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To select the optimal minithoracotomy approach, axial computerograms were studied in 45 male patients of the second period of adulthood, without pathology of the chest organs, with different body types (TTB): 15 people each with dolichomorphic, mesomorphic and brachymorphic. To determine the TTC using the “E-film” program, the chest width index was measured on the axial tomogram, which was calculated as the ratio of the transverse dimension to the anteroposterior dimension, multiplied by 100, and the epigastric angle was determined in the frontal plane. After establishing the TTS, the number of the thoracic vertebra and the intercostal space corresponding to it along the paravertebral line were determined on each section. Next, we studied the correspondence of the thoracic vertebral bodies and intercostal spaces along the remaining six conventional lines of the chest.

Human ecology. Part 2. Methods for assessing physical health...

The guidelines provide guidance for performing laboratory work on human ecology. Intended for students of the Faculty of Biology studying in the specialty 013100 Ecology. 511100 Ecology and environmental management (discipline “Human Ecology”, block of educational activities), full-time study.

The hypersthenic type is characterized by a relative predominance of transverse dimensions over longitudinal ones, the chest is short and wide, the epigastric angle is obtuse, the pelvis is wide, the muscular system is well developed.

Preview: Human ecology. Part 2. Methods for assessing physical health Guidelines.pdf (0.4 Mb)

Body type as a possible marker of diseases and characteristics of the organization of motor activity of students [Electronic resource] / Meshcheryakov, Levushkin // Sports medicine: science and practice. - 2015 .- No. 1 .- P. 61-67 .- doi: 10.17238/ISSN2223- 2524.2015.1.61 .- Access mode: https://site/efd/372943

Purpose of the study: To identify the relationship between the body type of male students of a special medical group with their existing diseases and the body’s susceptibility to physical activity of various types. Materials and methods: 644 students were examined - young men of a special medical group aged from 17 to 20 years, divided into 4 groups according to body types (asthenoid, thoracic, muscular and digestive). Methods were used to analyze heart rate variability, determine physical performance (bicycle ergometry, functional test PWC150, method for determining the intensity of pulse debt accumulation), and tests to determine physical fitness. The diagnosis was made during a medical examination and review of medical records. Results: Among the examined students, a connection was revealed between the existing “underlying disease” and body type, effective motor modes were identified aimed at optimizing the physical condition for students of different somatotypes. Conclusions: Representatives of different body types are characterized not only by the characteristics of the shape and size of the body, its component composition, but also by the specific activity of the neuroendocrine system, predisposition to various diseases, and the body’s susceptibility to physical stress of various types. The identified features can serve as the basis for building a system of physical education for young people, which would take into account the relationship of somatotype with motor preferences, the structure of motor skills and the presence of deviations in their health.

The chest is flattened from front to back, elongated, often narrowed downwards. The epigastric angle is acute. The back is often stooped with sharply protruding shoulder blades. The abdomen is sunken or straight.

The purpose of this study was to identify the morpho-functional characteristics of young sambo wrestlers living in the northern and southern regions of the Altai Mountains. Materials and methods. We studied 65 male people, regularly involved in the sport of sambo, aged 17 to 20 years, representatives of the indigenous population of the Altai Mountains - the Altaians. All studies were carried out on the basis of the Republican Medical and Physical Education Dispensary in the first half of the day; at the time of the study, the athletes were in the preparatory period of the training cycle. The research program included: 1) analysis of the medical records of the subjects; 2) anthropometric measurements (body length, body weight, chest girth), carried out according to the standard anthropometric program [Bunak V.V., 1941]. Based on the measured somatic signs, the Quetelet weight-height index was calculated; 3) somatotyping was assessed according to the classification of body types by M.V. Chernorutsky. Determination of the constitutional type was carried out based on measurements of length, body weight and chest circumference and calculation of the Pigne index; 4) to determine the functional capacity of the muscular system, the strength of the muscles of the hand and back (back strength) was assessed using hand and back dynamometry; 5) the functional capabilities of external respiration were assessed by vital capacity (VC) using a dry portable spirometer; 6) the obtained experimental data were analyzed using the STATISTIKA 6.0 package. Results and discussion. Athletes from the low-mountainous northern regions of the Altai Mountains are distinguished by greater body length and weight, and higher values of chest circumference, compared to athletes from the high-mountainous southern Altai Mountains. Among the former, there are more people with a hypersthenic body type; they have higher levels of muscle strength (hand strength and backbone strength) and better indicators of external respiration function compared to sambo wrestlers from the south of the Altai Mountains. There are three main reasons that cause differences in morphofunctional indicators among sambo athletes in the North and South of the republic: extreme natural and climatic conditions, environmental pollution and socio-economic instability of society. To more fully answer the questions posed, further research is needed on the morphofunctional indicators of Altai youth, both involved and not involved in sports, as well as a more detailed description of the social and living conditions of the youth of Gorny Altai, taking into account environmental factors. Conclusions. 1) Athletes from the north of Gorny Altai have significantly higher anthropometric indicators (DT, MT, OGK) compared to athletes from the south of Gorny Altai. 2) Normosthenic body type is more often represented among sambo wrestlers in the south compared to athletes in the north of the Altai Mountains. There are more people with a hypersthenic body type among sambo wrestlers in the north of the Altai Mountains, and the asthenic type is more common among representatives of the southern regions of the Altai Mountains. 3) Sambo athletes from the north of the Altai Mountains have better indicators of external respiration (VC, VEL), the muscular system of the body (hand strength and deadlift strength) compared to sambo athletes from the south of the Altai Mountains.

Contents and methods for assessing physical development: ...

The methodological recommendations are written in accordance with the state program and are devoted to the section of sports medicine - medical supervision. They present methods for examining athletes and athletes: somatoscopy and physical development. This section of a doctor’s practical activity allows one to indirectly assess the body’s reserve capabilities. The presented work promptly compensates for the shortage of textbooks and other educational literature in the libraries of medical universities. The methodological recommendations are intended for students of medical, pediatric and medical-prophylactic faculties, interns, residents and outpatient doctors.

Proportional relationships of longitudinal and transverse dimensions: the shoulders are quite wide, the chest is cylindrical in shape and sufficiently developed, the epigastric angle is straight, the fatness is moderate, the muscles are well developed and prominent.

Preview: Contents and methods for assessing physical development Methodological recommendations for students of the medical, pediatric and medical-preventive faculties of the Medical Academy.pdf (0.9 Mb)

The role of mitophagy—selective removal of mitochondria by autophagy—was studied 48 hours after subarachnoid hemorrhage (SAH) in rats. We specifically assessed the ability of mitophagy, through voltage-gated anion channels (PGAs) interacting with microtubule-associated protein 1 light chain 3 (LC3), to drive the induction of apoptotic and necrotic cell death in neurons. PZAK1siRNA and activator of rapamycin (RM) were used. 112 male Sprague-Dawley rats were divided into 4 groups: sham-operated, SAH, SAH+PZAK1siRNA and SAH+RM. Parameters measured included mortality rate, severity of cerebral edema, blood-brain barrier disruption, and behavioral tests.

"Terminologia Anatomica", containing 7428 terms, as well as textbooks and atlases do not consider in detail the anatomy of the palmar surface of the hand, despite the growing interest in biometric documents and access control systems around the world. On the distal phalanges of the fingers, arcs, loops, curls are described, and the ridge count, which has individual and age-related characteristics, is measured. In addition to the elements mentioned above, papillary lines have a number of morphological features: branches, hooks, bridges, eyes, bends, endings, fragments and points, notches and protrusions, pores. A number of fairly noticeable formations are revealed on the palm. Deltas (triradii) - 4 finger and 3 axial. The folds of the palm include: metacarpophalangeal, flexor thumb, three-finger and four-finger (distal and proximal transverse palmar lines), carpal flexion folds. These morphological objects appear in a number of federal legislative acts. Data from fingerprint cards are used by the Ministry of Internal Affairs to search and identify criminals and identify people. Dermatoglyphics parameters are used in their work by geneticists and psychologists. Access control systems are based on recognition of fingerprints, iris, and facial shape. There is a need to describe the anatomy of the palmar surface of the hand in “Terminologia Anatomica”

The epigastric angle was determined in the frontal plane. After establishing the TTS, the number of the thoracic vertebra and the intercostal space corresponding to it along the paravertebral line were determined on each section. Next, we studied the correspondence of the thoracic vertebral bodies and...

Preparation of final qualifying work on...

The educational manual presents research methods that are differentiated not only depending on the area and focus of the research, but also classified taking into account the problems being solved.

This is a relatively narrowly built type: with a cylindrical, sometimes flattened chest, average width of shoulders and pelvis. The epigastric angle is close to right or straight. The back is straight, sometimes with protruding shoulder blades.

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Anthropological monitoring of preschool children. allowance

M.: Physical culture

The textbook presents the anatomical and physiological characteristics of preschool children, the individual typological diversity of children during their first childhood, as well as the main methods for assessing the physical development of preschool children and their implementation in monitoring the physical health of the younger generation. The textbook was prepared within the framework of the subprogram “Physical education and health improvement of children, adolescents and youth in the Russian Federation” (2002-2005) of the Federal Target Program “Youth of Russia” (2001-2005).

The shape of the chest is conical, short and widened downwards, the epigastric angle is obtuse. The abdomen is convex, rounded, usually with folds of fat, especially above the pubis. The back is straight or flattened.

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In order to detail the data on the structure of bone tissue (CT) of the proximal epiphysis (PE) of the femur (FB), frontal cuts of 196 certified adult BFs were studied. The material was grouped into 3 groups depending on the shape of the BC and the size of the thickness-length index. In the entire sample of CD, the spongy substance (S) of PE had a “lamellar” type of structure in 26.7%, “mesh” in 20.0%, and “transitional” in 53.3%. HV PE has a different structure in different forms of BC: in dolichomorphic ones - a “plate” type of structure

M.: PROMEDIA

The author continues to introduce readers to the main principles of Dr. Mayr's therapy. To increase the effectiveness of Mayra therapy, in addition to diet, a variety of therapeutic measures are used to intensify the processes of cleansing the body, namely: self-massage of the abdomen and rectum, intestinal lavage. A set of exercises for training abdominal breathing is given.

Key points in the diagnosis of internal diseases Educational...

Much attention is paid to the description of clinical syndromes, which allows us to demonstrate algorithms for medical diagnostic search. Separate chapters are devoted to a description of clinical manifestations, issues of diagnosis and treatment of specific pathologies of internal organs.

To study it, it is convenient to use the following technique: the palmar surface of the thumbs of both hands is pressed against the lower costal arches. The epigastric angle is the angle between the fingers.

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Sports medicine textbook. Direction of preparation...

publishing house NCFU

The manual is a course of lectures developed on all topics of subject training, includes theoretical material and test questions for the student’s independent work, and also includes a list of terms and tables, which greatly facilitates the student’s work. The manual talks about the main pathological conditions that arise in athletes and people involved in physical education, reveals the basics of the etiopathogenesis of many diseases

The asthenoid type is characterized by narrow body shapes, hands, and feet. The epigastric angle is acute. The back is stooped, the shoulder blades protrude. The bones are thin. Poor development of fat and muscle components.

Preview: Sports medicine.pdf (1.2 Mb)

Propaedeutics of internal diseases. General clinical...

Medicine Far East

The course of lectures was prepared in accordance with the standard teaching program for propaedeutics of internal diseases, approved by the Ministry of Health of the Russian Federation. They consistently present the basics of medical deontology, basic general clinical methods for diagnosing internal diseases, modern additional (functional, laboratory, instrumental) research methods, as well as the range of syndromes under consideration. Particular attention is paid to semiotics - the most complex section of diagnostics. The lectures are presented based on the experience of teaching this discipline at the Department of Propaedeutics of Internal Diseases of the Pacific State Medical University and the traditions of the domestic school of therapists. The book is intended for second- and third-year medical students and may be useful for senior students and novice doctors.

The supraclavicular and subclavian fossae are not sharply expressed, the shoulder blades fit tightly to the posterior surface of the chest. The epigastric angle is straight. The muscles of the shoulder girdle are well developed. The asthenic chest is narrow, long, flat.

Preview: Propaedeutics of internal diseases. General clinical research and semiotics lectures for students and aspiring doctors (part I).pdf (0.6 Mb)

No. 4 [Bulletin of Moscow University. Episode 23. Anthropology. , 2011]

First of all, the journal publishes original articles on biological problems of human evolution and its modern diversity, ontogenetic development and morphology, as well as on the ecology of human groups and anthropological aspects of the ethnogenesis of ancient and modern peoples. It also covers the main events in the life of the domestic and world anthropological community, provides information about upcoming and past conferences, symposia and seminars, critical reviews of newly published books and other bibliographic information. Problems of related sciences that are closely related to the main topics of the journal will also be reflected. We hope that the new journal will be of interest not only to specialists, but also to a wider readership interested in the problems of biological and historical anthropology.

Normosthenic - has average development of bone and muscle tissue, moderate fat deposition, harmoniously combined height and weight, epigastric angle of about 900; IP within 10–30 conventional units. units

Preview: Bulletin of Moscow University. Series 23. Anthropology No. 4 2011.pdf (0.7 Mb)

Fundamentals of sports training: methods of assessment and...

M.: Soviet sport

The scientific and methodological manual summarizes the theoretical and methodological material obtained by the author in the course of numerous scientific studies, as well as on the basis of 35 years of work experience. The description and characteristics of the prerequisites for sports activity are given based on the analysis of morphological parameters, physical and functional readiness, biological analysis, as well as the features of the formation of motor actions and their complex control in the process of sports activity.

The epigastric angle protrudes. Anatomically, this type is characterized by extremely strong development of all parts of the large intestine - asthenoid. Thin, delicate bones. Predominant development of the lower extremities.

Preview: Fundamentals of sports training, methods of assessment and forecasting (morphobiomechanical approach).pdf (0.8 Mb)

Physical education of children 5-7 years old, taking into account somatic...

Publishing house of ZabGGPU

The textbook was developed in the research laboratory “Modeling the content and medical and biological substantiation of physical culture and sports” of the Transbaikal State Humanitarian Pedagogical University. The manual examines a model for constructing physical education classes for children aged 5−7 years in preschool educational institutions, taking into account the somatic characteristics of the body. The model of the educational process has been tested and is recommended for physical education teachers, methodologists and teachers of preschool educational institutions, physical education teachers, as well as for students, graduate students, teachers of secondary and higher educational institutions of physical education.

b Fig.5. Shape of the chest: a) flattened, epigastric angle acute; b) cylindrical, epigastric angle is straight; c) conical, obtuse epigastric angle 2. Shape of the back: – straight or normal – this shape of the back is observed with normal...

Preview: Physical education of children 5-7 years old, taking into account the somatic characteristics of the body, textbook by A.A. Korenevskaya, V.N. Prokofiev; Transbaikal. state hum-ped. univ. .pdf (0.7 Mb)

Innovative approaches to content and organization...

Publishing house of ZabGGPU

This work is the result of a fruitful integration of the theory and practice of preschool education and upbringing and represents an opportunity to get acquainted with the result of cooperation between a scientific school and practical work in kindergartens of the Trans-Baikal Territory on innovative technologies for improving the health of the younger generation.

5–3 2–3 2–3 flattened convex obtuse conical a b Fig.3. Shape of the chest: a) flattened, epigastric angle acute; b) cylindrical, epigastric angle is straight; c) conical, obtuse epigastric angle 2. Shape of the back: – straight or...

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Sports medicine textbook. allowance

M.: Man

The textbook is written in accordance with the sports medicine curriculum for physical education universities and the requirements of the Federal State Educational Standard for Higher Professional Education. This manual contains a dictionary of medical terms.

The anteroposterior (sterno-vertebral size) is smaller than the lateral (transverse) one, the supraclavicular fossa is slightly pronounced. The epigastric angle approaches 90.

Sports selection: theory and practice [monograph]

M.: Soviet sport

The monograph, consisting of two books, reveals the theoretical and practical foundations of sports selection based on modern scientific data. The first book outlines the theoretical foundations of sports selection and examines the systems of sports selection that exist in countries with developed sports. The structure and genetics of sports talent are determined, the organizational and methodological foundations of sports selection are given, as well as diagnostics of the development of general and special abilities of athletes. The second book examines the key issues of sports selection for individual sports (athletics, gymnastics, figure skating, football, basketball, tennis, swimming, rowing, cycling, skiing, wrestling, boxing, fencing, weightlifting, power lifting).

Characterized by abundant fat deposition. The shape of the chest is conical, short and widened downwards, the epigastric angle is obtuse. The abdomen is convex, rounded, usually with folds of fat (especially above the pubis).

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Correction of the figure of female students with various types of gymnastics in...

The manual contains information about the history of the beauty of female figures and the concept of beauty in the modern world. A definition of various body types, proportionality of the figure and body constitution is given. The history of the development of various gymnastic types and their influence on figure correction, health, and improvement of appearance are considered. Anthropometric measurements (I.V. Prokhortsev) and methods of regulating body weight are presented. The manual includes exercises aimed at body shaping and healthy eating rules.

This type is characterized by proportionality between the length and width of the body: – fairly broad shoulders with a well-developed chest: – the epigastric angle is straight or close to straight; – moderately narrow pelvis; – prominent and well developed...

Preview: Correction of the figure of female students with various types of gymnastics at the university.pdf (1.1 Mb)

Physiological and hygienic foundations of physical education of children...

M.: FLINTA

This textbook complements information about the physiological and hygienic foundations of physical education for children of early and preschool age. The manual examines modern ideas about health, various approaches to identifying the typological characteristics of children, reveals the patterns of building skills and muscle development, and features of the development of movements in children at different age periods.

The abdomen is strongly developed, with pronounced fat folds, especially above the pubis, the epigastric angle is obtuse. The skeleton is large and massive. The bone relief is not visible. Muscle mass is abundant, muscle tone is good.

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Pathophysiology: issues of general nosology

Medicine Far East

The manual includes materials reflecting the current state of issues of general nosology: concepts and categories of nosology (health, normal, pre-illness, disease, pathological process, etc.). The role and significance of reactivity, resistance and body constitution in pathology are presented in detail. Attention is focused on the relative pathogenicity of reactivity mechanisms, the relationship of constitutional types of people not only with certain diseases, but also with professional inclinations.

Kretschmer called the temperature corresponding to the asthenic type schizoid;  picnic type - people of this type have a wide, stocky figure, a short neck, a round head, a broad chest, a protruding abdomen, and an obtuse epigastric angle.

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Physical examination of the patient: examination of the respiratory,...

The manual describes in detail the methods of physical examination of the patient. For each stage of the study, the sequence of implementation of various methods and the technique for their implementation are outlined. At the end of each section, examples of descriptions of research results in normal and pathological conditions are given. The manual is designed both for independent training of students and for work during practical classes. For medical students.

18 Example of a conclusion for the norm: The chest is cylindrical in shape, corresponds to the normosthenic constitutional type, symmetrical, the epigastric angle is straight.

Preview: Physical examination of the patient, examination of the respiratory, digestive and urinary systems.pdf (1.2 Mb)

Collection of tests on propaedeutics of internal diseases

52. Asthenic chest: 1) resembles a truncated cone; 2) elongated, narrow, flat; 3) has a cylindrical shape; 4) occurs in patients with pulmonary emphysema; 5) has an epigastric angle > 90°.

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Guide to practical exercises on topographic...

The textbook is intended for independent work of students in preparation for practical classes in topographic anatomy and operative surgery. The manual is compiled in accordance with the Model program for the discipline “Operative surgery and topographic anatomy” for the specialties: 060101 (040100) – General medicine, 060103 (040200) – Pediatrics, 060104 (040300) – Medical and preventive medicine, 060105 (040400) – Dentistry (Moscow, Federal State Educational Institution “VUNMC Roszdrav”, Ministry of Education and Science of the Russian Federation 2006). The need to publish this manual is dictated by the fact that when studying the subject, certain difficulties arise due to the large volume of material, unequal interpretation of some issues in different manuals, time limits and insufficient preparation of students in clinical terms. The textbook highlights the key points of each topic of the practical lesson, which provides motivation for the cognitive activity of students, and reveals the applied significance of topographic anatomy in relation to clinical disciplines.

her" 1) A hypersthenic is characterized by an epigastric angle. 2) The length of the upper opening of the hypersthenic chest is located in the _ direction. 3) The upper aperture of normosthenics is _ shaped.

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Operative and clinical surgery of the abdominal organs

The manual presents in an accessible form basic information on topographic anatomy and surgical interventions in the abdominal cavity. The textbook on the discipline “Operative and Clinical Surgery” is compiled in accordance with the requirements of the Federal State Educational Standard and is intended for students in higher education programs - specialty programs, in the specialties “General Medicine”, “Pediatrics”.

A dolichomorphic physique is characterized by the shape of the abdomen, when the interspinous line is larger than the intercostal line, which is typical for a narrow lower aperture of the chest and a wide pelvis. The epigastric angle is narrow, equal to 85-95, long.

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Surgery of the abdominal organs. T.I Topographic...

Far Eastern Federal University Publishing House

The manual presents patterns and basic information on topographic anatomy and surgical interventions on the anterior abdominal wall and abdominal organs, provided for by the program for students to master the block of the Federal State Educational Standard in the specialty of General Medicine and Pediatrics, taking into account the relevant competencies. In the preparation of the presented textbook, the many years of experience of its compilers in teaching the corresponding section of the curriculum for students of the above-mentioned specialties was used. For the second edition, the manual has been revised and supplemented with modern technologies used in surgery. Intended for medical students enrolled in specialty programs in General Medicine and Pediatrics.

Preview: Abdominal surgery. T.I Topographic anatomy of the anterior wall of the abdomen and abdominal organs..pdf (0.3 Mb)

No. 3 [Morphology, 2008]

Founded in 1916 (former name - “Archive of Anatomy, Histology and Embryology”). Publishes original research, review and general theoretical articles on anatomy, anthropology, histology, cytology, embryology, cell biology, morphological aspects of veterinary medicine, issues of teaching morphological disciplines, history of morphology.

