za a iya yada sauti a cikin ciki. 

Wani bincike mai yiwuwa da aka buga a cikin 2014 inda likitocin 41 suka saurari sautin hanji na masu aikin sa kai na 177 (19 daga cikinsu suna da shingen hanji da 15 tare da ciwon ciki) sun gano cewa "Auscultation na sautin hanji ba aikin asibiti bane mai amfani lokacin da aka bambanta marasa lafiya tare da al'ada tare da pathologic. Sauti na hanji.  Wannan labarin yana ba da shawarar mayar da hankali ga wasu alamomi (tushe, zafi, tashin zuciya) maimakon. Babu wata shaidar bincike da ke tabbatar da alaƙar da aka ɗauka tsakanin sautin hanji da yanayin motsi na hanji. 

Har ila yau, mai jarrabawar yana sauraren jijiyoyi biyu na na koda don rashin sautin kwararar jini na rashin daidaituwa ta hanyar sauraren kowane yanki na sama, kusa da kuma sama da cibiya . Ƙunƙarar da aka ji a cikin epigastrium waɗanda aka keɓe ga systole ana ɗaukar al'ada. 

## Palpation

Ya kamata mai jarrabawar ya fara magana da majiyyaci kuma ya bayyana abin da wannan ɓangaren gwajin zai ƙunsa. Shi ko ita za su rika tausasa duk wuraren tara na cikin mara lafiyan, da kuma lura da wuraren rashin jin daɗi, za su fara da tausasawa wuraren da babu ciwo. Ana yin wannan yawanci sau biyu, na farko tare da matsi mai haske sannan tare da matsi mai zurfi don gwada gabobin ciki.

A kan ƙwanƙwasa haske, mai jarrabawar yana gwada kowane taro mai ɗaci, tauri, ko zafi a saman.

A kan zurfin jin daɗi, mai jarrabawar yana gwada kowane organomegaly (ƙaramar gabobin.) Yawanci, likitancin yana neman haɓaka hanta da saifa ko kuma maras kyau a cikin hanji. Wani lokaci likita yakan nemi koda da mahaifa shima.

Abubuwan da za su iya nuna pathology sun haɗa da:

* Karewa: raunin tsoka yayin da ake matsa lamba.
* Rigidity: yana nuna kumburin peritoneal.
* Komawa: zafi akan saki.
* Ciwon da ake magana: ciwon da aka samu daga wurin da ake murƙushewa.

## Wasa
Ana iya yin bugun a cikin duka huɗun huɗun na ciki kuma yana iya bayyana martani mai raɗaɗi daga majiyyaci. A lokacin binciken ciki, bugun jini na iya ba da damar kimanta wurin da adadin iskar gas, mai wuya ko taushi, da kuma girman wasu gabobin, kamar hanta da safiya. Abubuwan da ba a saba gani ba na iya haɗawa da splenomegaly, hepatomegaly da riƙewar fitsari .

Organomegaly na hanta da kuma maƙarƙashiya za a iya godiya ta hanyar yin amfani da su a cikin wani nau'i na musamman:

* Hepatomegaly ta hanyar bugun daga yankin iliac na dama zuwa hypochondrium na dama
* Splenomegaly ta hanyar bugun daga yankin iliac na dama zuwa hypochondrium na dama da iliac na hagu zuwa hypochondrium na hagu.

Gwajin ƙwayar cuta na iya bayyana alamar Castell ko kuma a madadin Traube's sarari .

Sautunan da ba su da kyau a cikin ciki na iya ba da shawarar daukar ciki, ciwon daji na ovarian, mafitsara maras kyau, hepatomegaly ko splenomegaly. Lalacewa a kowane gefen ciki na iya ba da shawarar ascites . Wasu wurare na cikin ciki na iya yin sautin dusar ƙanƙara da ke nuna cewa za a iya samun wani ruwa ko najasa . Za a iya godiya da dullness na hanta ta hanyar bugawa a gefen ƙananan ƙirjin dama sama da iyakar farashi . Ana iya jin daɗin sautin sautin kumfa na iska na ciki a gefen hagu. A lokuta da ba kasafai ba, lokacin da aka jujjuya gabobin jiki kamar yadda lamarin yake a yanayin da ake ciki, za a sa ran sautuna masu raɗaɗi a gefen dama da dushewar hanta a hagu. 

## Sauran gwaje-gwaje da motsa jiki na musamman

* Binciken nodes na pelvic pelvic
* Gwajin duburar dijital kawai idan an nuna asibiti.
* Gwajin mahaifa kawai idan an nuna asibiti.

Hakanan ana iya yin motsi na musamman, don nuna alamun takamaiman cututtuka.   Waɗannan sun haɗa da

* Gallbladder mai kumburi: Alamar Murphy
** Yayin da ake jin zafi a ƙasan gefen ƙashin haƙarƙarin dama, majiyyaci yana jin zafi akan wahayi.
* Appendicitis ko peritonitis :
** Alamar Psoas - jin zafi tare da tsawo na hip da kuma tayar da tsoka na psoas
** Alamar obturator - zafi lokacin da ake tayar da tsokar obturator 
** Alamar Rovsing - ciwo a cikin ƙananan ƙananan ciki na dama a kan palpation na gefen hagu na ciki
** Alamar McBurney - zurfin tausayi a wurin McBurney
** Alamar Carnett – zafi lokacin dagula tsokoki na bangon ciki
** Alamar Patafio - jin zafi lokacin da aka nemi mara lafiya yayi tari yayin da yake tayar da tsokar psoas
** Gwajin tari - zafi lokacin da aka nemi mara lafiya ya tari
** Valsalva maneuver - zafi lokacin da majiyyaci yayi ƙoƙarin fitar da ƙarfi yayin da suke rufe bakinsu da tsutsa hanci
* Pyelonephritis da ake zargi: alamar naushi na Murphy
* Hepatomegaly: gwajin hanta
* Alamar Rosenbach - rashin reflex na ciki a gefe ɗaya na ciki a cikin hemiplegia na cerebral
* Alamar Courvoisier - gallbladder mai ɗorewa a cikin marasa lafiya jaundiced saboda malignancy ko toshewa.
* Alamar Boas - Ƙarar ƙwayar cuta zuwa hagu na 12th thoracic vertebrae a cikin cholelithiasis.
* Krymov alama
* Berthomier-Michelson ta alamar
* alamar Blumberg
* Alamar Haruna
* Kocher-Volkovich alama
* Alamar ƙaho goma
* Alamar Baldwin
* Rosenstein alama
* Alamar Fothergill
* Ascites : ƙwanƙwasa ƙwanƙwasa, gwajin motsi na ruwa, rashin jin daɗi

## Hanyoyin haɗi na waje

* Gwajin ciki  - jagora mai amfani ga likitancin asibiti daga Jami'ar California, San Diego .

## Manazarta