Standard morphometric criteria were established: weight, parietal-coccygeal, parietal-calcaneal dimensions, epigastric angle; head dimensions (biparietal, sagittal); head circumference...

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A short guide to practical exercises in propaedeutics...

The proposed textbook provides basic information about semiotics, etiopathogenesis and diagnosis of diseases, and presents the main modern classifications of diseases of internal organs. The main objective of the proposed textbook is a concise presentation of theoretical material with a syndromic approach to the diagnosis of diseases. For each topic, test tasks are given that allow you to control the assimilation of basic theoretical information. The proposed manual does not replace modern manuals on internal medicine and cannot replace a deep and systematic study of textbooks on the course of propaedeutics of internal diseases, but is additional material that helps future doctors master clinical thinking at the initial stage of clinical training.

13. Asthenic chest: 1) resembles a truncated cone; 2) elongated, narrow, flat; 3) has a cylindrical shape; 4) occurs in patients with pulmonary emphysema; 5) has an epigastric angle of more than 90°.

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Preview: A short guide to practical training in propaedeutics of internal diseases (1).pdf (1.2 Mb)

No. 9 ["60 years is not an age" supplement to the magazine Be Healthy! for pensioners, 2010]

Nowadays, 60 years is the age of second youth. It is no coincidence that 35% of pensioners in Russia continue to work. How to maintain physical tone, maintain active thinking and a creative spirit? Experienced doctors, psychologists, and healthy lifestyle enthusiasts talk about this in the magazine.

The expansion and rigidity of the chest undergo reverse development. The costal humps decrease and soften, the epigastric angle, the level of the sternum and the lateral part of the torso begin to return to normal.

Preview: 60 years is not an age. Archive of magazines for 2010 No. 9 2010.pdf (37.3 Mb)

Mark Midler's story about a swordsman

M.: Man

A documentary story about the life of the famous foil fencer Mark Midler, a participant in the first Olympics for Soviet athletes in 1952, a two-time Olympic champion and a six-time world champion in team competitions, a four-time winner of the European Cup, a six-time national champion and the permanent captain of the national team for many years, who by right called "a legend of the twentieth century."

Uh-uh... the shoulders are wider than the hips, the arms and legs are medium, - Vitaly Andreevich began to mutter, - the epigastric angle between the lower ribs of the straight line, muscle strength is clearly greater, and endurance, as we know, is absolutely not characteristic of the muscular type, it ...

Basic aerobics in group programs, educational method. allowance...

The manual discusses the problems of organizing and conducting basic aerobics in group programs, the influence of physical activity on the functional systems of the body and the anatomical and physiological characteristics of the human body. The manual contains theoretical and practical information, diagrams and illustrations, which makes it easier to understand the educational material. The purpose of this textbook is to increase the level of knowledge of fitness club instructors on the issues of choosing the optimal load when doing basic aerobics and is a valuable educational and pedagogical material for training students in the direction 032100 “Physical Education”, as well as students of the Faculty of Advanced Training.

In representatives of brachymorphic 11 (with predominant width) types, the chest becomes barrel-shaped, short, with an obtuse epigastric angle. In the intermediate mesomorphic type, the epigastric angle is straight. Skeleton of the upper limb.

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No. 1 [Pacific Medical Journal, 2004]

"Pacific Medical Journal" is intended to unite specialists from the Russian Far East and the countries of the Asia-Pacific region working in the field of medicine and biology on a wide range of issues related to scientific research, educational and methodological work and healthcare practice. Unlike other periodical scientific publications published by academic institutions and medical organizations in Siberia and the Far East, the Pacific Medical Journal is focused primarily on current regional problems, which are considered in a wide range from pilot innovative research to the widespread implementation of scientific developments in practice. The journal provides its pages for publishing the results of research by specialists working in various fields of medicine and biology, the topics of which do not always correspond to the format of scientific publications published in other regions of Russia, but are of high importance for the Far East and Asia-Pacific countries. A wide range of issues covered on the pages of the publication is structured in accordance with the formation of thematic issues of the magazine devoted to specific problems of medicine and biology. The journal serves as an information platform for major scientific and practical conferences and forums taking place in the Russian Far East. Considerable attention is paid to covering issues related to the general ethnic and environmental conditions for the development of pathology for the population of the Russian Far East and the countries of the Asia-Pacific region.

Epigastric

No. 7 [Siberian Lights, 2012]

"SIBERIAN LIGHTS" is one of the oldest Russian literary regional magazines. It has been published in Novosibirsk since 1922. During this time, several generations of talented writers, known not only in Siberia, such as: Vyach. Shishkov and Vs. Ivanov, A. Koptelov and L. Seifullina, E. Permitin and P. Proskurin, A. Ivanov and A. Cherkasov, V. Shukshin, V. Astafiev and V. Rasputin and many others. Among the poets, the most famous are S. Markov and P. Vasiliev, I. Eroshin and L. Martynov, E. Stewart and V. Fedorov, S. Kunyaev and A. Plitchenko. Currently, the literary, artistic and socio-political magazine "Siberian Lights", awarded with certificates of honor from the administration of the Novosibirsk region (V.A. Tolokonsky), regional council (V.V. Leonov), MA "Siberian Agreement" (V. Ivankov) , edited by V.I. Zelensky, worthily continues the traditions of his predecessors. The editors of the magazine are a team of well-known writers and poets in Siberia, members of the Writers' Union of Russia.

I can, I can! - Then tell me, what is his epigastric angle - obtuse or acute? Oh, you don't know. Then here's what: give him hot cabbage soup.

Preview: Siberian Lights No. 7 2012.pdf (0.6 Mb)

Methods for determining and assessing health and physical...

Medicine Far East

The textbook presents didactic material for students to master an important block of the Federal State Educational Standard in the specialty of Pediatrics, taking into account the relevant competencies for mastering future pediatricians. This material reveals the essence of the methodology for determining and assessing the health status and physical development of children and adolescents, which is widely in demand by pediatric specialists. As a basis, the training manual uses modern information resources, including official methodological documents of the Ministry of Health of the Russian Federation. In preparing the presented methodological publication, its compiler has used many years of experience in teaching the relevant section of the curriculum for students of the above specialty.

Preview: Scheme for writing an academic medical history. Study guide..pdf (1.7 Mb)

Clinical training on supervision of sick children and registration...

Medicine Far East

The training manual presents materials on methodological support for clinical educational training for the formation of a set of professional skills and abilities among students of the Faculty of Medicine in the process of supervising sick children with various nosological forms of diseases. A scheme for preparing an educational medical history and accompanying medical documentation is given. Standards for indicators of the health status of children and adolescents, standardized tests and educational situational tasks that are as close as possible to practice are provided.

The epigastric angle is assessed, which makes it possible to determine the constitutional type of the child.

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Clinical and pharmacological foundations of modern pulmonology...

M.: Knowledge Laboratory

From the standpoint of evidence-based medicine, clinical experience in treating patients with lung diseases is summarized. For each nosological form, a set of therapeutic measures, physiotherapeutic procedures and other methods of influencing the causative agent of the disease is proposed. Methods for eliminating intoxication syndrome, restoring the drainage function of the bronchi and normalizing the immunological status of the patient's body are described. Particular attention is paid to drugs used for prophylactic purposes. The diagnosis and treatment of both emergency conditions and chronic diseases of the bronchopulmonary system are considered.

Gaps, increased epigastric angle more than 90°C, smoothed supraclavicular fossae, box percussion sound, lower borders of the lungs are shifted downward, respiratory excursion of the lower borders of the lungs is limited; shallow breathing...

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The rib cage is a natural internal shell designed to protect vital organs from damage, bruises or injury. The chest cavity contains the heart, lungs, pulmonary arteries and veins, thymus, bronchi, esophagus, and liver. The respiratory muscles and muscles of the upper limbs are attached to it.

Structure of the human chest

The chest is formed by:

12 pairs of arched ribs, connected at the back to the thoracic spine, and at the front connected to the sternum using costal cartilages.
The sternum is an unpaired bone with an elongated shape. It is characterized by a convexity on the front surface and a concavity on the back. Includes three parts: handle, body and
Muscles.

It is flexible, meaning it expands and contracts as you breathe.

Types of chest

The size and shape of the chest are variable and may change depending on the degree of development of the muscles and lungs. And the degree of development of the latter is closely related to a person’s life activity, his activity and profession. The normal shape of the chest has three types:

flat;
cylindrical;
conical.

Flat chest shape

It is often found in people with weak muscles and leading a passive lifestyle. It is long and flattened in anteroposterior diameter, the anterior wall is almost vertical, the clavicles are clearly visible, and the intercostal spaces are wide.

Conical chest shape

This wide and short chest shape is characteristic of people with a well-developed shoulder girdle muscle group. Its lower part is wider than the upper. The inclination of the ribs and intercostal spaces are small.

Cylindrical chest shape

This chest shape is normally found in short people. It is round, the same along its entire length. The horizontal arrangement of the ribs explains the unclear intercostal spaces. The inframammary angle is obtuse. People, professionally, have exactly this breast shape.

Age and physiological characteristics

The shape of a person's chest changes significantly with age. Newborns are characterized by a narrow and shortened shape of a truncated pyramid. It is slightly compressed from the sides. The transverse size is smaller than the anteroposterior one. teaching him to crawl and stand up, the development of the musculoskeletal system and the growth of the internal organs determine the rapid growth of the chest. The shape of the chest in children in the third year of life becomes cone-shaped. At 6-7 years of age, growth slows down slightly, and an increase in the angle of inclination of the ribs is observed. School-age children have more convex chest shapes than adults, and the slope of the ribs is also less. This is associated with the more frequent and shallow breathing of younger schoolchildren. In boys, the chest begins to grow rapidly at the age of 12, in girls - 11 years. In the period up to 18 years, the middle section of the chest changes the most.

The shape of the chest in children largely depends on the position of the body during landing. Physical activity and regular exercise will help increase the volume and width of the chest. The expiratory form will be the result of weak muscles and poorly developed lungs. Incorrect sitting, resting on the edge of the table, can lead to changes in the shape of the chest, which will negatively affect the development and function of the heart, lungs and large vessels.

Reducing the size, lowering and changing the shape of the chest in older people is associated with a decrease in the elasticity of the costal cartilages, frequent diseases of the respiratory tract and kyphotic curvature.

The male chest is larger than the female and has a more pronounced rib curve at the angle. In women, the spiral-shaped twisting of the ribs is more pronounced. Due to this, a flatter shape and the predominance of chest breathing are obtained. Men have an abdominal type of breathing, which is accompanied by a displacement of the diaphragm.

The chest and its movements

The respiratory muscles play an active role in the process of inhalation and exhalation.
Inhalation is carried out by contracting the diaphragm and external intercostal muscles, which, lifting the ribs, move them slightly to the sides, increasing the volume of the chest. Exhalation of air is accompanied by relaxation of the respiratory muscles, lowering of the ribs, and raising of the dome of the diaphragm. The lungs perform a passive function in this process, following the moving walls.

Types of breathing

Depending on the age and development of the chest, there are:

This is the name for the breathing of newborns who do not yet have a good bend of the ribs, and they are in a horizontal position, the intercostal muscles are weak.
Thoracic breathing with a predominance of diaphragmatic breathing is observed in children in the second half of the first year of life, when the intercostal muscles begin to strengthen and the ore cell begins to descend downwards.
The pectoral girdle begins to predominate in children from 3 to 7 years of age, when the shoulder girdle is actively developing.
After seven years, gender differences in breathing patterns appear. Abdominal will predominate in boys, thoracic in girls.

Pathological forms of the chest

Pathologies are most often noticed by patients. They can be congenital (associated with impaired bone development during pregnancy) or acquired (a consequence of injuries and diseases of the lungs, bones, and spine). Deformations and distortions are usually revealed by a simple examination of the chest. The shape and its changes, asymmetry, and irregular breathing allow an experienced doctor to make a preliminary diagnosis. The shape of the chest becomes irregular under the influence of pathological processes in the organs of the chest cavity and with curvature of the spine. Pathological forms of the chest can be:

Barrel-shaped. This deviation is found in people whose lung tissue has increased airiness, that is, its elasticity and strength are impaired. This is accompanied by an increased air content in the alveoli. The barrel-shaped chest has an expanded transverse and, especially, anteroposterior diameter, with horizontally located ribs and wide intercostal spaces.
Paralytic. This chest looks flat and narrow. The collarbones are pronounced and located asymmetrically. The shoulder blades clearly lag behind the chest, their location is at different levels and during the breathing process they shift asynchronously. The location of the ribs is oblique downward. Paralytic forms of the chest occur in emaciated people, in people with poor constitutional development, and in people with severe chronic diseases, such as tuberculosis.
Rachitic. This shape is also called keel-shaped or chicken-shaped. It is characterized by a significant increase in anteroposterior size, which is a consequence of rickets suffered in childhood. The keel shape also occurs as a result of a genetic deviation in the development of the skeletal system. Bone protrusion may or may not be significant. The severity of the pathology affects the secondary symptoms of the disease that arise due to compression of the heart and lungs.

Funnel-shaped. This type of pathology is expressed in a noticeable retraction of individual zones: ribs, cartilage, sternum. The depth of the funnel can reach 8 cm. A pronounced funnel-shaped deformity is accompanied by displacement of the heart, curvature of the spine, problems in lung function, and changes in arterial and venous pressure. In infants, the pathology is little noticeable, only when inhaling is there a slight depression in the chest area. It becomes more pronounced as it grows.
Scaphoid. Characteristic of this pathology is the presence of an elongated depression in the middle and upper part of the sternum. Develops in children suffering from diseases of the nervous system, in which motor functions and sensitivity are impaired. Severe deformity is accompanied by shortness of breath, fatigue, intolerance to physical activity, and rapid heartbeat.
Kyphoscoliotic. It develops against the background of diseases of the spine, namely the thoracic region, or is a consequence of traumatic injury.

Evolution has ensured that the most important organs of the human body are protected by the chest. The chest cavity contains organs without which we cannot survive for even a few minutes. A rigid bone frame not only protects, but also fixes them in a constant position, ensuring stable operation and our satisfactory condition.

The chest is a natural shield that covers the vital structures located underneath it - the heart, lungs and large vascular trunks, which must be protected from various types of injuries and damage. In this regard, the ribs, spine, sternum, joints, synchondrosis, ligamentous apparatus, muscular frame and diaphragm work as a single whole.

Normally, the chest is somewhat flattened in anteroposterior size and has the appearance of an irregular cone. It has four walls: the anterior one, formed by the sternum and costal cartilages, the posterior one, formed by twelve thoracic vertebrae with the posterior ends of the ribs attached to them, as well as the medial and lateral (that is, lateral) walls, which are created by the ribs. The latter are separated from one another by intercostal spaces.

The upper opening, or aperture of the chest, is limited by the first thoracic vertebra, the upper edge of the manubrium of the sternum, and the inner edges of the first ribs. In the anteroposterior direction, the upper aperture has a length of about 5-6 cm, in diameter - 10-12 cm. The lower opening of the chest is limited in front by the xiphoid process of the sternum, in the back by the body of the twelfth thoracic vertebra, and on the sides by the lower ribs.

Normally, depending on the constitution of a person, all chest cells are divided into normo-, hyper- and asthenic. In addition, against the background of certain diseases, injuries, etc. pathological variants may develop. For example: emphysematous, rachitic, funnel-shaped, etc.

Normosthenic, or conical, in shape resemble a truncated cone with an upward-facing base (shoulder girdle area). The anteroposterior diameter of such a chest is smaller than the lateral one. The supraclavicular and subclavian fossae are, as a rule, poorly expressed. There is a moderately oblique course of the ribs along the lateral surfaces, the intercostal spaces are not clearly defined, the shoulder blades are contoured, but slightly, and the shoulders are located at right angles to the neck. The muscle group of the shoulder girdle in this case is well developed. The epigastric (epigastric) angle, measured between the costal arches (to do this, the examiner presses the palmar surfaces of his thumbs tightly against the costal arches so that their ends rest against the xiphoid process), is 90°.

Hypersthenic chests are wide and shaped like a cylinder. The anteroposterior size here is approximately equal to the lateral size, and all absolute values of diameters are greater than similar indicators in normosthenics. The supraclavicular and subclavian fossae are practically not pronounced or not visible at all, the shoulders are straight and wide. The ribs run almost horizontally, the spaces between them are narrow and barely noticeable. The epigastric angle is more than 90°, the muscles of the chest are well developed, and the shoulder blades fit tightly to it.

The asthenic chest is outwardly flat and narrow - due to the reduced anteroposterior and lateral dimensions, it looks somewhat elongated. It shows the supraclavicular and subclavian fossae very clearly, the clavicles stand out well, the spaces between the ribs are wide, and along the lateral surfaces the ribs have a more vertical direction. The epigastric angle is acute (less than 90°). The shoulders are lowered, the shoulder blades are noticeably behind the back, and the muscles of the shoulder girdle are usually poorly developed.

When starting to study the respiratory system, first visually determine the shape and symmetry of the chest, then the frequency of breathing, its rhythm, depth and uniformity of participation of both halves of the chest in the act of breathing. In addition, pay attention to the ratio of the duration of the inhalation and exhalation phases, as well as which muscles are involved in breathing.

The chest is examined from all sides using direct and lateral lighting. Its shape is judged by the ratio of the anteroposterior and transverse dimensions (determined visually or measured with a special compass), the severity of the supra- and subclavian fossae, the width of the intercostal spaces, the direction of the ribs in the inferolateral sections, and the size of the epigastric angle. In the case when the epigastric angle is not outlined, in order to determine its size, it is necessary to press the palmar surfaces of the thumbs to the costal arches, resting their tips on the xiphoid process (Fig. 35).

When measuring chest circumference, it is advisable to compare the distance from the middle of the sternum to the spinous process of the vertebra on both sides.

The respiratory rate is usually determined by visual observation of the respiratory excursions of the chest, however, if the patient is breathing shallowly, you should place your palm on the epigastric region and count the respiratory movements by lifting the hand as you inhale. Respiratory movements are counted over one or more minutes, and this must be done unnoticed by the patient, since breathing is a voluntary act. The rhythm of breathing is judged by the uniformity of respiratory pauses, and the depth of breathing is determined by the amplitude of respiratory excursions of the ribs. In addition, by comparing the amplitude of movements of the ribs, collarbones, angles of the shoulder blades and shoulder girdles on both sides, one gets an idea of the uniformity of participation of both halves of the chest in the act of breathing.

When comparing the duration of inhalation and exhalation, it is necessary to pay attention to the intensity of the noise created by the air flow in both phases of breathing.

Normally, the chest has a regular, symmetrical shape.
For normosthenics it has the shape of a truncated cone, with its apex facing downward, its anteroposterior size is 2/3-3/4 of the transverse size, the intercostal spaces, the supra- and subclavian fossae are not clearly expressed, the direction of the ribs in the inferolateral sections is moderately oblique, the epigastric angle approaches the right angle.

For asthenics the chest is narrow and flattened due to a uniform decrease in its anteroposterior and transverse dimensions, the supra- and subclavian fossae are deep, the intercostal spaces are wide, the ribs go steeply down, the epigastric angle is acute.

In hypersthenics the anteroposterior and transverse dimensions of the chest, on the contrary, are uniformly increased, so it appears wide and deep, the supra- and subclavian fossae are barely outlined, the intercostal spaces are narrowed, the direction of the ribs approaches horizontal, the epigastric angle is obtuse.

Changes in the shape of the chest may be due to pathology of the lung tissue or improper formation of the skeleton during development.

Patients with tuberculosis of both lungs with cicatricial wrinkling of the lung tissue are characterized by the so-called paralytic chest, reminiscent of an extreme version of the chest of asthenics: it is significantly flattened and is constantly in a position of complete exhalation, the ribs are drawn closer together, the intercostal spaces are retracted, supra- and subclavian fossa, atrophy of the pectoral muscles.

With emphysema (bloating) of the lungs, a barrel-shaped chest is formed, which resembles an extreme version of the chest of hypersthenics: both of its diameters, especially the anteroposterior one, are significantly increased, the ribs are directed horizontally, the intercostal spaces are widened, the supra- and subclavian fossae are smoothed out or even bulge in the form of so-called "emphysematous pillows". At the same time, the amplitude of respiratory excursions is significantly reduced and the chest is constantly in a position of deep inspiration. A similar shape of the chest, but with sharply thickened collarbones, sternum and ribs, can be observed in patients with acromegaly. It should also be taken into account that the smoothness of both supraclavicular fossae due to myxedematous edema is sometimes detected in hypothyroidism.

Congenital abnormalities of the chest sometimes result in a funnel-shaped depression in the lower part of the sternum (funnel chest, or cobbler's chest) or, less commonly, an elongated depression running along the upper and middle parts of the sternum (scaphoid chest). The scaphoid shape of the chest is usually combined with a congenital disease of the spinal cord, characterized by impaired pain and temperature sensitivity (syringomyelia).

In patients who suffered from rickets in early childhood, in some cases a characteristic deformation of the chest is observed: it is as if compressed on both sides, while the sternum sharply protrudes forward in the form of a keel (rachitic, or keeled, chest, “chicken breast”). A keeled chest shape can also be detected with Marfan syndrome.

Changes in the shape of the chest are often caused by the previously described spinal deformities (p. 90): lordosis, kyphosis, scoliosis and, especially, hump. Deformations of the chest can lead to changes in the relationships of the organs located in it and, as a result, have an adverse effect on the function of the respiratory and cardiovascular systems. In addition, they must be taken into account when performing percussion and auscultation of the heart and lungs.

Violation of the symmetry of the chest is observed when the volume of one half of it increases or decreases, as well as in the presence of local protrusions of the chest wall. Thus, the accumulation of a significant amount of fluid or air in one of the pleural cavities leads to an increase in the size of the corresponding half of the chest. At the same time, on the affected side, the intercostal spaces widen and smooth out, the supra- and subclavian fossae bulge, the shoulder, collarbone and scapula are raised, the spine is curved with a convexity towards the affected side.

With cicatricial shrinkage of the lung or pleura, atelectasis (collapse) of the lung, or after its resection, the affected half of the chest, on the contrary, decreases in volume. It becomes flat and narrow, the intercostal spaces on the affected side are retracted and sharply narrowed, the ribs sometimes overlap each other, the supra- and subclavian fossae are sunken, the shoulder, clavicle and scapula are lowered, the spine is curved with a convexity towards the healthy side.

Local bulging of the chest occurs in patients with congenital heart defects (heart hump), aortic aneurysm, and in addition, with inflammatory or tumor lesions of the chest wall itself. With a tumor of the apex of the lung or local enlargement of the lymph nodes, smoothing of the corresponding supraclavicular and subclavian fossae may be observed.

Breathing assessment

The normal respiratory rate in adults is 12-18 per minute. In newborns, the respiratory rate reaches 40-45 per minute, by 5 years it decreases to 25-30, and during puberty - to 20 per minute. Women breathe slightly more frequently than men. In a lying position and, especially, in sleep, breathing slows down.

Breathing movements are normally rhythmic, of medium depth, both halves of the chest are evenly involved in the act of breathing, inhalation is active and relatively short, exhalation is passive and longer. The noise created by the air stream in both phases of breathing is barely audible. In men, breathing occurs mainly due to contraction of the diaphragm, due to which during inhalation the abdominal wall moves forward and the volume of the abdomen increases (diaphragmatic, or abdominal, type of breathing). Respiratory movements in women are accomplished primarily through contraction of the intercostal muscles, so during inhalation their chest rises and expands (costal, or thoracic, type of breathing). However, sometimes in healthy men and women both the diaphragm and intercostal muscles take part in breathing without a noticeable predominance of one of these types of breathing. In such cases they speak of a mixed type of breathing.

An increase in respiratory rate of more than 18 per minute (tachypnea) in combination with a decrease in its depth (shallow breathing) is observed with respiratory or heart failure, as well as with severe anemia. Normally, the ratio of respiratory rate and pulse is 1/4. If during tachypnea this ratio is violated due to an increase in the numerator of the fraction, then this indicates the presence of pathology in the respiratory system. In patients with pulmonary edema, frequent shallow breathing is accompanied by the release of pink, foamy sputum from the mouth and a peculiar noise audible at a distance, reminiscent of the bubbling of liquid when air is passed through it (stertorous breathing).

With a high fever with chills or with severe psycho-emotional arousal, breathing also quickens, becomes deeper, exhalation is lengthened, and inhalation is sometimes intermittent and is carried out as if in several steps (saccade breathing). A sharp increase in breathing (up to 60 per minute) can be observed in patients with hysteria.

In patients in a comatose state, breathing, on the contrary, becomes rare, but noisy and very deep, with a maximum volume of respiratory excursions (“big breathing” by Kussmaul). This type of breathing occurs in diseases of the brain and its membranes, severe infections, poisoning, diabetic coma, severe liver and kidney failure.

The lag of one of the halves of the chest in the act of breathing is manifested by a decrease in its respiratory excursions compared to the other half. Such a lag may be due to the presence on the corresponding side of a widespread lesion of the lung tissue (pneumonia, tuberculosis, atelectasis, cancer, heart attack), pleural effusion, pneumothorax, extensive pleural adhesions or paralysis of the dome of the diaphragm. In addition, in some diseases (dry pleurisy, rib fractures, intercostal neuralgia or myositis of the intercostal muscles), patients voluntarily restrain the respiratory movements of one half of the chest in order to avoid the sharp pain that arises.

Changes in the normal ratio of the duration of the inspiratory and expiratory phases are usually caused by airway obstruction. Thus, a pronounced prolongation of the inspiratory phase occurs when there is an obstruction to breathing in the upper respiratory tract. Most often it is caused by damage to the larynx, for example, with diphtheria (true croup), allergic edema, acute viral respiratory infections in children (false croup), tumors, as well as compression of the larynx from the outside by a cancerous tumor of the thyroid gland. An extended inhalation in these patients is accompanied by a loud whistling or hissing sound (stridulous breathing, or stridor). Inhalation prolongation can also be caused by tumors and foreign bodies of the trachea and large bronchi.

If the patency of the small bronchi and bronchioles is impaired, on the contrary, the expiratory phase lengthens. In this case, the exhalation becomes noisy and is often accompanied by whistling or buzzing sounds audible at a distance. Similar changes in breathing are observed in patients with bronchial asthma and chronic obstructive bronchitis. The causes of impaired bronchial obstruction are spasm of the smooth muscles of the bronchi, swelling of their mucous membrane, accumulation of viscous secretions in the lumen of the bronchi, as well as changes in the elastic properties of the bronchial wall.

The appearance in a man of the costal type of breathing characteristic of women can be caused by acute pathology of the abdominal organs with irritation of the peritoneum, a significant increase in intra-abdominal pressure, or damage to the diaphragm. Diaphragmatic breathing in women is usually observed with dry pleurisy, rib fractures, intercostal neuralgia or myositis of the intercostal muscles.

With a significant increase in breathing, as well as with a lengthening of its individual phases, as a rule, one can detect the participation of auxiliary muscles in the act of breathing: sternocleidomastoid, trapezius, pectoralis. By the predominant participation of auxiliary muscles in the inhalation or exhalation phase, as well as by the lengthening of the corresponding breathing phase, one can roughly judge the level of airway obstruction.

Brain lesions may be accompanied by disturbances in breathing rhythm with the appearance of special types of pathological arrhythmic so-called periodic breathing: Cheyne-Stokes, Grocco or Biot. During Cheyne-Stokes breathing, over 10-12 respiratory cycles, the depth of respiratory movements first increases, and then, having reached a maximum, decreases, after which a breath hold (apnea) is observed lasting up to one minute, and again a period of 10-12 initially increasing, follows. and then the respiratory movements decreasing in depth, the breath is held again for up to one minute.

Respiratory system

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Many conversations about how obesity or thinness affects the likelihood of getting pregnant do not contain any useful information. This is due to the fact that even determining the percentage of fat is a rather complicated task, and there’s nothing to say about interpreting the results, so first let’s define the concepts.

About body mass index and body types

The range of a person's body weight can vary from underweight (hypotrophy) to obesity. How to determine what body weight can be considered normal?

There is not an ideal, but the most optimal solution - body mass index (BMI), this is the ratio of weight in kilograms to the square of height in meters. The normal range is based on age.

On average, a range from 20 to 24.9 is considered normal. This ratio works in a large percentage of cases, but as always there are exceptions.

Body tissues have different properties, bones and muscles give weight gain, but adipose tissue is quite light and first gives an increase in volume, and then weight. Each person's bones have their own thickness and width.

Based on the type of bone structure, there are 3 body types:

Adynamic(thin bone, epigastric angle less than 90º),
Normosthenic(normal bone thickness, epigastric angle 90º, most common body type),
Hypertensive(broad-boned, stocky people, epigastric angle more than 90º).

Epigastric angle- this is the angle formed by the costal edges in the sternum area, open downwards.

Accordingly, in people with an asthenic physique, the BMI may be insufficient, and in hypersthenics it may be excessive, with a normal ratio between lean mass and fat.

Another body type can be determined by the index of the ratio of chest volume at rest to height in centimeters.

For asthenics this ratio is less than 50%, for normosthenics it is from 50 to 55%, for hypersthenics it is more than 55%.

How to determine your body fat percentage?

In order to determine the percentage of fat contained in the body and the weight of lean mass, there is a special method. A direct method for determining body composition is weighing in water, the fatty tissue floats up, and you press the lean mass onto the scales, i.e. everything except fat. Accordingly, the difference in indicators will be the amount of fat. This is the simplest and most accurate method. There are also indirect methods based on the principle of impedance (special devices), as well as indices calculated by the sum of the thickness of fat folds (caliperometry). But these methods are less accurate and produce errors.

The optimal range for health is the % body fat range for women from 18 to 33 (for men from 12 to 25). The critical level of % fat tissue for women is 12% (for men 5%).

We present the norms of adipose tissue as a percentage by age for women and men. Keep in mind that the upper and lower limits of the range are actually no longer the norm, but also not a reason to talk about being overweight or underweight. They can be compared to a lottery and count on luck.

Age	Men		Women
Age	norm	increased weight	norm	increased weight
18-29	8-18	19-24	20-28	29-36
30-39	11-20	20-26	22-31	32-38
40-49	13-22	23-28	24-32	34-40
50-59	15-24	25-30	26-35	37-42

Adipose tissue and women's reproductive health

Adipose tissue is not only a site for the deposition of fatty acids, it performs an endocrine function and is the site of extraovarian synthesis of estrogens.

When planning pregnancy, gynecologists recommend being within the normal range for health by age, both in weight and in % of fat tissue.

What happens if you lose a lot of weight?

With a sharp decrease in weight, when the percentage of body fat is less than 12%, a sharp hormonal change occurs - menstruation stops, i.e. secondary amenorrhea occurs. The mechanism of development of this condition is associated with a violation of the neuroendocrine control of the synthesis and release of gonadotropin-releasing hormone (aka gonadorelin, gonadoliberin, or GnrH for short) in the hypothalamus. A decrease in its entry into the pituitary gland leads to a decrease in the synthesis and disruption of the rhythm of synthesis of gonadotropins: FSH, ACTH, TSH, LH, Prolactin, STH. With a decrease in the synthesis of FSH and LH, the growth of follicles slows down, and accordingly, underdeveloped follicles will synthesize less estrogens - secondary hypoestrogenism develops, against the background of which full ovulation does not occur. When treating this pathology, with weight gain, the menstrual cycle is usually restored, but ovulation is very difficult to restore.

How will excess body weight affect?

With obesity, secondary amenorrhea also often occurs, but the reasons for its development are different: polycystic ovary syndrome, hyperprolactinemia, hyperandrogenism, dysfunction of the thyroid gland. As a rule, these disorders develop from early childhood, they are associated with pathology of neuroendocrine regulation, and obesity in such cases develops secondarily, from puberty.

The development of obesity after puberty, due to insufficient physical activity and poor nutrition, can also lead to a number of endocrine disorders that negatively affect a woman’s reproductive health.

Estrogen is found in the ovaries and adrenal glands. The ovaries produce estrogen constantly, and the adrenal glands produce the hormone androstenedione, which is converted in fat cells to folliculin, which is very close to estrogen. This will disrupt the natural ovulation cycle and can lead to infertility.

Excess weight can cause:

Menstrual irregularities;
Increased risk of developing infertility;
Low probability of successful infertility treatment;
Increased risk of spontaneous abortion.

But there are also diabetes, cardiovascular diseases, arterial hypertension, etc. All these diseases, including infertility, are extremely difficult to treat, since excess fat in the body makes it difficult to absorb drugs.

Let's name the numbers. According to research, the likelihood of becoming pregnant in obese women is on average 45% lower than in women with normal body weight. And this is subject to regular menstrual cycles. As soon as problems with ovulation begin, the picture becomes much worse. We would like to emphasize once again that even with a normal ovulatory cycle, excess body weight reduces the likelihood of getting pregnant.

Conclusion

Nature does not like extremes and the mechanism of natural selection will not work at this stage of development of medical science. Developed countries are literally groaning at the rate at which obesity is affecting the population. Your weight and your reproductive health depend only on you. This is not a loud phrase, but a simple statement of fact, as obvious as the phrase that smoking kills. By making your choices today you influence your future.

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An acute angle will indicate an asthenic physique, a narrow chest. Normosthenics have a right angle, but hypersthenics have a wide chest, and hypersthenics have a wide chest.

To determine it yourself, stand in front of a mirror, place the edges of your palms against your costal arches, with your fingertips meeting at the top of the angle. Looking at the angle of the palms, it is not difficult to assess the type of angle formed. In degrees with a protractor, it is not determined.

How to determine your body type

There are several approaches to determining your somatotype. The methods for determining physique described in the article are suitable for men and women. Find out who you are by simply measuring your wrist circumference.

In the article “Body types: how does genetics affect your figure?” I talked in detail about the characteristic features of ectomorphs, mesomorphs and endomorphs. In this article I will talk about how you can determine which somatotype you belong to.

There are several ways.

Wrist measurement

It is necessary to measure your wrist at the narrowest point with a measuring tape and compare it with the data in the table.

This method is the simplest, but its accuracy is very relative and today, some studies generally question the possibility of determining the somatotype using such parameters.

Determination of the epigastric angle

The epigastric angle is the angle that forms between the 12th pair of ribs (the lowest pair). To determine it, go to the mirror, take a deep breath and hold your breath. Take two pencils and arrange them so that their ends on one side meet at the junction of the lower edges, and the pencils themselves are located along each of the edges. The location of the pencils will clearly show you the size of the intercostal angle. By its value you can determine your body type.

Determination of anthropometric indicators

Anthropometric indicators are age, gender, race and other characteristics of the physical structure that can be expressed quantitatively.

This method is the most accurate, but you cannot use it yourself. Such measurements can be carried out in medical centers or in fitness rooms where there is special equipment.

Determination of body type based on visual assessment

You can also roughly determine your body type simply by analyzing your appearance. And the best way to do this is to remember what kind of child you were as a child. If you are thin and tall, then most likely you are an ectomorph. If you were overweight as a child, then it is more likely that you are an endomorph. But do not forget about the objective factors that could influence this. So, if you were “fed for three” as a child, then the reason for excess weight is most likely this, and not your somatotype.

Why do you need to know your body type?

In order to rely on this data when compiling your diet and training regimen. For different body types, nutrition recommendations and training strategies can be very different, even if the goals are the same.

Epigastric angle

1. Undress to the waist, go to the mirror, take a deep breath and hold your breath for a while. The pair of lower ribs form the epigastric angle (highlighted in gray in the figure), the meaning of which we need to find out. Determine its value by eye.

You are asthenic if you have an epigastric angle< 90°

a normosthenic has an angle = 90°

in hypersthenic > 90°

Sorry for the scary picture, there are others on the Internet, but this one is visual.

That's all I'm talking about.

By all indications and by all descriptions, I am a normosthenic.

I tried to look at my ribs, the angle looks about 90.

I recently took an x-ray of the lumbar spine - clearly, clearly an acute angle!

no, it’s not very spicy, it’s close to 90, but clearly less than 90))

what is this?? can I be really slim?? Am I thin-boned??

How to determine your body type
how to determine your body type

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The diagnosis of obesity is established when the body mass index (BMI) is more than 30 kg/m². Hormonal levels, metabolism and heredity influence the distribution of excess adipose tissue. Women and men, young and old, gain weight differently. There are two main types of obesity:

How to determine the type of obesity

In order to determine the type of obesity, it is necessary to measure the circumference of the waist and hips with a measuring tape. The waist is assessed along a horizontal line midway between the edges of the costal arch and the iliac crests. Hips are measured at the fullest point of the buttocks. Next, the resulting waist circumference is divided by the hip circumference. If the result is more than one in a man or more than 0.85 in a woman, then it is legitimate to talk about the abdominal type of obesity. If the numbers are lower, then the patient has the femorogluteal type.

Type of obesity and metabolism

The abdominal type of obesity indicates insulin resistance. This condition is caused by hereditary receptor deficiency. Very often, abdominal obesity is accompanied by arterial hypertension, diabetes mellitus, hypercholesterolemia, and polycystic ovary syndrome. To normalize metabolism, a low-calorie diet, physical activity and drug therapy are required. The drug of choice is metformin.

Femoral and gluteal obesity is common in women of reproductive age. Lipid and carbohydrate metabolism are most often not affected in this type of disease. Patients experience osteoporosis, venous insufficiency, and arthrosis. Treatment is primarily aimed at correcting eating behavior. Medications that may be recommended include orlistat and sibutramine.

Body weight and reproductive health

About body mass index and body types

The range of a person's body weight can vary from underweight (hypotrophy) to obesity. How to determine what body weight can be considered normal?

There is not an ideal, but the most optimal solution - body mass index (BMI), this is the ratio of weight in kilograms to the square of height in meters. The normal range is based on age.

On average, a range from 20 to 24.9 is considered normal. This ratio works in a large percentage of cases, but as always there are exceptions.

Body tissues have different properties, bones and muscles give weight gain, but adipose tissue is quite light and first gives an increase in volume, and then weight. Each person's bones have their own thickness and width.

Based on the type of bone structure, there are 3 body types:

Asthenic (thin bone, epigastric angle less than 90º),
Normosthenic (normal bone thickness, epigastric angle 90º, the most common body type),
Hypertensive (big-boned, stocky people, epigastric angle more than 90º).

The epigastric angle is the angle formed by the costal edges in the sternum area, open downwards.

Accordingly, in people with an asthenic physique, the BMI may be insufficient, and in hypersthenics it may be excessive, with a normal ratio between lean mass and fat.

Another body type can be determined by the index of the ratio of chest volume at rest to height in centimeters.

For asthenics this ratio is less than 50%, for normosthenics it is from 50 to 55%, for hypersthenics it is more than 55%.

How to determine your body fat percentage?

The optimal range for health is the % body fat range for women from 18 to 33 (for men from 12 to 25). The critical level of % fat tissue for women is 12% (for men 5%).

Adipose tissue and women's reproductive health

Adipose tissue is not only a site for the deposition of fatty acids, it performs an endocrine function and is the site of extraovarian estrogen synthesis.

When planning pregnancy, gynecologists recommend being within the normal range for health by age, both in weight and in % of fat tissue.

What happens if you lose a lot of weight?

How will excess body weight affect?

Excess weight can cause:

Menstrual irregularities;
Increased risk of developing infertility;
Low probability of successful infertility treatment;
Increased risk of spontaneous abortion.

Conclusion

Respiratory system. Basic research methods for subjective sensations

RESPIRATORY SYSTEM. BASIC RESEARCH METHODS

1. Subjective sensations

Healthy people sometimes notice physiological shortness of breath, dry reflex cough and muscle pain in the chest. Untrained individuals may experience dizziness when breathing frequently and deeply.

Physiological shortness of breath, as a rule, appears during significant physical and neuropsychic stress, staying in a stuffy and smoky room, or in high altitude conditions.

Dry reflex cough is a protective reaction when mucus accumulates in the larynx, when a foreign body, dust, smoke particles, etc. enter the upper respiratory tract. A reflex cough can be caused by irritation of the receptors in the ear canal or esophagus.

Chest pain often occurs in poorly trained individuals when they perform significant physical activity (for example, long running) and is explained by overstrain of the intercostal muscles and diaphragm.

In practically healthy people, the skin has a uniform pale pink color over the entire surface of the body. Exposed skin may be tanned. In some cases, a pale color of the skin is observed, due to the reduced transparency of its upper layers and the depletion of blood vessels in the skin. Visible mucous membranes are pink, moderately moist.

When examining the chest, the doctor determines its shape, symmetry, the participation of both halves in the act of breathing, the type of breathing, its frequency, depth and rhythm. The patient should sit or stand completely straight with the torso bare to the waist, evenly illuminated from all sides.

2.1. Determining the shape of the chest

To determine the shape of the chest it is necessary to examine:

chest diameters;

supra- and subclavian fossae;

angle of connection between the body and the manubrium of the sternum;

epigastric (epigastric) angle;

direction of the ribs in the lateral parts of the chest;

adhesion of the shoulder blades to the chest.

2.1.1. Study of chest diameters

There are two diameters:

costal (transverse or lateral).

They are determined using a special compass, the legs of which are installed in certain places of the chest. So, to determine the first diameter, one leg of the compass is placed on the sternum area, and the other on the spine at the same level. To measure the second diameter, the legs of the compass are placed on symmetrical points along the middle axillary lines. In practice, most often, to determine the diameters of the chest, a centimeter tape is used, with which the doctor measures both diameters, projecting them onto the patient’s chest. Normally, in adults, the sternovertebral diameter is smaller than the costal diameter.

2.1.2. Study of the supraclavicular and subclavian fossae

The supraclavicular and subclavian fossae may be of varying degrees of severity or absent (“smoothed”), for example, in obese people or in people with a hypersthenic physique. Along with a visual assessment of the condition of the supraclavicular and subclavian fossae, they must be palpated.

2.1.3. Study of the angle of connection between the body and the manubrium of the sternum

This angle is determined visually and is called the Louis angle. It serves as an identification point for the P edge, from which edges are usually counted. The degree of its severity can vary - from significant to complete smoothness.

2.1.4. Study of the epigastric (epigastric) angle

This angle is formed by the costal arches. To determine the size of the epigastric angle, the palmar surfaces of the thumbs are pressed tightly against the costal arches, and their ends rest against the xiphoid process. The epigastric angle can be acute, straight or obtuse.

2.1.5. Study of the direction of the ribs in the lateral parts of the chest

The direction of the ribs in the lateral parts of the chest in thin people can be determined visually, in overweight people - by palpation. The ribs in the lateral sections have an oblique, vertical or horizontal direction.

2.1.6. Study of intercostal spaces

Intercostal spaces are determined both visually and by palpation. Palpation is performed simultaneously on both sides of the chest or alternately on each side. The researcher's fingers are placed only in one intercostal space, then in the next intercostal space, etc. The intercostal spaces can be widened or reduced, drawn inward, smoothed or bulging.

2.1.7. The fit of the shoulder blades to the chest

It is determined both visually and by palpation. The shoulder blades can fit tightly to the chest and be located at the same level, wing-shaped behind the chest and be at different levels.

Shapes of the chest in a healthy person

Normal forms of the chest, depending on the constitutional type, include normosthenic (conical), hypersthenic and asthenic.

1.Normosthenic (conical) chest in persons of normosthenic physique. The anteroposterior (sternovertebral) size is smaller than the lateral (transverse) size. The ratio of anteroposterior to transverse dimensions is in the range of 0.65 - 0.75. The supraclavicular and subclavian fossae are poorly marked. The angle formed by the body of the sternum and its manubrium is clearly visible; the epigastric angle approaches 90°. The ribs in the lateral sections have a moderately oblique direction; the shoulder blades fit snugly to the chest and are located at the same level; The thoracic section of the body is approximately equal in height to the abdominal section.

2. Hypersthenic chest in persons with a hypersthenic physique. Its anteroposterior size approaches the lateral one; the ratio of the anteroposterior to transverse dimensions is greater than 0.75. The hypersthenic chest is characterized by a predominance of the transverse size over the longitudinal; it is wide but short. The supraclavicular and subclavian fossae are not visible, “smoothed out”. The angle of connection between the body and the manubrium of the sternum is pronounced; the epigastric angle is obtuse (more than 90°). The ribs have an almost horizontal direction, the intercostal spaces are narrow. The shoulder blades fit snugly to the back of the chest.

3. Asthenic chest in persons of asthenic physique. It is elongated, narrow and flat, i.e. has the shape of a cylinder flattened in the anteroposterior direction. The longitudinal size of the asthenic chest significantly prevails over the transverse one, as a result of which it looks long. The absolute values of the anteroposterior and lateral dimensions are reduced, the lateral dimension prevails over the anteroposterior, and therefore the chest of an asthenic is flat. The ratio of anteroposterior to lateral dimensions is less than 0.65. The supraclavicular and subclavian fossae stand out sharply. The ribs have an oblique direction and approach vertical. There is no angle of connection between the sternum and its manubrium - the sternum and its manubrium form a straight “plate”. Epigastric angle less than 90°. The tenth ribs are not attached to the costal arch, the intercostal spaces are widened, the shoulder blades are wing-shaped behind the chest.

2.2. Determination of the symmetry of the right and left halves of the chest and their participation in the act of breathing

After a general examination of the chest, you should determine whether both halves are symmetrical. Normally, both halves of the chest are almost the same size. A slight predominance of the right half over the left is normal and is associated with greater development of the muscles of the right shoulder girdle. In left-handed people, both halves of the chest are equal or the left half may be slightly dominant.

The symmetry or asymmetry of the halves of the chest can be objectified through comparative measurement. To do this, with the patient’s arms raised, a measuring tape is placed on the chest from the middle of the sternum to the spinous process of the vertebra lying at the same level, after which the patient lowers his arms. In order not to miss the increase or decrease of any part of one of the halves of the chest, it is necessary to take measurements at several levels either during inhalation or during exhalation. During the measurement, the subject should hold his breath as much as possible.

A static examination of the chest does not always allow one to decide which of the two halves, unequal in volume, is normal and which is pathological. That is why a static examination of the chest should always be supplemented by a dynamic one, in which the degree of participation of each half in the act of breathing is determined. Normally, in healthy people, both halves of the chest are equally involved in the act of breathing. To judge the synchronicity of movement of the right and left halves of the chest, the patient is asked to breathe deeply and monitor the angles of the shoulder blades. If during deep breathing they rise to the same level, it means that both halves are equally involved in the act of breathing; if one of the shoulder blades remains lower, this indicates a lag in the corresponding half of the chest. The half that lags behind in the act of breathing is pathological. In order to obtain more accurate data, inspection is combined with palpation. To do this, hands are placed on the chest in such a way that the end phalanges of the thumbs are at the corners of the shoulder blades, and the remaining fingers, slightly apart, are placed along the lateral surfaces of the chest. With normal mobility of both halves of the chest, the thumbs rise to the same level on the right and left, and the remaining fingers, due to the expansion of the chest in the lateral directions, move slightly apart. If one of the halves lags behind, the thumb on the corresponding side will be lower.

To study the mobility of the chest, its circumference is measured in the position of inhalation and exhalation. The difference between these figures reflects her excursion. With quiet breathing, the chest excursion does not exceed 2 - 3 cm. The maximum chest excursion ranges from 7.0 to 8.5 cm (the position of maximum inhalation and maximum exhalation). The chest circumference is measured with a measuring tape, preferably with the patient standing and arms down. The patient should not change his position. You need to make sure that the tape runs at the angle of the shoulder blades at the back and at the level of the 4th rib at the front.

When examining the chest, it is necessary to pay attention to the participation of auxiliary respiratory muscles in the act of breathing. Normally, these muscles, like the abdominal muscles, do not participate in the act of breathing.

2.3. Determination of the type, frequency, depth and rhythm of breathing

The following types of breathing are distinguished: chest, abdominal and mixed. If the expansion of the chest during breathing occurs mainly due to the contraction of the intercostal muscles, then this type of breathing is called thoracic, or costal. In this case, the chest during inhalation noticeably expands and rises slightly, and during exhalation it narrows and falls slightly. To better understand the chest type of breathing, we can say that this is “chest” breathing. The chest type of breathing is characteristic mainly of women.

When the diaphragm takes the main part in expanding the chest, this type of breathing is called diaphragmatic, or abdominal, since during inhalation the protrusion of the upper abdomen is noticeable. The abdominal type of breathing, or “belly” breathing, is more common in men.

If breathing movements are performed simultaneously due to contraction of the intercostal muscles and the diaphragm, then this type of breathing is called mixed. Breathing involves the lower chest and upper abdomen. Mixed breathing is observed in older people.

Respiratory rate is determined by monitoring breathing. For this purpose, a palm is placed on the epigastric region of the subject and the number of complete respiratory cycles (breathing movements) per minute is calculated by lifting the subclavian region with each inhalation. Inhalation corresponds to the raising of the palm, and exhalation corresponds to its lowering. With noisy breathing, its frequency can be determined at a distance from the patient. It is best if he does not realize that his breathing is being counted, otherwise he may unwittingly change its frequency. To distract the subject's attention, you can simultaneously place the fingers of the other hand on the radial artery to simulate palpating the pulse or simulate determining the pulse rate and at the same time follow the respiratory movements of the chest with your eyes. For an accurate determination, you should count your breathing rate for at least one minute.

The number of breaths per minute in a healthy person at rest ranges from 12 to 18, averaging 16 respiratory movements. Significant changes in respiratory rate can be expressed either by an increase in frequency (tachypnea) or a decrease in frequency (bradypnea). Under physiological conditions, a sharp increase in breathing occurs during nervous excitement, during and immediately after physical stress. However, such an increase is usually short-lived and quickly passes after the cause that caused it is eliminated.

During the study, it is necessary to pay attention to the relationship between respiratory rate and pulse rate. Usually it is 1:4.

In addition to determining the frequency of breathing, during examination you can establish its depth and rhythm.

The depth of breathing is determined by the volume of inhaled and exhaled air in a calm state. In adults, under physiological conditions, the volume of respiratory air ranges from 300 to 900 ml, averaging 500 ml. A change in breathing rate is usually combined with a change in its depth. Rapid breathing is usually shallow, as inhalation and exhalation become shorter. Slow breathing, on the contrary, is usually deep.

The breathing rhythm of a healthy person is correct, which is expressed in the same duration and the same depth of each respiratory movement - inhalation and exhalation. The pause is practically not defined. An exception may be a slight respiratory arrhythmia in healthy people during sleep.

3. Palpation of the chest

3.1. Techniques and rules of palpation

Palpation (feeling) of the chest as a research method consists of independent methodological techniques that allow:

clarify the examination data regarding the shape of the chest and the nature of breathing (see section “Inspection of the chest”);

if there is pain in the chest, determine its location and severity;

determine the resistance (elasticity) of the chest;

if the pleura is affected, detect the pleural friction noise and the sound of liquid splashing.

When palpating the chest, it is necessary to follow the general rules: carry it out in a warm room with the palmar surfaces of the fingers of one or both hands in symmetrical areas; the examiner’s hands should be sufficiently warm, nails should be cut short; if palpation causes pain, it should be done with extreme caution.

To accurately indicate the localization of changes in the chest area, it is conventionally divided by generally accepted horizontal and vertical identification lines. Horizontal lines are located along the ribs and intercostal spaces. Vertical lines - anterior median, sternal right and left, midclavicular right and left; anterior, middle and posterior axillary, scapular, paravertebral, posterior median.

Palpation is carried out methodically, starting from the upper sections in front. The skin and subcutaneous fat, muscles, ribs, sternum, shoulder blades, spine, intercostal spaces are palpated.

The thickness of the skin fold in symmetrically located areas of the chest is determined by palpation. To do this, take the skin fold with the index and thumb of both hands at the same time.

3.2. Determination of resistance (elasticity) of the chest

The study of the resistance (elasticity) of the chest is carried out by squeezing it in the anteroposterior and lateral directions, as well as palpating the intercostal spaces.

With compression in the anteroposterior direction, the palm of the right hand is placed on the area of the middle of the sternum, the left hand is placed on the interscapular space at the same level. Compression of the chest in the lateral direction is performed along the axillary lines closer to the armpits. When palpating the intercostal spaces, the researcher's fingers are placed only in one intercostal space, both on the right and on the left. Normally, in young people, when palpating the chest and intercostal spaces, a feeling is created of their elasticity, pliability, they seem to be springing. With age, the elasticity of the chest decreases, it becomes less pliable and rigid (rigidity is increased resistance).

3.3. Definition of the phenomenon of vocal tremors

The phenomenon of vocal tremor is a palpable sensation of vibration in the patient’s chest when speaking or pronouncing individual words containing the letter “P”. The vibration of the vocal cords that occurs when pronouncing these words is transmitted through the bronchi to the chest.

The palms of the hands are placed on symmetrical areas of the chest, and then the patient is asked to loudly pronounce several words that contain the letter “P” (for example, “thirty-three”, “three hundred thirty-three”, “forty three”, “forty four”). Voice tremor is studied on symmetrical areas of the chest, starting from the top in front. In this case, the degree of vibration of the chest on the right and left is assessed. Normally, vocal tremor is better felt over the upper parts of the chest, and weaker over its lower parts. Increased vocal fremitus in the upper chest is explained by a shorter distance from the glottis to this area. Moreover, on the right side in the upper section, vocal tremor in healthy people is slightly stronger than on the left, which is due to the shorter and straighter right bronchus. Voice tremors are better detected in men with low voices and in people with thin chests, and weaker in women and children with high-pitched voices, as well as in obese people.

4.1. Rules

Percussion of the lungs as a research method consists of tapping on the surface of the chest in order to judge the physical properties of the respiratory organs by the nature of the resulting sound. Percussion of the lungs allows you to identify pathological changes in any part of the lung, determine the boundaries of the lungs and the mobility of their lower edge.

The patient's position during lung percussion should be vertical: standing or sitting. The doctor, percussing the anterior and lateral walls of the chest, is in front of the subject, and when percussing the posterior surface, he is behind him. When percussing the front surface, the patient stands with his arms down, the side surfaces with his hands behind his head, the back surface with his head down, slightly bent forward, with his arms crossed, with his hands on his shoulders so as to move the shoulder blades away from the spine as much as possible. The muscles of the upper shoulder girdle should be relaxed, since even slight muscle tension can change the percussion sound.

Possible pathological changes in the lungs or pleura can be detected using comparative percussion, i.e. percussion strictly on symmetrical areas of the chest. In this case, the percussion sound obtained in this area is compared with that in a symmetrical area of the other half of the chest.

4.2. Method of comparative lung percussion

Comparative percussion of the lungs begins in the front in the supraclavicular fossae (above the apices of the lungs). The pessimeter finger is first placed parallel to the collarbone, then directly along the collarbones. Using a hammer finger, apply uniform blows first on the collarbones (direct percussion according to Yanovsky F.G.), then below the collarbones (in the first and second intercostal spaces). The pessimeter finger is placed in the intercostal spaces parallel to the ribs in strictly symmetrical areas of the right and left halves of the chest.

In the 3rd and lower intercostal spaces in front, comparative percussion is not performed, since from the 3rd intercostal space on the left, dullness of the percussion sound from the adjacent heart begins. You can only percuss below, along the parasternal line, comparing the sounds obtained by percussion in the 3rd, 4th and 5th intercostal spaces.

In the lateral areas of the chest, percussion is performed in the axillary fossa and along the 4th and 5th intercostal spaces. The pessimeter finger in the axillary areas is placed in the intercostal spaces parallel to the rib. In the 6th intercostal space, comparative percussion along the axillary lines is not carried out, since on the right in this intercostal space the dullness of sound from the adjacent liver begins, and on the left the sound acquires a tympanic hue due to the proximity of the gas bubble of the stomach.

From behind, comparative percussion is carried out in the suprascapular areas, in the upper, middle and lower parts of the interscapular spaces and under the shoulder blades - in the 8th and 9th intercostal spaces. The pessimeter finger is installed horizontally in the suprascapular region, and vertically in the interscapular spaces, parallel to the spine; under the shoulder blades - horizontally, parallel to the ribs.

4.3. Types of percussion sound and conditions for its appearance during comparative percussion of the lungs

Over the lungs of a healthy person, during percussion, a clear pulmonary sound is heard, which is mainly due to vibrations of the dense elements of the alveoli and the air contained in them. A clear pulmonary sound is a clear (loud), full (long-lasting), rather low and non-tympanic percussion sound.

During comparative percussion of the lungs of a healthy person, the percussion sound in symmetrical areas may not be exactly the same. This depends on the mass or thickness of the pulmonary layer, muscle development, and the effect on the percussion sound of neighboring organs.

A quieter and shorter percussion sound is determined by:

above the right apex - due to the shorter right upper bronchus, which reduces its airiness, and greater development of the muscles of the right shoulder girdle;

in the 2nd and 3rd intercostal spaces on the left due to the closer location of the heart;

over the upper lobes of the lungs compared to the lower lobes as a result of different thicknesses of air-containing lung tissue;

in the right axillary region compared to the left due to the proximity of the liver.

The difference in percussion sound in the latter case is also due to the fact that the stomach is adjacent to the diaphragm and lung on the left, the bottom of which is filled with air and, upon percussion, gives a loud tympanic sound (Traube's semilunar space). Therefore, the percussion sound in the left axillary region, due to resonance from the “air bubble” of the stomach, becomes louder and higher, with a tympanic tint. Traube's space is limited on the right by the edge of the left lobe of the liver, on the left by the spleen, above by the lower border of the heart and the lower edge of the left lung, below by the left costal arch. When fluid accumulates in the left pleural cavity, Traube's space disappears, since the pleural sinus is filled with exudate and the percussion blow does not reach the gas bubble of the stomach.

4.4. Determination of the boundaries of the lungs and mobility of the lower edge of the lungs

Determination of the boundaries of the lungs and the mobility of their lower edge is carried out by the method of topographic percussion, which is based on determining the line of transition of one sound to another.

Topographic percussion allows you to establish:

the upper borders of the lungs or the height of the apexes and their width (the width of the Krenig fields);

lower borders of the lungs;

mobility of the lower edge of the lungs.

4.4.1. Determination of the upper boundaries of the lungs or the height of the apexes

The height of the tops is determined from the front and back. On this day, the front finger-pessimeter is installed in the supraclavicular fossa. Percussion is carried out in an oblique direction from the middle of the collarbone upward to a dull sound. A mark is made on the side of the pessimeter finger that faces the clear pulmonary sound, the collarbone. Normally, the height of the apex ranges from 3 to 4 cm. The right apex is 1 cm lower than the left.

To determine the posterior height of the apex, a finger-pessimeter is installed in the middle of the suprascapular fossa at the scapular crest, and then moved in the direction of the 7th cervical vertebra until a dull sound occurs. The mark is made on the side of the clear pulmonary sound. Normally, the height of the apex on the back right and left corresponds to the level of the spinous process of the 7th cervical vertebra.

4.4.2. Determining the width of the Krenig margins

The Kroenig field is a band of clear pulmonary sound that extends in front from the clavicle back to the scapula. The width of the Krenig field is determined as follows: the pessimeter finger is installed in the middle of the upper edge of the trapezius muscle. Then percussion is carried out from the middle of this muscle along its upper edge to the shoulder until there is a dull sound. A mark is made on the side of the clear pulmonary sound. Next, percussion is carried out again from the middle of the trapezius muscle along its upper edge to the neck until a dull sound occurs. The mark is placed on the side of the clear pulmonary sound. The distance in centimeters between two marks is the width of the Kroenig field. Normally it ranges from 5 to 8 cm.

4.4.3. Determination of the lower border of the lungs

First, the lower border of the right lung is determined, i.e. establish the hepatopulmonary boundary. For this purpose, tap from above, going down along the intercostal spaces (starting from the 2nd intercostal space) along the periosternal, midclavicular, axillary and scapular lines. On the left, it is customary to begin determining the lower border from the anterior axillary line. To determine the lower border of the lungs, quiet percussion is used. The pessimeter finger is installed on the corresponding line parallel to the desired boundary and gradually moves towards it. The displacement of the pessimeter finger down to the expected border should not exceed its width. Percussion is carried out both along the ribs and intercostal spaces until a dull sound occurs. The mark is placed on the side of the pessimeter finger that faces the clear pulmonary sound. The boundaries along all lines, excluding the paravertebral line, are assigned to the corresponding ribs. The border along the paravertebral line is referred to as the spinous process of the corresponding vertebra, since it is impossible to palpate the ribs near the spine due to the powerful back muscles. The location of the lower border of the lungs in people of different builds is not entirely the same. In typical hypersthenics it is one rib higher, and in asthenics it is one rib lower.

Table 1.1. Lower limit of the lungs in normosthenics

How to determine your body type?

Determine your body type! Training mode!

Good day to everyone who visited the site about Natural Bodybuilding! From this post you will get information on how to determine your body type. I think this article will be very useful for beginning bodybuilders, as well as girls and women. I ask smart people to walk by. So.

From a physiological point of view, there are three fundamental types of human physique - asthenic (ectomorph), normosthenic (mesomorph) and hypersthenic (endomorph). Each specific type has individual characteristics of muscle development and requires appropriate training and nutrition.

In order to find out your body type, it is enough to use a simple and accessible method - measure the thickness of the wrist of your right (or left - if you are left-handed) hand. An ectomorph has a circumferential wrist thickness of no more than 17.5 cm, a mesomorph has 17.5-20 cm, and for an endomorph this figure exceeds 20 cm.

In general, I believe that the most accurate way to find out your type is to determine the epigastric angle of the chest. The epigastric angle is measured between the costal arches, see the figure below.

a. Hypersthenic-Endomorph, obtuse epigastric angle.

b. Normosthenic-Mesomorph, right epigastric angle.

V. Asthenic-ectomorph, acute epigastric angle.

This applies to both men and women.

So, let's determine your body type, diet and training regimen.

1. Who is an ectomorph, type of training and nutrition?

Ectomorphs or Asthenics have a body type characterized by tall stature, elongated long limbs, thin bones, long and thin muscle fibers. People with this type of build have a low rate of muscle development, however, the percentage of body fat is low - this is their noticeable advantage when gaining lean muscle mass. How to gain weight for an asthenic person?

For ectomorphs, the most important factor in body building is proper high-calorie nutrition. Hyposthenics, in order to get their body weight off the ground, need to increase the calorie content of their diet to more than 3.5-4 thousand calories per day. To increase the calorie content in the diet, it is recommended to use gainers as a source of essential carbohydrates.

Ectomorph workouts are designed with an emphasis on heavy compound exercises, such as deadlifts, squats, and bench presses - three or two heavy workouts per week. Taking this into account, isolation exercises and cardio training are kept to a minimum, and the average training duration is no more than an hour.

A separate training day is allocated for each basic exercise; the optimal option for such training is 2-3 exercises of 3-4 sets of 6-10 repetitions. It is important to maintain a sufficiently long rest between sets (from two to three minutes) and limit the use of auxiliary exercises after the basic one - 1-2 “auxiliary” exercises will be enough for ectomorphs.

2. Who is a mesomorph, type of training and nutrition?

Mesomorphs or Normosthenics differ from nature in having a developed muscular skeleton, strong bones of moderate size, their muscle mass initially occupies a significant part of the body weight. Body fat content is relatively average.

Such people have beautiful correct proportions of limbs, wide rounded shoulders, and a massive chest. The mesomorph's metabolism is ideally suited to convert nutrients into muscle fiber growth. Mesomorphs have the greatest tendency to gain muscle mass and, with proper training, can get good results in bodybuilding in the shortest possible time.

The diet of a mesomorph bodybuilder should consist of high-quality healthy food. It is important to limit the consumption of fast carbohydrates – foods that lead to a gain of “fat” mass.

Mesomorph training should combine aerobic and strength components. You can dedicate one training day a week purely to aerobic and cardio exercises. The principle of strength training is generally similar to training ectomorphs - the heaviest working weights, short training duration - 3-4 exercises of 4 sets of 8-12 repetitions.

However, unlike asthenics, mesomorphs can expand the arsenal of auxiliary and isolating exercises, since it is easier for them to recover after heavy strength training.

3. Who is an endomorph, type of training and nutrition?

Endomorphs or Hypersthenics are people who tend to be overweight, characterized by short stature (in relation to weight) and wide bones. Hypersthenics have a fairly high body fat content and have a slow metabolism.

For good results in the body structure, the endomorph must follow a strict diet and almost completely give up fast carbohydrates and saturated fats. It is also important to consume starchy foods such as rice or potatoes in moderation. The diet of an endomorph should include a large amount of foods containing fiber and protein. The most preferred food for this is various vegetables, boiled meat and fish.

The optimal training regimen for an endomorph or hypersthenic is alternating cross-fit and cardio training with heavy strength training, in an approximate ratio of 65/35%. The cross-fit program and aerobic exercise allow hypersthenics to work in the mode of maximum elimination of adipose tissue, and heavy strength loads will give an additional signal to the body aimed at overall muscle growth.

It is worth noting the necessary frequency of training for an endomorph - the more regularly he trains, the better the fat layer is lost. Naturally, you shouldn’t force yourself into daily cardio training; it’s important to think through a program with 4-5 training days a week, 3-5 exercises of 4 sets of repetitions.

For more information about training for each body type, its intensity, approaches and repetitions, you can find information in the “PROGRAMS” section.

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The hypersthenic chest (in persons with a hypersthenic physique) has the shape of a cylinder. Its anteroposterior size approaches the lateral one; supraclavicular fossae are absent, “smoothed out”. The angle of connection between the body and the manubrium of the sternum is pronounced; epigastric angle is greater than 90°. The direction of the ribs in the lateral sections of the chest approaches horizontal, the intercostal spaces are reduced, the shoulder blades fit tightly to the chest, the thoracic region is smaller than the abdominal region.

The asthenic chest (in persons of asthenic build) is elongated, narrow (both the anteroposterior and lateral dimensions are reduced), flat. The supraclavicular and subclavian fossae are clearly defined. There is no angle of connection between the sternum and its manubrium: the sternum and its manubrium form a straight “plate”. Epigastric angle less than 90°. The ribs in the lateral sections acquire a more vertical direction, the X ribs are not attached to the costal arch (costa decima fluctuans), the intercostal spaces are widened, the shoulder blades are wing-shaped behind the chest, the muscles of the shoulder girdle are poorly developed, the shoulders are lowered, the thoracic region is larger than the abdominal region.

The pathological forms of the chest are as follows: 1. Emphysematous (barrel-shaped) chest in its shape resembles a hypersthenic one. It differs from the latter in its barrel-shaped shape, bulging of the chest wall, especially in the posterolateral sections, and an increase in the intercostal spaces. Such a chest develops as a result of chronic emphysema of the lungs, in which their elasticity decreases and their volume increases; the lungs are as if in the inhalation phase. Therefore, natural exhalation during breathing is significantly difficult, and the patient experiences expiratory shortness of breath not only when moving, but often at rest. When examining the chest of patients with pulmonary emphysema, one can see the active participation in the act of breathing of the auxiliary respiratory muscles, especially the sternocleidomastoid and trapezius, retraction into the intercostal spaces, upward lifting of the entire chest during inhalation, and relaxation of the respiratory muscles during exhalation muscles and lowering the chest to its original position.

2. The paralytic chest resembles an asthenic one in its characteristics. It occurs in severely malnourished people, with general asthenia and poor constitutional development, for example in those suffering from Marfan's disease, often with severe chronic diseases, more often with pulmonary tuberculosis. Due to the progression of chronic inflammation, fibrous tissue developing in the lungs and pleura leads to their shrinkage and a decrease in the total surface of the lungs. When examining patients with a paralytic chest, along with signs typical of an asthenic chest, one often notices pronounced atrophy of the chest muscles, asymmetrical arrangement of the clavicles, and unequal retraction of the supraclavicular fossae. The shoulder blades are located at different levels and during the act of breathing they shift asynchronously (not simultaneously).

3. Rachitic (keel-shaped, chicken) chest - pectus carinatum (from Latin pectus - chest, carina - keel of a boat) is characterized by a pronounced increase in anteroposterior size due to the sternum protruding forward in the form of a keel. In this case, the anterolateral surfaces of the chest wall seem to be compressed on both sides and, as a result, connect to the sternum at an acute angle, and the costal cartilages at the site of their transition into the bone thicken clearly (“rachitic rosary”). In persons who previously suffered from rickets, these “rosaries” can usually be palpated only in childhood and adolescence.

4. The funnel-shaped chest in its shape can resemble normosthenic, hypersthenic or asthenic and is also characterized by a funnel-shaped depression in the lower part of the sternum. This deformity is considered as a result of an abnormal development of the sternum or long-term compression on it. Previously, such deformation was observed in teenage shoemakers; the mechanism of formation of the “funnel” was explained by the daily long-term pressure of the shoe last: one end of it rested on the lower part of the sternum, and the shoe blank was pulled on the other. Therefore, the funnel-shaped chest was also called the “shoemaker's chest.”

5. The scaphoid chest is distinguished by the fact that the depression here is located mainly in the upper and middle parts of the anterior surface of the sternum and is similar in shape to the depression of a boat (rook). This anomaly has been described in a rather rare disease of the spinal cord - syringomyelia.

6. Deformation of the chest is also observed in spinal curvatures that occur after injury, spinal tuberculosis, ankylosing spondylitis (Bechterew's disease), etc. There are four variants of spinal curvature: 1) curvature in lateral directions - scoliosis (scoliosis); 2) backward curvature with the formation of a hump (gibbus) - kyphosis; 3) forward curvature - lordosis; 4) a combination of sideways and posterior curvature of the spine - kyphoscoliosis.

Scoliosis is the most common. It develops mainly in school-age children when sitting incorrectly at a desk, especially if it does not correspond to the student’s height. Spinal kyphoscoliosis and very rare lordosis are much less common. Curvatures of the spine, especially kyphosis, lordosis and kyphoscoliosis, cause a sharp deformation of the chest and thereby change the physiological position of the lungs and heart in it, creating unfavorable conditions for their activity.

7. The shape of the chest can also change due to an increase or decrease in the volume of only one half of the chest (chest asymmetry). These changes in its volume can be temporary or permanent.

An increase in the volume of one half of the chest is observed when a significant amount of inflammatory fluid, exudate, or non-inflammatory fluid - transudate effusions into the pleural cavity, as well as as a result of the penetration of air from the lungs during injury. During examination, on the enlarged half of the chest, one can see smoothness and bulging of the intercostal spaces, an asymmetrical arrangement of the clavicles and shoulder blades, and a lag in the movement of this half of the chest during the act of breathing from the movement of the unchanged half. After resorption of air or fluid from the pleural cavity, the chest in most patients acquires a normal symmetrical shape.

A decrease in the volume of one half of the chest occurs in the following cases:

due to the development of pleural adhesions or complete fusion of the pleural fissure after resorption of exudate that has been in the pleural cavity for a long time;

when a significant part of the lung shrinks due to the proliferation of connective tissue (pneumosclerosis), after acute or chronic inflammatory processes (lobar pneumonia with subsequent development of lung carnification, pulmonary infarction, abscess, tuberculosis, pulmonary syphilis, etc.);

after surgical removal of part or the whole lung;

in the case of atelectasis (collapse of the lung or its lobe), which can occur as a result of blockage of the lumen of a large bronchus by a foreign body or tumor growing in the lumen of the bronchus and gradually leading to its obstruction. In this case, the cessation of air flow into the lung and the subsequent resorption of air from the alveoli lead to a decrease in the volume of the lung and the corresponding half of the chest.

Due to the reduction of one half, the chest becomes asymmetrical: the shoulder on the side of the reduced half is lowered, the collarbone and scapula are located lower, their movements during deep inhalation and exhalation are slow and limited; the supraclavicular and subclavian fossae sink more deeply, the intercostal spaces are sharply reduced or not expressed at all.

13. Inspiratory and expiratory dyspnea. Various forms of breathing rhythm disturbances. The concept of respiratory failure. Graphic recording of breathing rhythm disturbances. Shortness of breath (dyspnea) is a violation of the frequency and depth of breathing, accompanied by a feeling of lack of air.

By its nature, pulmonary dyspnea can be: inspiratory, in which it is mainly difficult to inhale; characteristic of a mechanical obstruction in the upper respiratory tract (nose, pharynx, larynx, trachea). In this case, breathing is slowed down, and with a pronounced narrowing of the airways, the inhalation becomes loud (stridor breathing). expiratory shortness of breath - with difficulty exhaling, observed with a decrease in the elasticity of the lung tissue (emphysema) and with narrowing of the small bronchi (bronchiolitis, bronchial asthma). mixed shortness of breath - both phases of respiratory movements are difficult, the reason is a decrease in the area of the respiratory surface (with inflammation of the lung, pulmonary edema, compression of the lung from the outside - hydrothorax, pneumothorax).

Breathing rhythm. The breathing of a healthy person is rhythmic, with the same depth and duration of the inhalation and exhalation phases. In some types of shortness of breath, the rhythm of respiratory movements may be disrupted due to changes in the depth of breathing (Kussmaul breathing is pathological breathing, characterized by uniform, rare, regular respiratory cycles: deep noisy inhalation and intense exhalation. Usually observed with metabolic acidosis due to uncontrolled diabetes mellitus or chronic renal failure in patients in serious condition due to dysfunction of the hypothalamic part of the brain, in particular in diabetic coma.This type of breathing was described by the German doctor A. Kussmaul), the duration of inhalation (inspiratory dyspnea), exhalation (expiratory dyspnea) and the respiratory pause.

A dysfunction of the respiratory center can cause a type of shortness of breath in which, after a certain number of respiratory movements, a visible (from several seconds to 1 minute) prolongation of the respiratory pause or short-term breath holding (apnea) occurs. This type of breathing is called periodic breathing. There are two types of dyspnea with periodic breathing:

Biot's breathing is characterized by rhythmic but deep respiratory movements, which alternate at approximately equal intervals with long (from several seconds to half a minute) respiratory pauses. It can be observed in patients with meningitis and in an agonal state with deep cerebrovascular accident. Cheyne-Stokes breathing (from a few seconds to 1 minute) respiratory pause (apnea) first appears silent shallow breathing, which quickly increases in depth, becomes noisy and reaches a maximum on the 5-7th breath, and then decreases in the same sequence and ends with the next regular short pause. Sometimes during a pause, patients are poorly oriented in their surroundings or completely lose consciousness, which is restored when breathing movements are resumed. This kind of breathing rhythm disturbance occurs in diseases that cause acute or chronic cerebral circulatory failure and brain hypoxia, as well as in severe intoxication. It often manifests itself during sleep and often occurs in older people with severe atherosclerosis of the cerebral arteries. Periodic breathing also includes the so-called wave breathing, or Grocco breathing. In its form, it is somewhat reminiscent of Cheyne-Stokes breathing, with the only difference that instead of a respiratory pause, weak shallow breathing is observed, followed by an increase in the depth of respiratory movements, and then its decrease. This type of arrhythmic shortness of breath, apparently, can be considered as a manifestation of an earlier stages of the same pathological processes that cause Cheyne-Stokes respiration. Currently, it is customary to define respiratory failure as a condition of the body in which the maintenance of normal blood gas composition is not ensured or it is achieved through more intensive work of the external respiratory apparatus and heart, which leads to a decrease in the functional capabilities of the body. It should be borne in mind that the function of the external respiration apparatus is very closely related to the function of the circulatory system: in case of insufficient external respiration, increased work of the heart is one of the important elements of its compensation. Clinically, respiratory failure is manifested by shortness of breath, cyanosis, and in the late stage - in the case of the addition of heart failure - by edema.

14. Determination of the type of breathing, symmetry, frequency, depth of breathing, respiratory excursion of the chest.

When measuring chest circumference, it is advisable to compare the distance from the middle of the sternum to the spinous process of the vertebra on both sides.

When comparing the duration of inhalation and exhalation, it is necessary to pay attention to the intensity of the noise created by the air flow in both phases of breathing.

Normally, the chest has a regular, symmetrical shape. In normosthenics, it has the shape of a truncated cone, with its apex facing downwards, its anteroposterior size is 2/3-3/4 of the transverse size, the intercostal spaces, supra- and subclavian fossae are not clearly expressed, the direction of the ribs in the inferolateral sections is moderately oblique, the epigastric angle approaches direct

In asthenics, the chest is narrow and flattened due to a uniform decrease in its anteroposterior and transverse dimensions, the supra- and subclavian fossae are deep, the intercostal spaces are wide, the ribs go steeply down, the epigastric angle is acute.

In hypersthenics, the anteroposterior and transverse dimensions of the chest, on the contrary, are uniformly increased, so it appears wide and deep, the supra- and subclavian fossae are barely outlined, the intercostal spaces are narrowed, the direction of the ribs approaches horizontal, the epigastric angle is obtuse.

Changes in the shape of the chest may be due to pathology of the lung tissue or improper formation of the skeleton during development.

15. Palpation of the chest. Determination of pain, elasticity of the chest. Determination of vocal tremors, the reasons for its strengthening or weakening.

First, the degree of resistance of the chest is determined, then the ribs, intercostal spaces and pectoral muscles are felt. After this, the phenomenon of vocal tremors is examined. The patient is examined in a standing or sitting position. The resistance (elasticity) of the chest is determined by its resistance to compression in various directions. First, the doctor places the palm of one hand on the sternum, and the palm of the other on the interscapular space, while both palms should be parallel to each other and at the same level. With jerking movements it compresses the chest in the direction from back to front (Fig. 36a).

Then, in a similar way, alternately compresses both halves of the chest in the anteroposterior direction in symmetrical areas. After this, place your palms on symmetrical areas of the lateral sections of the chest and compress it in the transverse direction (Fig. 36b). Next, placing your palms on symmetrical areas of the right and left halves of the chest, sequentially palpate the ribs and intercostal spaces in front, from the sides and from behind. The integrity and smoothness of the surface of the ribs are determined, and painful areas are identified. If there is pain in any intercostal space, the entire intercostal space from the sternum to the spine is felt, determining the extent of the area of pain. It is noted whether the pain changes when breathing and bending the body to the sides. The pectoral muscles are felt by grasping them in the fold between the thumb and forefinger.

Normally, when compressed, the chest is elastic and pliable, especially in the lateral sections. When feeling the ribs, their integrity is not broken, the surface is smooth. Palpation of the chest is painless.

The presence of increased resistance (rigidity) of the chest to the pressure exerted on it is observed with significant pleural effusion, large tumors of the lungs and pleura, emphysema, as well as with ossification of the costal cartilages in old age. Pain in the ribs in a limited area may be due to their fracture or inflammation of the periosteum (periostitis). When a rib is fractured, a characteristic crunch appears at the site of palpable pain when breathing, due to the displacement of bone fragments. With periostitis, in the area of the painful area of the rib, its thickening and uneven surface are felt. Periostitis of the III-V ribs to the left of the sternum (Tietze syndrome) can mimic cardialgia. In patients who have suffered rickets, in the places where the bony part of the ribs passes into the cartilaginous part, thickenings are often determined by palpation - “rickets rosaries”. Diffuse pain in all ribs and sternum upon palpation and tapping on them often occurs with bone marrow diseases.

Pain that occurs on palpation of the intercostal spaces may be caused by damage to the pleura, intercostal muscles or nerves. Pain caused by dry (fibrinous) pleurisy is often detected in more than one intercostal space, but not throughout the entire intercostal space. This local pain intensifies during inhalation and when the torso is tilted to the healthy side, but it weakens if the mobility of the chest is limited by squeezing it on both sides with the palms. In some cases, in patients with dry pleurisy, when palpating the chest over the affected area, a rough pleural friction noise can be felt.

In the case of damage to the intercostal muscles, pain on palpation is detected throughout the corresponding intercostal space, and with intercostal neuralgia, three pain points are determined by palpation in places of the superficial location of the nerve: at the spine, on the lateral surface of the chest and at the sternum.

Intercostal neuralgia and myositis of the intercostal muscles are also characterized by a connection between pain and breathing, but it intensifies when bending to the painful side. Detection of pain when palpating the pectoral muscles indicates their damage (myositis), which may be the cause of the patient’s complaints of pain in the precordial region.

In patients with significant effusion into the pleural cavity, in some cases it is possible to palpate thickening of the skin and pastosity over the lower parts of the corresponding half of the chest (Wintrich's sign). If the lung tissue is damaged, subcutaneous emphysema of the chest may develop. In this case, areas of swelling of the subcutaneous tissue are visually identified, upon palpation of which crepitus occurs.

Vocal tremors are vibrations of the chest that occur during conversation and are palpably felt, which are transmitted to it from the vibrating vocal cords along the column of air in the trachea and bronchi.

When determining vocal tremor, the patient repeats in a loud, low voice (bass) words containing the sound “r”, for example: “thirty-three”, “forty-three”, “tractor” or “Ararat”. At this time, the doctor places his palms flat on symmetrical areas of the chest, lightly presses his fingers against them and determines the severity of vibrating tremors of the chest wall under each of the palms, comparing the sensations received on both sides with each other, as well as with the vocal tremor in adjacent areas of the chest. If unequal severity of vocal tremor is detected in symmetrical areas and in doubtful cases, the position of the hands should be changed: put the right hand in place of the left, and the left hand in place of the right, and repeat the study.

When determining vocal tremor on the anterior surface of the chest, the patient stands with his arms down, and the doctor stands in front of him and places his palms under the collarbones so that the bases of the palms lie on the sternum and the ends of the fingers are directed outward (Fig. 37a).

Then the doctor asks the patient to raise his hands behind his head and places his palms on the lateral surfaces of the chest so that the fingers are parallel to the ribs and the little fingers are at the level of the 5th rib (Fig. 37b).

After this, he invites the patient to lean forward slightly, lowering his head, and cross his arms over his chest, placing his palms on his shoulders. At the same time, the shoulder blades diverge, expanding the interscapular space, which the doctor palpates by placing his palms longitudinally on both sides of the spine (Fig. 37d). Then he places his palms in the transverse direction on the subscapular areas directly under the lower angles of the shoulder blades so that the bases of the palms are at the spine, and the fingers are directed outward and located along the intercostal spaces (Fig. 37e).

Normally, vocal tremor is moderately expressed, generally the same in symmetrical areas of the chest. However, due to the anatomical features of the right bronchus, vocal tremor over the right apex may be slightly stronger than over the left. With some pathological processes in the respiratory system, vocal tremors over the affected areas may increase, weaken, or disappear completely.

An increase in vocal tremors occurs when the conduction of sound in the lung tissue improves and is usually determined locally over the affected area of the lung. The reasons for increased vocal tremors may be a large focus of compaction and decreased airiness of the lung tissue, for example, with lobar pneumonia, pulmonary infarction, or incomplete compression atelectasis. In addition, vocal trembling can be intensified over a cavity formation in the lung (abscess, tuberculous cavity), but only if the cavity is large, located superficially, communicates with the bronchus and is surrounded by compacted lung tissue.

A uniformly weakened, barely perceptible vocal tremor over the entire surface of both halves of the chest is observed in patients with pulmonary emphysema. It should, however, be taken into account that vocal tremor may be slightly pronounced over both lungs and in the absence of any pathology in the respiratory system, for example, in patients with a high or quiet voice, a thickened chest wall.

The weakening or even disappearance of vocal tremors may also be due to the displacement of the lung from the chest wall, in particular, the accumulation of air or fluid in the pleural cavity. In the case of pneumothorax, weakening or disappearance of vocal tremor is observed over the entire surface of the air-pressed lung, and in the case of effusion into the pleural cavity, usually in the lower parts of the chest above the place of fluid accumulation.

When the lumen of the bronchus is completely closed, for example, due to its obstruction by a tumor or compression from the outside by enlarged lymph nodes, there is no vocal tremor over the collapsed part of the lung corresponding to the given bronchus (complete atelectasis).

16. Percussion of the lungs. Physical justification of the method. Percussion methods. Types of percussion sound.

Percussion (percussio) - tapping, one of the main methods of objective examination of the patient, which consists in tapping areas of the body and determining, by the nature of the sound that arises, the physical properties located under the percussed area of organs and tissues. The nature of the sound depends on the density of the organ, its airiness and elasticity. Based on the properties of the sounds generated during percussion, the physical properties of the organs lying under the tapped area are determined.

Direct percussion - Auenbrugger percussion - is now rarely used; sometimes when determining the boundaries of the heart, during comparative percussion of the lower parts of the lungs, during percussion along the collarbones, although in the latter case we already have a transition from direct to mediocre percussion, since the collarbone plays the role of a plessimeter. With direct percussion, we have a very low intensity of percussion sound and the difficulty of distinguishing sounds from each other, but here we can fully use the sense of touch and the sensation of resistance of the percussed tissues. The development of direct percussion in this direction led to the development of methods that can be called silent percussion methods: this can, for example, to a certain extent include Obraztsov’s clicking method and the stroking or sliding method. For percussion, Obraztsov used a click (strike) with the flesh of the index finger of his right hand as it slipped from the back surface of the middle finger. Stroking or sliding percussion is performed with the flesh of three or four fingers on the exposed surface of the chest. In this way, it is possible, as our own experience convinces us, to determine the boundaries of organs with sufficient accuracy. Mediocre percussion in its various forms, due to the influence of the plessimeter (by which the percussed area is compressed, made denser and more elastic, and therefore more capable of vibration and sound transmission), has two main advantages: the percussion sound becomes louder and more distinct. In addition, with mediocre percussion, there is a much greater possibility of adapting percussion sound for various purposes pursued by percussion. The finger-finger method of percussion has a number of advantages: 1) with it the doctor is independent of the instruments, 2) the finger plesimeter is convenient and easily adapts to any surface of the body , 3) with this method, both acoustic and tactile sensations are used to evaluate research data, 4) once you master this method of percussion, it is not difficult to master others. The middle or, less commonly, index finger of the left hand serves as a plessimeter. For this purpose, it is applied with its palmar surface to the percussed area tightly but easily (without much pressure). For percussion, use the middle or index finger of the right hand. The finger should be best bent so that its last two phalanges, or at least the end phalanx, are at right angles to the main one. In any case, the angle of its bending should always be the same. The remaining fingers should not touch it (they should be moved away from it). Movements for striking must be free and flexible and must be made at the wrist joint. A blow to the plessimeter finger (on its middle phalanx, less often on the nail) should be made with the flesh of the mallet finger and have a perpendicular direction to the percussed surface. This is a very important condition for obtaining a good, strong percussion sound. Further, the blow must have a number of other properties: it must be short, jerky, fast and elastic (it is best to remove the hammer finger from the plessimeter finger immediately after the blow, the blow must be rebounding). This achieves greater impact force and greater distribution in depth than on the surface. For a successful assessment of percussion sound and in the interests of a certain summation of auditory impressions, repeated blows should be used, that is, at each percussed place, make two or three identical blows at equal intervals. Deep and superficial percussion. A further division of percussion from the point of view of its methodology is its division into: 1) deep, strong or loud and 2) superficial, weak or quiet. The distribution of oscillatory movements across the surface and in depth, the amount of air brought into oscillation and the intensity of the percussion tone largely depend on the strength of the percussion blow. With deep (strong) percussion, vibrations of the percussed tissues spread over the surface to 4-6 cm and to a depth of 7 cm. With superficial (weak) percussion, vibrations spread over the surface to 2-3 cm and to a depth of 4 cm. In other words, acoustic the scope of action with strong percussion is approximately twice as large as with weak percussion. Depending on the circumstances - the greater or lesser size of the affected area, the greater or lesser depth of its location, and the purpose of the study - comparison of sound in different places or delimitation of two adjacent organs from each other - we use either stronger or less strong percussion. If the pathological focus in the lungs is small, its superficial location, or when determining the boundaries of organs, it is more advantageous to use weak (superficial) percussion. Conversely, for large-sized lesions, their deep location and for the purpose of sound comparison, it is better to use stronger (deep) percussion. A variation and further development of the principles of quiet (weak) percussion is the quietest (weakest), the so-called extreme or threshold percussion of Goldscheider. With this method of percussion, the strength of the percussion sound is reduced to the limits of the threshold for the perception of sound sensations (hence the name of the method), so that when we tap on airless parts of the body, we do not perceive any sound, but when moving to air-containing organs, a very light sound is heard. Goldscheider's method of extreme percussion is based on the idea that our hearing organ more easily notes the appearance of sound than its intensification. In practice, however, this method has not found general acceptance, and in any case there is no doubt that stronger percussion, when used correctly, of course, gives no worse results. With the quietest or threshold percussion, you need to percussion only along the intercostal spaces in order to avoid intensifying the beetle on the ribs, and at the same time either finger on finger or finger on a special so-called stylus plessimeter. When percussing the finger, the latter should be held according to Plesch: the pessimeter finger is straightened at the second (distal) interphalangeal joint and bent at a right angle at the first; the dorsal surface of the second and third phalanges forms a concave surface. Tapping is done with the flesh of the middle finger of the right hand on the head of the main first phalanx of the plessimeter finger. The latter comes into contact with the percussed surface with its most sensitive part - the apex, which ensures the best perception of the difference in the feeling of resistance, which, undoubtedly, with this method of percussion plays a significant role, bringing it closer to tactile percussion. A slate plessimeter is a curved glass rod with a rubber cap at the end. Adjacent to the quietest (ultimate) percussion is the so-called tactile or palpatory percussion, although it is no longer based on sound perceptions, but on the sense of touch, on the sensation of resistance, which to a greater or lesser extent occurs with any percussion, but here it is placed, so say, in the eye of the corner. Tactile percussion can be, like percussion in general, direct and mediocre, and in the latter case not only finger-to-finger, but also instrumental (pessimeter - hammer). In any case, a percussion blow should not cause a sound. The blow should not be short and abrupt, as with ordinary percussion, but, on the contrary, slow, long and pressing. The position of the percussing hand corresponds to its position when writing, and the blow (or, perhaps, more accurately, pressure) is made by the soft part of the nail phalanx of the middle finger. Determination of the boundaries of organs by this method is carried out successfully, but it does not seem to have any significant advantages over conventional percussion. Comparative and topographical percussion. Depending on the goal we set for ourselves during percussion, we can distinguish two fundamentally different types of percussion: 1) comparative percussion, which aims to compare anatomically identical areas; 2) delimiting or topographical percussion, which has as its task the delimitation of anatomically different areas from each other and the projection of their boundaries onto the surface of the body. During comparative percussion, it is necessary to carefully monitor the equality (identity) of conditions when percussing symmetrical places: the same impact force, the same position and pressure of the plessimeter finger, the same breathing phase, etc. If in general during comparative percussion they usually use stronger percussion, then, if the data is unclear, doubtful, one should try successively strong, moderate, weak, and weakest percussion, and then it is often possible to obtain a completely clear result. In the interests of a more reliable comparison and for the purposes of self-control, the sequence of percussion blows should be changed: for example, if, when comparing two symmetrical places, we percussed first the right and then the left side and at the same time received some difference in sound, then we should percuss in the opposite direction order (first left, then right). Often with this technique, the apparent difference in percussion tone disappears. Comparative percussion is, of course, applicable not only to comparing two symmetrical places, but also to comparing two places with a certain and known difference in their sound on the same side of the body. With comparative percussion, it is not enough to simply establish the fact of a change in sound, for example, dulling it, as with restrictive percussion, but detailed differentiation of the percussion tone according to all its basic properties is necessary: intensity, tonality, timbre. This is extremely important for obtaining a clear picture of the physical state of the organ being percussed. Discriminating topographical percussion, as stated above, requires quiet percussion, a short impact and a possibly smaller surface area. The latter can be achieved by using the pessimeter in its edge position, and with a finger-pessimeter - by contacting only its apex with the percussed surface (conditions necessary to obtain intermittent oscillations of the percussed body). A very important point when delimiting percussion is the greatest possible elasticity, springy nature of both the percussing and percussed hands. The conditions necessary for this are difficult to describe, but they are easy to learn in practice. It is necessary to ensure that the pessimeter finger is applied to the percussion site, as indicated above, as easily as possible, without any pressure. For any strong pressure of the plessimeter already gives the percussion a strong character. When distinguishing air-containing parts of the body from airless ones, some recommend percussion in the direction from air-containing to airless, others - vice versa. In practice, this is not significant, and you need to percuss in both directions, crossing the desired boundary several times until its position is clearly determined. The organs of our body are located in such a way that they, as a rule, overlap one another, and the boundaries between them never go perpendicular to the surface of the body. Therefore, for most organs, when percussing them, we get two areas of dullness: 1) superficial or absolute in the part where the organ is directly adjacent to the outer wall of the body and where we get an absolutely dull percussion tone, and 2) deep or relative area of dullness - there, where the airless organ is covered by the air-containing one and where we get a relatively dull percussion tone. The rule for determining superficial (absolute) dullness is superficial (weak) percussion, in which in the area of absolute dullness the sound is inaudible or almost inaudible. In a word, the general rules of topographic percussion apply here. To determine deep (relative) dullness, deeper, stronger percussion is also used. But the percussion blow should essentially be only slightly stronger than with superficial percussion (when determining absolute dullness), but the percussed finger should be pressed against the surface of the body much stronger, although again not too tightly. One thing to remember is that a common mistake for beginners is to use too much percussion. Of the special methods of percussion, two more need to be mentioned - the method of auscultatory percussion or, which is the same thing, percussion auscultation, i.e., the method of simultaneous use of percussion and auscultation, and then the method of rod-pleximeter percussion. The method of auscultatory percussion has been proposed for determining the boundaries of organs and consists in placing a stethoscope on the organ being examined and listening through it to hear the percussion tone, or better yet, the sound of friction (scratching) of the skin, which is produced in different directions or from the stethoscope to the periphery, or, conversely,” from the periphery to the stethoscope. In the first case, a percussion tone. or friction noises are heard clearly while they are produced within the organ being examined, and are sharply and suddenly muffled, weakened or disappear as soon as the border of the organ is crossed. In the second case, the change in sounds is the opposite: weak and dull at first, they intensify as they cross the border of the organ. This method has not found widespread use since, being more complex, it does not have any advantages over simple percussion. But in some cases it gives better results, namely: when determining the boundaries of the stomach and the lower border of the liver. Rod-pleximeter percussion has been proposed to obtain a metallic shade of percussion tone, characteristic of air-containing cavities with smooth? walls and due to the sharp predominance of high overtones. You need to percussion on the plessimeter with some more or less sharp metal object (a metal stick, the end of a hammer handle, the edge of a coin, etc.). .

The position of the patient is distinguished: active, passive, forced.

Active position typical for patients with relatively mild illnesses or in the initial stages of severe illnesses. Patients actively move, at least within the hospital ward, although they experience various painful sensations.

Passive position- a condition when the patient cannot independently change the position given to him.

Forced position taken by the patient to alleviate his condition. During an attack of bronchial asthma (suffocation accompanied by a sharp difficulty in exhaling), the patient takes a forced sitting position. Resting your hands on the back of the chair, the edge of the bed, your knees. This allows you to fix the shoulder girdle and connect additional respiratory muscles, in particular the muscles of the neck, back and pectoral muscles, which help to exhale.

During an attack of cardiac asthma and pulmonary edema caused by blood overflow of the vessels of the pulmonary circulation, the patient tends to take a vertical position (sitting) with his legs down, which reduces the blood flow to the right side of the heart and makes it possible to somewhat relieve the pulmonary circulation (orthoptic position).

Patients with inflammation of the pleura and intense pleural pain often take a forced position lying on the affected side or sitting, pressing the chest on the affected side with their hands. This position limits the respiratory movements of the inflamed pleura, rubbing them against each other, which helps reduce pain.

Many patients with unilateral lung diseases (pneumonia) try to lie on the affected side. This position facilitates the respiratory excursion of a healthy lung, and also reduces the flow of sputum into the large bronchi, which reflexively causes a painful cough.

CONSTITUTION.

Different people have different body structure (physique) traits. Although each person has his own constitution, certain types of people can be distinguished according to their most important constitutional characteristics - constitutional types.

There are three constitutional types:

Asthenic;

Normosthenic;

Hypersthenic.

Asthenic type.

The body structure (habitus) of asthenics is distinguished by the predominance of longitudinal dimensions over transverse ones. Growth is predominantly in length. The limbs are long and thin, the hands and fingers are narrow, the frame is light and slender. The skull is elongated in height and in anteroposterior size (dolichocephalic). The face is most often sharply defined, the profile is angular, and the nose is large and narrow. The chin is weakly expressed, the hairline is abundant, extending to the forehead and temples. The eyebrows are wide. The neck is long and thin, the shoulders are narrow.

The chest is long, narrow and flat, the intercostal spaces are wide. The epigastric angle is acute. The belly is small. The pelvis is small. The skin is thin, soft, dry, pale. The subcutaneous fat layer is slightly developed. Asthenics are thin. Their muscles are thin and relatively poorly developed.

Asthenics tend to have relatively lower blood pressure. Their intestinal absorption capacity is less intense. Metabolism is accelerated.

Hypersthenic type.

The structure of the hypersthenic body is distinguished by the predominance of transverse dimensions over longitudinal ones. These are massive, well-fed and strong people. He is tall, his body is large, his limbs are short, his fingers are short and blunt, his hands are wide. The head of a hypersthenic is round in shape and of considerable size. The face is wide, the features are soft, regular, the forehead is high. Well defined mouth with full lips and prominent chin. The hair is soft and there is a tendency to go bald. The neck is short and thick, the head sits deep in the shoulders, the shoulders are wide and straight. The chest is wide, short and deep. The ribs run almost horizontally, the intercostal spaces are narrow. Epigastric angle obtuse . The abdominal cavity and pelvis are capacious. The skin is dense and elastic, little pigmented. The bones of the skeleton are wide, heavy, strong.

This type of people tends to have higher blood pressure and red blood composition. Prone to obesity. Exchange is slow.

Normosthenic type.

Normosthenics have a right epigastric angle. Characterized by a correct physique with a proportional relationship between body parts, well-developed skeletal muscles, a regular chest shape with costal angle (epigastric), approaching the right angle .

SKIN CONDITION.

When examining the skin, attention is paid to its color, moisture, elasticity, condition of the hair, the presence of rashes, hemorrhages, vascular changes, scars, etc.

Skin coloring.

Normal skin has a physiological color.

Pallor skin can be explained by coldness, fear, anemia. Hyperemia(redness) is characteristic of feverish patients, occurs during neuropsychic excitement, overheating, after taking certain medications (nicotinic acid), etc. Cyanosis– bluish discoloration of the skin and visible mucous membranes. There are general and local cyanosis. General cyanosis is most noticeable in those places where the skin is thin (lips, cheeks, tip of the nose, ears) or where circulatory conditions are less favorable due to the distance from the heart (tips of fingers and toes - acrocyanosis). Local (or limited) cyanosis has a different meaning and mostly depends on local circulatory disorders (for example, due to cessation of venous outflow in a particular part of the body). Jaundice the skin is observed when there is a violation of the outflow of bile from the liver into the intestines through the bile ducts; if there is a violation of the secretion of bile by liver cells; with excessive breakdown of red blood cells. Jaundice is noticeable first of all on the sclera, as well as on the mucous membranes.

Skin moisture.

When examining the skin, pay attention to sweating. In pathological conditions, increased sweating is caused by: fever, some nervous conditions (pain, fear), strong accumulation of carbon dioxide in the blood (toxic or acidic sweats due to suffocation, sudden shortness of breath). The latter type of sweat is usually observed not on hyperemic, but on pale skin.

Some infectious diseases are accompanied by a strong tendency to sweat (tuberculosis, brucellosis, influenza, rheumatism). Due to increased sweating, special rashes (prickly heat) sometimes appear in the form of matte white bubbles the size of a poppy seed, covering the skin like dew.

Skin elasticity (turgor).

Elasticity is determined by the fold in which the skin can be taken along with subcutaneous fat. Normal skin elasticity is characterized by rapid straightening of the skin fold after the doctor’s fingers are unclenched; when the elasticity of the skin decreases after the fingers are unclenched, the fold persists for some time. A decrease in skin elasticity is observed:

In elderly and senile patients,

When the body is dehydrated (uncontrollable vomiting, diarrhea),

An increase in skin turgor often indicates fluid retention in the body, which is often accompanied by some swelling of the skin.

Clean skin.

Skin pigmentation – the appearance of its dark color. Strong pigmentation occurs when exposed to sunlight ( Tan). Of the pathological forms, skin pigmentation is most pronounced when the adrenal glands are damaged.

In addition to general disorders of pigmentation of the integument, there are local, focal disorders. Such, for example, are the well-known freckles, birthmarks ( nevi). During pregnancy, pigment deposition around the nipples and along the linea alba increases sharply, giving these areas a dark brown color. During pregnancy, as well as with diseases of the uterus and general exhaustion, rather large brown spots appear on the face - chloasma.

Reverse changes in the skin are also known: the skin loses its normal pigment. Complete absence of skin pigment - albinism It is extremely rare and represents an anomaly that is inherited. Loss of pigment in certain areas of the skin occurs in the form of vitiligo– white spots on the body, often located symmetrically.

When examining the external integument, scars may be discovered after wounds, abscesses, or operations. There are known scars on the face after smallpox or scar stripes on the abdomen after pregnancy ( striae).

Rash found in many acute infectious diseases. Of particular importance are roseola, i.e. round pink small spots, on average 2 mm in diameter, not sharply demarcated from the surrounding skin. When pressed, roseola disappears. Roseola often turns into petechiae, i.e. the same formations in the center of which hemorrhage occurs.

There are also large spotted redness of the skin - erythema.

Often found on the skin rash(for urticaria). After the rash on the skin is noticeable peeling.

Hemorrhages in the skin and mucous membranes it occurs with bruises, wounds, infectious and toxic lesions of blood vessels, and with a lack of vitamin C in the body.

Examination of the skin can reveal various types of ulceration - ulcers

Traumatic, infectious or trophic order, in particular bedsores, formed in bedridden patients.

To the question: how to determine your body type? asthenic and hyperasthenic... given by the author Seres Pilton the best answer is You can measure it by the wrist if your height is 160-175 cm. Measure it with a measuring tape, see the results:
up to 16 cm - asthenic
16-18 cm - normosthenic
more than 18.5 cm - hypersthenic.
Source: Booklet included with the product "Propolis Heliant".

Answer from Fluffy[guru]
Asthenic (ectomorph)
Asthenics look fragile and sophisticated. They are usually tall and thin. Due to their high metabolic rate, they have difficulty gaining weight and have a low fat content. The muscles are weakly expressed, not prominent, the contours of the body are angular. Asthenics can indulge in food excesses and alcohol, without gaining weight, especially at a young age. As you age, fat is deposited mainly in the abdomen. To build muscle tissue, asthenics need to engage in sports, primarily strength training. Tall height and low weight are advantages in sports such as basketball, running and pole vaulting. To strengthen bones and prevent the development of osteoporosis in adulthood, asthenics need to follow a diet rich in calcium and fatty acids, and also ensure that their weight is not below normal (BMI 18.5-24.99).
Normosthenic (mesomorph)
Normosthenics have a proportional, muscular figure. Men have wide shoulders and chest, narrow hips. Women of this type often seem denser than fragile asthenics, however, the greater body weight of normosthenics is caused not by fat, but by muscle tissue. People of this type are more suited to sports than others and show better results. They often have an increased appetite due to high physical activity. Forced to lead a sedentary lifestyle, normosthenics may gain weight due to a positive calorie balance. To become slim and thin, a woman of this type will have to lose not so much fat as muscle tissue. This will lead to a significant slowdown in metabolism. And with an increased appetite, maintaining a thin figure can become a very difficult task for her. The best weight loss strategy for normosthenics is to reduce the percentage of fat to a minimum through diet, while simultaneously strengthening muscles. A proportionate figure without folds of fat is attractive at any time.
Hypersthenic (endomorph)
Hypersthenics have wide, rounded shapes. They generally have a higher fat content than other types. Due to their slow metabolism, endomorphs quickly gain weight. They do not like to play sports, preferring to follow a diet if necessary. However, representatives of this type need to build muscle tissue more than others. Muscles expend a lot of energy, speeding up metabolism. To maintain an attractive figure, hypersthenics will have to make a lot of effort. Often, with age, the figure of an endomorph begins to blur more and more, despite physical activity and reasonable nutrition.

Instructions

It is customary to distinguish between people with asthenic (asthenic), normosthenic (), hypersthenic () body types (Professor V. M. Chernorutsky). It is very important to know your own constitutional type, because each type of constitution predisposes you to certain diseases.

People with an asthenic body type are called asthenics. They are usually of thin build and tall or medium height. Asthenics have a narrow, elongated torso and a narrow and elongated chest. The abdomen, compared to the chest, is small, and the diaphragm is located quite low. If such an angle between the costal arches in the area of the sternum (epigastric angle), it will be acute (less than 90 degrees). The heart of people with an asthenic constitution is relatively small in size and located almost vertically. The lungs are slightly elongated and the diaphragm is low. The legs and arms, compared to the body, are long and thin, the muscles are poorly developed.

People with an asthenic body type are not prone to gaining excess weight and often have a low or normal body mass index. However, asthenics more often than others suffer from diseases of the stomach with reduced secretion and intestines. Blood pressure in such people is usually lower than normal, and the content of hemoglobin and red blood cells in the blood is also reduced. Asthenics are also prone to diseases of the bronchopulmonary system, in particular the lungs.

People with a hypersthenic body type can also be easily recognized. They give the impression of being overweight people. Hypersthenics are often of small or medium height. Their body is relatively long; in comparison, their legs and arms seem slightly shortened. The chest is wide and short, the ribs are located almost horizontally. The angle formed by the costal arches in the sternum area is obtuse (more than 90 degrees). The belly is larger than the chest and is usually of considerable size. Diaphragm. All internal organs of hypersthenics are relatively large (larger than those of asthenics). The heart is located almost horizontally or semi-horizontally.

People with a hypersthenic physique are prone to obesity and high blood pressure. Their body mass index is normal or high. Hypersthenics are characterized by an increased content of red blood cells and hemoglobin in the blood, as well as high cholesterol levels. Quite often, people of this body type have hypothyroidism (decreased thyroid function). Hypersthenics often suffer from diseases of the gastrointestinal tract with increased secretion.

Those with a normosthenic type of constitution are distinguished by their proportional physique. occupy an intermediate position between asthenics and hypersthenics. The angle between their costal arches is 90 degrees. The dimensions of the torso and limbs are approximately the same. The heart is located semi-horizontally. Body mass index is usually normal. Normosthenics do not have a clear predisposition to certain diseases.

The effectiveness of exercise in the gym directly depends on the correctly chosen training program. Therefore, the first step on the path to an ideal appearance is to determine your type physique.

You will need

- mirror;
- tape measure;
- assistant.

Instructions

Undress and stand directly in front of the mirror. Take a close look at your figure, paying attention to proportions. If you have a short neck, a round face, weak muscles, and a fairly large amount of fat on your hips and buttocks, then you are classified as endomorphic. type at physique. A long body, a wide chest, well-developed muscles in representatives of the mesomorphic type A. Main characteristics of a person with ectomorphic type ohm physique- long limbs, short body, narrow chest and shoulders.

Define type your constitution according to Solovyov’s method. Measure your wrist at its thinnest point. If your result is less than 15 cm and 18 cm, then you have an asthenic physique, characterized by long limbs, a thin neck and underdeveloped muscles. A wrist of 15-17 cm and a wrist of 18-20 cm indicates a normosthenic proportional build of the body. A result of more than 17 cm and 20 cm occurs in representatives of hypersthenic, or large-boned, physique. These people have wide hips and shoulders and short legs.

Determine the value of the epigastric angle. Stand facing the assistant. Bare your upper torso to the waist. Ask an assistant to place their hands on your chest so that the tips of the thumbs meet at the point of convergence of the lowest twelfth pair of ribs. The remaining fingers should lie in the intercostal space. Take a deep breath and hold in this position. Let your assistant determine by eye the value of the epigastric angle formed by the lower ribs. If the epigastric angle is less than 90 degrees, then your type the figure is asthenic, if it is more than 90 degrees, then it is hypersthenic, and if this angle is right, then you are a representative of the normosthenic figure.

Sources:

How to determine your body type
how to determine your body type

When choosing software for your computer you need to know type, or its bit depth. In particular, the system can be 32 or 64 bit. These terms basically refer to the way the central processing unit processes data. However, the software for 32-bit systems may be incompatible with 64-bit and vice versa. To know type systems can be found in the documentation. If documentation is missing, follow these steps:

You will need

Computer running Windows operating system (XP, Vista, Windows 7) or Server 2003

Instructions

Video on the topic

Ernst Kretschmer (1888-1964) – German psychologist and psychiatrist. Not immediately finding himself, this man began by studying philosophy, literature and art history, but already at the university he turned to medicine. One of his first works, “Sensitive Delirium of Attitude,” was assessed by the famous psychologist and philosopher K. Japers as “close to genius.” E. Kretschmer is best known for his typology of temperaments.

Attempts to classify people according to their psychological characteristics have been made for a long time. The doctrine of 4 temperaments, belonging to Hippocrates, is widely known. I. Pavlov’s typology, based on the strength, balance and mobility of nervous processes, intersects with this classification.

E. Kretschmer drew attention to the fact that the signs that characterize mental disorders - manic-depressive psychosis - are also observed in healthy people, the difference lies only in the degree of their manifestation. This principle was the basis for the typology of temperaments proposed by E. Kretschmer. The researcher called people with varying degrees of severity of signs of manic-depressive psychosis cyclothymics and cycloids, and people with schizophrenic traits - schizothymics and schizoids.

E. Kretschmer associated these psychological traits with body type. In his opinion, schizothymics and schizoids are often distinguished by a leptosomal (asthenic) physique, and cyclothymics and cycloids - by a pyknic one.

Leptosomal type

People with a leptosomal body type are thin, slender, and have elongated necks and limbs. The lower jaw is small, the nose is clearly defined, the hair is coarse and thick. They are sensitive to some phenomena and completely indifferent to others.

Among people with a leptosomal body type - schizothymics and schizoids - there are many dreamers and connoisseurs of art. In everyday life, they are distinguished by their tendency to conflict, pedantry, perseverance, and concentration on their own interests. Often such people create for themselves a kind of fictional world, built from dreams and ideas, but they can be witty and ironic. Schizothymic scientists most often devote themselves to the exact sciences or philosophy.

Picnic type

The picnic type is characterized by a dense physique, large bones, and roundness of shape. The face is wide, the head is large, the neck is short, the hair is soft. Such people are often overweight, but at the same time they are distinguished by mobility, smoothness and naturalness of movements.

The pace of life of such people - cycloids and cyclothymics - depends on their mood, which constantly fluctuates between sadness and joy. These are open, good-natured people who easily come into contact with others. The worldview of cyclothymics and cycloids is characterized by realism, and they are characterized by gentle humor. A cyclothymic scientist is an empiricist who prefers visual descriptions, and is often a popularizer of science.

Along with the leptosomal and pycnic types, E. Kretschmer identified an intermediate type - the viscose type. Such people have an athletic build, are prone to emotions and are predisposed to epilepsy.

E. Kretschmer's classification became widespread, but it immediately began to be criticized. The transfer of patterns identified in psychiatric practice to healthy people and the connection between mental traits and physique also raised doubts. By the middle of the 20th century. the theory was considered unscientific. Currently, this typology is considered from the point of view of the history of psychology and is not used in psychological practice.

Sources:

What is the typology of characters according to E. Kretschmer in 2019

The problem of defining normal weight body is always relevant, especially when a person cares about his health. After all, a deviation from the norm in one direction or another indicates a violation of any body functions, and, as a consequence, the development and exacerbation of various diseases. But the concept of “normal weight” is ambiguous and can vary depending on race, gender, height and age. Let's try to highlight some basic principles.

You will need

Scales
Height meter
Calculator

Instructions

Subtract 100 from your value. The result will be an indicator of normal weight. In this case, it is necessary to adjust for body type: thin people are 3-5% lighter, and strongly built people, on the contrary, are 2-3% heavier than those who are normosthenics.

Calculate normal weight using Robinson's formula: 52+1.9*(0.394*h–60), where h is height in cm.

note

Each nationality has its own normal weight. This fact must be taken into account when you get acquainted with tables compiled by Western or American nutritionists.
A person’s weight is made up of various indicators: muscle mass, the amount of fluid in the body, the weight of each organ and the contents of the gastrointestinal tract. In this connection, depending on the time of day, its value can change both smaller and larger.

Helpful advice

N. Amosov, a surgeon, cardiologist, author of many works on gerontology, says that normal weight for each person is individually established at 25-26 years of age. It is these indicators that he advises to look at throughout your life, trying to maintain them. The only amendment: weight at this age should not be overweight.

MORPHOLOGICAL CONSTITUTIONAL FEATURES

With a differentiated approach to teaching and raising children, the study of the constitutional characteristics of their body is of great practical importance.

When studying physical development, to identify types of constitution, it is traditionally taken as a basis morphological criterion (somatotype).

3.1. Determination of the constitutional somatotype of children

When determining the constitutional somatotype, attention is paid to the development and correlation of such features as the shape of the back, chest, abdomen, legs; degree of development of bone, muscle and fat tissue.

Chest shape - one of the most constant signs, changes little with age and is considered fundamental in assessing the constitutional type. There are three main shapes of the chest - flattened, cylindrical and conical (Fig. 3.1).

Flattened Cylindrical Conical

Rice. 3.1. Chest shape

The shape of the ribcage is related to the epigastric angle (the angle formed by the costal arches; the angle at which the ribs attach to the sternum). The angle varies from acute (less than 90°) to obtuse (more than 90°). The chest can be more or less elongated in length, have the same shape along its entire length, or change - narrow or expand downward.

Flattened shape characterized by an acute epigastric angle. In profile, the chest looks like an elongated cylinder, strongly flattened from front to back, usually narrowing downward.

Cylindrical shape- the epigastric angle is straight, in profile the chest looks like a rounded cylinder of moderate length.

Conical shape- characterized by an obtuse epigastric angle. In profile, the chest has the shape of a rounded cylinder, noticeably expanding downwards like a cone.

The back can be straight, stooped, or flattened (Fig. 3.2).

Straight (normal) the shape of the back is observed with a normal spinal column, without hypertrophic curves of any of its sections.

Slouched form characterized by a pronounced vertebral curve in the thoracic region. In this regard, wing-shaped diverging blades are almost always observed.

Straight

Slouching

Flattened

Rice. 3.2. Back shape

Flattened shape characterized by smoothness of the thoracic and lumbar curves, especially flattening in the area of the shoulder blades.

This sign is largely related to the shape of the chest (Fig. 3.3).

Sunken

Straight

(according to N.F. Lysova, R.I. Aizman et al., 2008)

Sunken belly characterized by a complete absence of subcutaneous fat tissue, weak muscle tone of the abdominal wall. Protruding pelvic bones are characteristic.

Straight belly- characterized by significant development of the abdominal muscles and its good tone. Fat deposition is weak or moderate, bone relief is almost smoothed.

Bulging belly characterized by an abundant subcutaneous fat layer. Muscle development may be weak or moderate. With this shape of the abdomen, a fold necessarily appears located above the pubis. The bony relief of the pelvic bones is completely smoothed and is often difficult to palpate.

Yoga form is taken into account when assessing constitutional affiliation, but is not of primary importance. It can be X-shaped, O-shaped and normal - straight legs. With the X-shape, the legs touch at the knee joint, and there is a gap between the thighs and calves. Depending on the size of this gap, the degree of X-shape can be assessed as 1, 2 and 3 (Fig. 3.4, A). An O-shape is defined as when the legs do not close together from the groin to the ankles. The degree of their discrepancy is estimated at 1,2 and 3 points (Fig. 3.4, b).

(according to N.F. Lysova, R.I. Aizman et al., 2008)

The development of bone, muscle and fat components of the physique is assessed using a 3-point system.

Bone component. The massiveness of the skeleton is taken into account by the degree of development of the epiphyses, bones, and the massiveness of the joints. The width of the epiphyses is measured at the upper arm, forearm, lower leg and thigh. Their arithmetic mean value can be considered an indirect characteristic of the massiveness of the skeleton and is assessed in points:

1 point - thin bone with thin epiphyses;
2 points - medium-massive bones with medium or large epiphyses;
3 points - strong, massive with very wide bones and powerful epiphyses.

Intermediate scores are also distinguished - 1.5 and 2.5.

Muscle component assessed by the size and turgor (degree of tension, tissue density) of muscle tissue on the limbs (shoulder and thigh) both in a calm and tense state. This component is also scored:

1 point - poor development of muscle tissue, its flabbiness, weak tone;
2 points - moderate development, the relief of the main muscle groups under the skin is visible, good muscle tone;
3 points - pronounced muscle development, clear relief, strong muscle tone.

Development fat component determined by the smoothness of the bone relief of the skeleton and the size of the fat folds. They are measured using a calypsra on the abdomen (at the intersection of lines drawn horizontally at the level of the navel and vertically through the nipple), on the back (under the shoulder blade) and on the back of the shoulder (above the triceps). Then their arithmetic average is calculated, which serves as a numerical characteristic of fat deposition. Score assessment of the degree of expression of the fat component:

1 point - the bone relief of the shoulder girdle is clearly visible, especially the collarbone and scapula, the ribs are visible at the place of their attachment to the sternum. There is practically no subcutaneous fat layer, the average size of the fat fold ranges from 3 to 6 mm;
2 points - bone relief is visible only in the area of the collarbones, the rest of the relief is smoothed out. Moderate development of the subcutaneous fat layer on the abdomen and back, the average size of the fat fold is from 7 to 19 mm;
3 points - abundant fat deposition in all parts of the body. The bone relief is completely smoothed. Severe fat deposits in the abdomen, back, and limbs. The thickness of the fat folds is from 20 mm and above.

Based on morphological features, four main constitutional somatotypes are distinguished - asthenoid, thoracic, muscular, digestive (Fig. 3.5).

Asthenoid type characterized by elongated limbs and thin bones. The chest is flattened, elongated, often narrowed downwards, the epigastric angle is acute. The back is usually stooped, with sharply protruding shoulder blades. The stomach is sunken or straight. The muscles are poorly developed and their tone is sluggish. The subcutaneous fat layer is extremely insignificant; the bones of the shoulder girdle and ribs are clearly visible. The shape of the legs is often O-shaped. The legs may also be straight, but not closed at the hips.

Thoracic type- relatively narrowly built type. The chest is cylindrical, less often slightly flattened. The epigastric angle is close to right or straight. The back is straight, sometimes with protruding shoulder blades; the stomach is straight. The muscle and fat components are moderately developed, and the latter may be small. The muscle tone is quite high, although their mass may be small. The legs are often straight, but O- and X-shaped ones are also found.

Muscle tyn characterized by a massive skeleton with clearly defined epiphyses, especially in the forearm and knee joint. The chest is cylindrical, round, of the same diameter along its entire length. The epigastric angle is straight. The back is straight. The abdomen is straight, with well-developed muscles. The muscles of children with this type of constitution are especially strongly developed. Both muscle volume and tone are significant. Fat deposition is moderate, bone relief is smoothed. The shape of the legs is straight, but O- or X-shaped is possible.

Digestive type characterized by abundant fat deposition. The shape of the chest is conical, short and widened downwards, the epigastric angle is obtuse. The abdomen is convex, rounded, usually with folds of fat, especially above the pubis. The back is straight or flattened. The bone component is well developed, the skeleton is large and massive. Muscle mass is developed and has good tone. The subcutaneous fat layer forms folds on the abdomen, back, and sides. The bone relief is not visible at all. Legs X-shaped or normal.

In addition to the above types, there are also transitional ones, when the constitution of children is characterized by the features of two adjacent types. For example, thoracic-muscular and muscular-thoracic types. The first place is given to the name of the type of constitution whose features predominate in a given individual. Such transition groups can only exist between two adjacent types. If a child has traits of two or more non-adjacent types, then his constitution is considered uncertain.

Some researchers of children's constitutional science believe that constitutional differences appear very early in ontogenesis and indicate the possibility of establishing body types even in infants. Others believe that these features can change greatly during the growth of the organism, modified under the influence of various factors that change the relationship of the organism with the environment. With the onset of puberty in adolescents, the intragroup distribution of constitutional types changes - from 8 to 15 years, the number of children of the muscular type increases. In most cases, the constitutional type does not change with age. During the pubertal period of ontogenesis, a temporary transition from one type of constitution to another is possible. As a rule, types located in the so-called transition zone are displaced; a transition from one extreme option to another is impossible. In recent years, the distribution of constitutional types has changed: the number of boys with the muscular type of constitution has sharply decreased and the number of boys with the digestive and asthenoid type has increased. The final formation of the muscular type of constitution occurs from the period of puberty, thoracic - from 10-13 years, asthenoid - from 10 years.

The development of the skeleton, muscle component and subcutaneous fat is the main indicator that determines the morphological constitution. The muscle and fat components are influenced by environmental factors. The most significant of these are physical education and sports.

Each constitutional type has its own average statistical values, i.e. the norm is individual (individual-typological).

As one of the significant features in determining the constitutional type of V.G. Shtefko and A.D. Ostrovsky also used the ratio of the three parts of the face.

All constitutional types differ significantly from each other in zygomatic diameter. In children of various constitutional types, regardless of gender, the largest zygomatic diameter is of the digestive type, and the smallest is of the asthenoid type. Similar constitutional features were noted in terms of mandibular diameter. Consequently, when determining the type of constitution, the zygomatic and mandibular diameters can be used (Fig. 3.6).

Asthenoid Thoracic Muscular

Digestive

A person’s constitutional somatotype reflects his individuality. Each type of constitution has characteristic features not only in anthropological indicators, but also in the activity of the nervous and endocrine systems, metabolism, structure and functions of internal organs. The constitutional affiliation of children determines the rate of growth and differentiation processes at different stages of ontogenesis. For example, girls of the digestive somatotype and boys of the muscular somatotype enter puberty earlier and reach puberty. Representatives of the asthenoid and thoracic somatotypes reach puberty later than others. Their growth processes usually end later.

Specific types of constitution are characterized by different features of immunity, predisposition to infectious and non-infectious diseases. Thus, the most likely diseases for the asthenoid somatotype are scoliosis, thoracic - lung disease, muscular - myocardial infarction, digestive - diabetes, obesity, stroke.

The approach to the study of constitutional types should not be evaluative, since none of the types is either good or bad.

Each type is justified both biologically and socially. Society must have representatives of various constitutional types, which is a guarantee of sustainable development of society.

The constitutional type indicates what kind of life nature has provided for a particular individual. Understanding the strengths and weaknesses of different types makes it possible to choose the appropriate approach to regimen, nutrition, behavior, prevention and treatment of diseases, professional and sports guidance, educational program and lifestyle for each individual person.

Questions and tasks

1. What is meant by physical development?
2. List the main criteria for assessing the physical development of children and adolescents and the identified groups of physical development.
3. What is meant by harmonious and disharmonious physical development?
4. Children of which of the four constitutional somatotypes are more or less tolerant of physical activity?
5. What is the significance, in your opinion, of determining the constitutional somatotypes of children (discuss in a group)?
6. What factors influence the physical development of children and adolescents? Give examples.
7. Using the textbook material, fill out the table:

Structure of the human chest

The chest is formed by:

12 pairs of arched ribs, connected at the back to the thoracic spine, and at the front connected to the sternum using costal cartilages.
The sternum is an unpaired bone with an elongated shape. It is characterized by a convexity on the front surface and a concavity on the back. Includes three parts: handle, body and
Muscles.

It is flexible, meaning it expands and contracts as you breathe.

Types of chest

flat;
cylindrical;
conical.

Flat chest shape

Conical chest shape

Cylindrical chest shape

Age and physiological characteristics

The chest and its movements

Types of breathing

Depending on the age and development of the chest, there are:

This is the name for the breathing of newborns who do not yet have a good bend of the ribs, and they are in a horizontal position, the intercostal muscles are weak.
Thoracic breathing with a predominance of diaphragmatic breathing is observed in children in the second half of the first year of life, when the intercostal muscles begin to strengthen and the ore cell begins to descend downwards.
The pectoral girdle begins to predominate in children from 3 to 7 years of age, when the shoulder girdle is actively developing.
After seven years, gender differences in breathing patterns appear. Abdominal will predominate in boys, thoracic in girls.

Pathological forms of the chest

Barrel-shaped. This deviation is found in people whose lung tissue has increased airiness, that is, its elasticity and strength are impaired. This is accompanied by an increased air content in the alveoli. The barrel-shaped chest has an expanded transverse and, especially, anteroposterior diameter, with horizontally located ribs and wide intercostal spaces.
Paralytic. This chest looks flat and narrow. The collarbones are pronounced and located asymmetrically. The shoulder blades clearly lag behind the chest, their location is at different levels and during the breathing process they shift asynchronously. The location of the ribs is oblique downward. Paralytic forms of the chest occur in emaciated people, in people with poor constitutional development, and in people with severe chronic diseases, such as tuberculosis.
Rachitic. This shape is also called keel-shaped or chicken-shaped. It is characterized by a significant increase in anteroposterior size, which is a consequence of rickets suffered in childhood. The keel shape also occurs as a result of a genetic deviation in the development of the skeletal system. Bone protrusion may or may not be significant. The severity of the pathology affects the secondary symptoms of the disease that arise due to compression of the heart and lungs.

Funnel-shaped. This type of pathology is expressed in a noticeable retraction of individual zones: ribs, cartilage, sternum. The depth of the funnel can reach 8 cm. A pronounced funnel-shaped deformity is accompanied by displacement of the heart, curvature of the spine, problems in lung function, and changes in arterial and venous pressure. In infants, the pathology is little noticeable, only when inhaling is there a slight depression in the chest area. It becomes more pronounced as it grows.
Scaphoid. Characteristic of this pathology is the presence of an elongated depression in the middle and upper part of the sternum. Develops in children suffering from diseases of the nervous system, in which motor functions and sensitivity are impaired. Severe deformity is accompanied by shortness of breath, fatigue, intolerance to physical activity, and rapid heartbeat.
Kyphoscoliotic. It develops against the background of diseases of the spine, namely the thoracic region, or is a consequence of traumatic injury.

7. The shape of the chest can also change due to an increase or decrease in the volume of only one half of the chest (chest asymmetry). These changes in its volume can be temporary or permanent.

A decrease in the volume of one half of the chest occurs in the following cases:

due to the development of pleural adhesions or complete fusion of the pleural fissure after resorption of exudate that has been in the pleural cavity for a long time;

after surgical removal of part or the whole lung;

14. Determination of the type of breathing, symmetry, frequency, depth of breathing, respiratory excursion of the chest.

When measuring chest circumference, it is advisable to compare the distance from the middle of the sternum to the spinous process of the vertebra on both sides.

When comparing the duration of inhalation and exhalation, it is necessary to pay attention to the intensity of the noise created by the air flow in both phases of breathing.

Changes in the shape of the chest may be due to pathology of the lung tissue or improper formation of the skeleton during development.

15. Palpation of the chest. Determination of pain, elasticity of the chest. Determination of vocal tremors, the reasons for its strengthening or weakening.

The presence of increased resistance (rigidity) of the chest to the pressure exerted on it is observed with significant pleural effusion, large tumors of the lungs and pleura, emphysema, as well as with ossification of the costal cartilages in old age. Pain in the ribs in a limited area may be due to their fracture or inflammation of the periosteum (periostitis). When a rib is fractured, a characteristic crunch appears at the site of palpable pain when breathing, due to the displacement of bone fragments. With periostitis, in the area of the painful area of the rib, its thickening and uneven surface are felt. Periostitis of the III-V ribs to the left of the sternum (Tietze syndrome) can mimic cardialgia. In patients who have suffered rickets, in the places where the bony part of the ribs passes into the cartilaginous part, thickenings are often detected by palpation - “rickets rosaries”. Diffuse pain in all ribs and sternum upon palpation and tapping on them often occurs with bone marrow diseases.

When determining vocal tremors, the patient repeats in a loud, low voice (bass) words containing the sound “r”, for example: “thirty-three”, “forty-three”, “tractor” or “Ararat”. At this time, the doctor places his palms flat on symmetrical areas of the chest, lightly presses his fingers against them and determines the severity of vibrating tremors of the chest wall under each of the palms, comparing the sensations received on both sides with each other, as well as with the vocal tremor in adjacent areas of the chest. If unequal severity of vocal tremor is detected in symmetrical areas and in doubtful cases, the position of the hands should be changed: put the right hand in place of the left, and the left hand in place of the right, and repeat the study.

16. Percussion of the lungs. Physical justification of the method. Percussion methods. Types of percussion sound.

Instructions

You will need

- mirror;
- tape measure;
- assistant.

Instructions

Sources:

How to determine your body type
how to determine your body type

You will need

Computer running Windows operating system (XP, Vista, Windows 7) or Server 2003

Instructions

Video on the topic

Leptosomal type

Picnic type

Sources:

What is the typology of characters according to E. Kretschmer in 2019

You will need

Scales
Height meter
Calculator

Instructions

Calculate normal weight using Robinson's formula: 52+1.9*(0.394*h–60), where h is height in cm.

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1. Shape and type of chest

The purpose of the examination is to determine the static and dynamic characteristics of the chest, as well as external indicators of breathing. To do this, determine the shape of the chest (correct or irregular); type of chest (normosthenic, hypersthenic, asthenic, emphysematous, paralytic, rachitic, funnel-shaped, scaphoid); symmetry of both halves of the chest; symmetry of respiratory excursions of both halves of the chest; curvature of the spine (kyphosis, lordosis, scoliosis, kyphoscoliosis); respiratory excursion of the chest at the level of the IV rib. The shape of the chest can be regular or irregular (in diseases of the lungs, pleura, as well as rickets, trauma to the chest and spine, bone tuberculosis).

The following types of chest are distinguished:

the normosthenic type is observed in persons of normosthenic physique. The anteroposterior dimensions of the chest are in the correct relationship with the lateral dimensions, the supra- and subclavian fossae are moderately pronounced, the ribs in the lateral sections have a moderately oblique direction, the shoulder blades do not fit tightly to the chest, the epigastric angle is straight;

the asthenic type is observed in persons of asthenic physique. The chest is elongated due to a decrease in the anteroposterior and lateral dimensions, sometimes flat, the supra- and subclavian spaces recede, the ribs in the lateral sections acquire a more vertical position, the shoulder blades lag behind the chest, the muscles of the shoulder girdle are poorly developed, the edge of the X rib is free and is easily identified when palpation, epigastric angle is acute;

The hypersthenic type is observed in individuals with a hypersthenic physique. The chest is shortened, the anteroposterior dimensions approach the lateral ones, the supraclavicular fossae are smoothed, the ribs in the lateral sections acquire a horizontal direction, the intercostal spaces are narrowed, the shoulder blades fit tightly to the chest, the epigastric angle is obtuse;

emphysematous (barrel-shaped) chest, in which the dimensions of the anteroposterior and lateral diameters approach each other, resulting in the shape of the chest resembling a barrel (wide and short); the ribs are located horizontally, the supraclavicular and subclavian fossae are not prominent, the shoulder blades are very close to the chest and are almost not contoured, the epigastric angle is obtuse. Observed with emphysema and during an attack of bronchial asthma;

the paralytic chest resembles an asthenic one (elongated and flattened). The anteroposterior dimensions are significantly smaller than the transverse ones, the clavicles are sharply outlined, the supra- and subclavian spaces are sunken. The shoulder blades are sharply behind the chest, the epigastric angle is acute. Paralytic chest is observed in patients with tuberculosis, chronic diseases of the lungs and pleura, with Marfan syndrome, in malnourished people;

rachitic chest (keeled) - the so-called chicken breast, in which the anteroposterior size is sharply increased due to the sternum protruding forward in the form of a keel, and there are also distinct thickenings at the junction of the costal cartilages into the bone ("rachitic rosary");

funnel chest has a funnel-shaped depression or depression in the lower third of the sternum and the area of the xiphoid process. This shape of the chest is observed in shoemakers due to the constant pressure of the block resting on the lower part of the still pliable sternum (“shoemaker’s chest”);

The scaphoid chest has a scaphoid oblong depression in the middle and upper parts of the sternum (with syringomyelia). In addition, breathing indicators are assessed: how the patient breathes - through the nose or mouth; type of breathing: thoracic (costal), abdominal (diaphragmatic or mixed); breathing rhythm (rhythmic or arrhythmic); depth of breathing (superficial, medium depth, deep); respiratory rate (number of respiratory movements per 1 minute).

Symmetry of respiratory excursions of the chest. Notice the movement of the angles of the scapula during deep inhalation and exhalation. Asymmetry of respiratory excursions can be a consequence of pleurisy, surgical interventions, and shrinkage of the lung. Asymmetry of the chest can be associated with an increase in lung volume (due to the accumulation of fluid or air in the pleural cavity) and with its decrease (due to the development of pleural adhesions, atelectasis (collapse) of the lung or its lobe). Measuring the maximum circumference and assessing respiratory excursions of the chest is carried out by measuring the circumference of the chest with a centimeter tape at the height of maximum inspiration, with the tape at the back located at the corners of the shoulder blades. The respiratory excursion of the chest is determined by measuring the circumference of the chest at the height of inhalation and exhalation. It decreases in the presence of pleural complications (after pleurisy, pneumonia), emphysema, and obesity. Deformation of the chest can be manifested by retraction or protrusion in any area, developing as a result of diseases of the lungs and pleura. Retraction may be the result of shrinkage (fibrosis) or collapse (atelectasis) of the lung. Unilateral protrusion or expansion of the chest may be caused by the accumulation of fluid (hydrothorax) or air (pneumothorax) in the pleural cavity. During examination, attention is paid to the symmetry of the respiratory movements of the chest. The doctor should place his hands on the posterior inferior surface of the chest on the left and right and ask the patient to take several deep breaths. The lag of any half of the chest may be a consequence of damage to the pleura (dry and effusion pleurisy) and lungs (pneumonia, atelectasis). A uniform decrease and even absence of respiratory excursions on both sides is characteristic of pulmonary emphysema.

Assessment of breathing indicators: Breathing through the nose is usually observed in a healthy person. Breathing through the mouth is observed in pathological conditions in the nasal cavity (rhinitis, ethmoiditis, polyposis, deviated nasal septum). The chest type of breathing is usually observed in women, abdominal (diaphragmatic) - in men.

Breathing rhythm: In a healthy person, uniform respiratory movements are observed; uneven respiratory movements occur in comatose states, agony, and cerebrovascular accident.

Breathing depth: shallow breathing occurs with intercostal neuralgia, pulmonary diseases involving the pleura, medium-depth breathing occurs in a healthy person, deep breathing occurs in athletes.

The respiratory rate is measured by counting the number of respiratory movements in 1 minute, unnoticed by the patient, for which a hand is placed on the surface of the chest. In a healthy person, the number of respiratory movements in 1 minute is 12-20. A decrease in the number of respiratory movements to 12 or less (bradypnea) is observed with cerebral edema and coma. Increased respiration rate (over 20) is observed when the function of external respiration is impaired, as well as in the presence of obstacles to normal breathing (ascites, flatulence, rib fractures, diseases of the diaphragm).

9. Examination of the head, face, eyes, eyelids, nose, oral cavity, neck.

10. Examination of the patient’s skin (color, elasticity, moisture, rashes, scars) Examination of the skin. Pay attention to the color, elasticity, moisture of the skin, various rashes and scars.

11. Inspection and palpation of lymph nodes, muscular system, joints, limbs.

14. Determination of the type of breathing, symmetry, frequency, depth of breathing, respiratory excursion of the chest.

15. Palpation of the chest. Determination of pain, elasticity of the chest. Determination of vocal tremors, the reasons for its strengthening or weakening.

16. Percussion of the lungs. Physical justification of the method. Percussion methods. Types of percussion sound.

17. Definition of Traube space, its diagnostic value.

18. Comparative percussion of the lungs. The distribution of sonority of percussion tone in different places of the chest is normal. Pathological changes in percussion sound.

19. Topographic percussion of the lungs. Determination of the upper and lower boundaries of the lungs, their location is normal. Determination of the excursion of the lower edge of the lungs.

20. Auscultation of the lungs, basic rules. Basic breath sounds. Changes in vesicular breathing (weakening and strengthening, saccadic, hard breathing).

21. Pathological bronchial breathing, causes of its occurrence and diagnostic significance. Bronchovesicular breathing, the mechanism of its occurrence.

22. Adverse respiratory sounds, the mechanism of their occurrence, diagnostic significance.

23. Bronchophony, determination method, diagnostic value

25. Pleural puncture, its technique, indications and contraindications. Study of pleural effusion, its types. Interpretation of analyses.

26. Basic methods for assessing the functional state of the respiratory system (spirography, pneumotachometry, pneumotachography, determination of Pa o2 and PaCo2 in arterial blood).

27. Spirography, main pulmonary volumes. Pneumotachometry, pneumotachography.

28 Bronchoscopy, indications, contraindications, diagnostic value

29. Methods of functional diagnosis of restrictive type of ventilation disorders.

30. Methods for diagnosing broncho-obstructive syndrome.

31. Examination of a cardiac patient. Appearance of patients with heart failure. Objective signs caused by stagnation of blood in the pulmonary and systemic circulation.

32. Examination of the vessels of the neck. Diagnostic value of “carotid dancing”, swelling and pulsation of veins (negative and positive venous pulse). Visual determination of central air pressure.

33. Examination of the heart area (cardiac and apex beat, cardiac hump, epigastric pulsation).

34. Palpation of the heart area. Apical, cardiac impulse, epigastric pulsation, systolic and diastolic tremors, palpation of the great vessels. Diagnostic value.

2. Blood expulsion period (0.25 s)

III. Ventricular diastole (0.37 s)

2. Period of isometric (isovolumetric) relaxation (0.08 s)

3. Ventricular filling period (0.25 s)

Projections and auscultation points of the heart valves.

Rules for cardiac auscultation:

37. Heart murmurs, the mechanism of their occurrence. Organic and functional noises, their diagnostic significance. Auscultation of heart murmurs.

General patterns:

38. Auscultation of arteries and veins. The sound of a spinning top on the jugular veins. Traube's double tone. Pathological Durosier murmur.

52. Superficial palpation of the abdomen, technique, diagnostic value.

53. Method of deep sliding palpation of the abdomen. Diagnostic value.

54. Acute abdomen syndrome

56. Methods for identifying Helicobacter pylori. Questioning and examination of patients with intestinal diseases.

57. General understanding of methods for studying the absorption of fats, proteins and carbohydrates in the intestine, syndromes of indigestion and absorption.

58. Scatological examination, diagnostic value, main scatological syndromes.

60. Percussion and palpation of the liver, determination of its size. Semiological significance of changes in the edge and surface consistency of the liver.

61. Percussion and palpation of the spleen, diagnostic value.

62. Laboratory syndromes for liver diseases (cytolysis, cholestasis, hypersplenism syndromes).

63. Immunological research methods for liver pathology, the concept of markers of viral hepatitis

64. Ultrasound examination of the liver, spleen. Diagnostic value.

65. Radioisotope methods for studying the function and structure of the liver.

66. Study of the excretory and neutralizing functions of the liver.

67. Study of pigment metabolism in the liver, diagnostic value.

68. Methods for studying protein metabolism in the liver, diagnostic value.

69. Preparing patients for x-ray examination of the stomach, intestines, and biliary tract.

70. Research methods for diseases of the gallbladder, palpation of the gallbladder area, evaluation of the results obtained. Identification of cystic symptoms.

71. Ultrasound examination of the gallbladder, common bile duct.

72. Duodenal sounding. Interpretation of research results. (option 1).

72. Duodenal sounding. Interpretation of research results. (option 2. Textbook).

73. X-ray examination of the gallbladder (cholecystography, intravenous cholegraphy, cholangiography, the concept of retrograde cholangiography).

74. Methods for examining the pancreas (questioning, examination, palpation and percussion of the abdomen, laboratory and instrumental research methods).

75. General understanding of endoscopic, radiological, and ultrasound methods for studying the gastrointestinal tract (stupid question - stupid answer).

89. Methods for diagnosing diabetes mellitus (questioning, examination, laboratory and instrumental research methods).

90. Determination of glucose in blood, in urine, acetone in urine. Glycemic curve or sugar profile.

91.Diabetic coma (ketoacidotic), symptoms and emergency care.

92. Signs of hypoglycemia and first aid for hypoglycemic conditions.

93. Clinical signs of acute adrenal insufficiency. Principles of emergency care.

94. Rules for collecting biological materials (urine, feces, sputum) for laboratory research.

1.Urine examination

2.Sputum examination

3. Stool examination

95. Technique for collecting blood for laboratory research.

96. Methods of examining patients with pathology of the hematopoietic organs (questioning, examination, palpation, percussion, laboratory and instrumental research methods).

1. Questioning, complaints of the patient:

2.Inspection:

B. Enlarged lymph nodes

D. Enlarged liver and spleen

3.Palpation:

4.Percussion:

5. Laboratory research methods (see Questions No. 97-107)

6.Instrumental research methods:

97. Methods for determining Hb, counting red blood cells, clotting time, bleeding time.

98. Counting leukocytes and leukocyte formula.

99. Methodology for determining blood group, the concept of the Rh factor.

Group I.

II (a) group.

III (c) groups.

100. Diagnostic value of a clinical study of a general blood test

127. Pulmonary edema, clinical picture, emergency care.

128. Emergency care for biliary colic.

129. Emergency care for acute urinary retention, catheterization of the bladder.

130. Emergency care for acute renal colic

131. Artificial ventilation and chest compressions.

132. Sudden death and resuscitation measures.

133.Technique of subcutaneous and intradermal injections. Complications, nurse tactics for them.

134.Technique of intramuscular injections. Complications, nurse tactics for them.

135.Technique of intravenous injections. Complications, nurse tactics for them.

136.Dilution of antibiotics, technique of collecting a medicinal solution from an ampoule and a bottle.

137.Technique for collecting and connecting systems for blood transfusion, blood substitutes and medications.

138.Indications and technique for applying tourniquets to limbs.

12. Examination of the chest. Signs that determine the shape of the chest. Physiological and pathological forms of the chest.

Inspection

Examination of the chest should always be carried out in strict sequence. First, you need to assess the shape of the chest, the location of the clavicles, supraclavicular and subclavian fossae, and shoulder blades, then characterize the type of breathing, its rhythm and frequency, and monitor the movements of the right and left shoulder blades, shoulder girdle and the participation of auxiliary respiratory muscles in the act of breathing during breathing. The examination is best carried out with the patient standing or sitting with the torso naked to the waist, which should be evenly illuminated from all sides.

Assessment of chest shape. The shape of the chest can be normal or pathological. A normal chest is observed in all healthy people of regular physique. Its right and left halves are symmetrical, the clavicles and shoulder blades are at the same level, the supraclavicular fossae are equally pronounced on both sides. But since all people of correct physique are conventionally divided into three constitutional types, the chest of different body types has a different shape, characteristic of its constitutional type. The pathological shape of the chest can arise as a result of both congenital bone abnormalities and various chronic diseases (emphysema, rickets, tuberculosis).

The normal shapes of the chest are as follows:

The normosthenic (conical) chest (in people of normosthenic physique) in its shape resembles a truncated cone, the base of which is formed by well-developed muscles of the shoulder girdle and is directed upward. The anteroposterior (sternovertebral) size is smaller than the lateral (transverse) size, the supraclavicular fossa is slightly pronounced. The angle formed by the body of the sternum and its manubrium (angulus Ludovici) is clearly visible; the epigastric angle approaches 90°. The ribs in the lateral sections have a moderately oblique direction; the shoulder blades fit snugly to the chest and are located at the same level; The thoracic section of the body is approximately equal in height to the abdominal section.

The hypersthenic chest (in persons with a hypersthenic physique) has the shape of a cylinder. Its anteroposterior size approaches the lateral one; supraclavicular fossae are absent, “smoothed out”. The angle of connection between the body and the manubrium of the sternum is pronounced; the epigastric angle is greater than 90 e. The direction of the ribs in the lateral parts of the chest approaches horizontal, the intercostal spaces are reduced, the shoulder blades fit tightly to the chest, the thoracic region is smaller than the abdominal region.

The asthenic chest (in persons of asthenic build) is elongated, narrow (both the anteroposterior and lateral dimensions are reduced), flat. The supraclavicular and subclavian fossae are clearly defined. There is no angle of connection between the sternum and its manubrium: the sternum and its manubrium form a straight “plate”. Epigastric angle less than 90°. The ribs in the lateral sections acquire a more vertical direction, the X ribs are not attached to the costal arch (costadecima fluctuans), the intercostal spaces are widened, the shoulder blades are wing-shaped behind the chest, the muscles of the shoulder girdle are poorly developed, the shoulders are lowered, the thoracic region is larger than the abdominal region.

The pathological forms of the chest are as follows:1. Emphysematous (barrel-shaped) The chest in its shape resembles a hypersthenic one. It differs from the latter in its barrel-shaped shape, bulging of the chest wall, especially in the posterolateral sections, and an increase in the intercostal spaces. Such a chest develops as a result of chronic emphysema of the lungs, in which their elasticity decreases and their volume increases; the lungs are as if in the inhalation phase. Therefore, natural exhalation during breathing is significantly difficult, and the patient experiences expiratory shortness of breath not only when moving, but often at rest. When examining the chest of patients with pulmonary emphysema, one can see the active participation in the act of breathing of the auxiliary respiratory muscles, especially the sternocleidomastoid and trapezius, retraction into the intercostal spaces, upward lifting of the entire chest during inhalation, and relaxation of the respiratory muscles during exhalation muscles and lowering the chest to its original position.

2. Paralytic The chest in its characteristics resembles an asthenic one. It occurs in severely malnourished people, with general asthenia and poor constitutional development, for example in those suffering from Marfan's disease, often with severe chronic diseases, more often with pulmonary tuberculosis. Due to the progression of chronic inflammation, fibrous tissue developing in the lungs and pleura leads to their shrinkage and a decrease in the total surface of the lungs. When examining patients with a paralytic chest, along with signs typical of an asthenic chest, one often notices pronounced atrophy of the chest muscles, asymmetrical arrangement of the clavicles, and unequal retraction of the supraclavicular fossae. The shoulder blades are located at different levels and during the act of breathing they shift asynchronously (not simultaneously).

3. Rachitic (keeled, chicken) chest -pectuscarinatum (from Latin pectus - chest, carina - keel of a boat) is characterized by a pronounced increase in anteroposterior size due to the sternum protruding forward in the form of a keel. In this case, the anterolateral surfaces of the chest wall seem to be compressed on both sides and, as a result, connect to the sternum at an acute angle, and the costal cartilages at the site of their transition into the bone thicken clearly (“rachitic rosary”). In persons who previously suffered from rickets, these “rosaries” can usually be palpated only in childhood and adolescence.

4. Funnel-shaped The shape of the chest can resemble normosthenic, hypersthenic or asthenic and is also characterized by a funnel-shaped depression in the lower part of the sternum. This deformity is considered as a result of an abnormal development of the sternum or long-term compression on it. Previously, such deformation was observed in teenage shoemakers; the mechanism of formation of the “funnel” was explained by the daily long-term pressure of the shoe last: one end of it rested on the lower part of the sternum, and the shoe blank was pulled on the other. Therefore, the funnel-shaped chest was also called the “shoemaker's chest.”

5. Scaphoid The chest is different in that the depression here is located mainly in the upper and middle parts of the anterior surface of the sternum and is similar in shape to the depression of a boat (rook). This anomaly has been described in a rather rare disease of the spinal cord - syringomyelia.

6. Chest deformity It is also observed with curvatures of the spine that occur after injury, spinal tuberculosis, ankylosing spondylitis (Bechterew's disease), etc. There are four options curvature of the spine: 1) curvature in lateral directions - scoliosis; 2) backward curvature with the formation of a hump (gibbus) - kyphosis; 3) forward curvature - lordosis; 4) a combination of sideways and posterior curvature of the spine - kyphoscoliosis.

7. The shape of the chest can also change due to an increase or decrease in the volume of only one half of the chest (chest asymmetry). These changes in its volume can be temporary or permanent.

Increase in the volume of one half of the chest observed when there is effusion into the pleural cavity of a significant amount of inflammatory fluid, exudate, or non-inflammatory fluid - transudate, as well as as a result of the penetration of air from the lungs during injury. During examination, on the enlarged half of the chest, one can see smoothness and bulging of the intercostal spaces, an asymmetrical arrangement of the clavicles and shoulder blades, and a lag in the movement of this half of the chest during the act of breathing from the movement of the unchanged half. After resorption of air or fluid from the pleural cavity, the chest in most patients acquires a normal symmetrical shape.

Reduction in the volume of one half of the chest occurs in the following cases:

due to the development of pleural adhesions or complete fusion of the pleural fissure after resorption of exudate that has been in the pleural cavity for a long time;

after surgical removal of part or the whole lung;

Breathing rhythm. The breathing of a healthy person is rhythmic, with the same depth and duration of the inhalation and exhalation phases. In some types of shortness of breath, the rhythm of respiratory movements may be disrupted due to changes in the depth of breathing (Kussmaul breathing is pathological breathing, characterized by uniform, rare, regular respiratory cycles: deep noisy inhalation and intense exhalation. Usually observed with metabolic acidosis due to uncontrolled diabetes mellitus or chronic renal failure in patients in serious condition due to dysfunction of the hypothalamic part of the brain, in particular in diabetic coma.This type of breathing was described by the German doctor A. Kussmaul), the duration of inhalation (inspiratory dyspnea), exhalation (expiratory dyspnea) and the respiratory pause.

A dysfunction of the respiratory center can cause a type of shortness of breath in which, after a certain number of respiratory movements, a visible (from several seconds to 1 minute) prolongation of the respiratory pause or short-term breath holding (apnea) occurs. This kind of breathing is called periodic. There are two types of dyspnea with periodic breathing:

Breath Biota characterized by rhythmic but deep breathing movements, which alternate at approximately equal intervals with long (from several seconds to half a minute) breathing pauses. It can be observed in patients with meningitis and in an agonal state with deep cerebrovascular accident. Cheyne-Stokes breathing(from several seconds to 1 minute) of a respiratory pause (apnea), first silent shallow breathing appears, which quickly increases in depth, becomes noisy and reaches a maximum on the 5-7th breath, and then decreases in the same sequence and ends with the next regular short pause. Sometimes during a pause, patients are poorly oriented in their surroundings or completely lose consciousness, which is restored when breathing movements are resumed. This kind of breathing rhythm disturbance occurs in diseases that cause acute or chronic cerebral circulatory failure and brain hypoxia, as well as in severe intoxication. It often manifests itself during sleep and often occurs in older people with severe atherosclerosis of the cerebral arteries. Periodic breathing also includes the so-called wave-like breathing, or Grocco's breath. In its form, it is somewhat reminiscent of Cheyne-Stokes breathing, with the only difference that instead of a respiratory pause, weak shallow breathing is observed, followed by an increase in the depth of respiratory movements, and then its decrease. This type of arrhythmic shortness of breath, apparently, can be considered as a manifestation of an earlier stages of the same pathological processes that cause Cheyne-Stokes respiration. It is currently customary to define respiratory failure as a condition of the body in which the maintenance of normal blood gas composition is not ensured or it is achieved due to more intensive work of the external respiration apparatus and heart, which leads to a decrease in the functional capabilities of the body. It should be borne in mind that the function of the external respiration apparatus is very closely related to the function of the circulatory system: in case of insufficient external respiration, increased work of the heart is one of the important elements of its compensation. Clinically, respiratory failure is manifested by shortness of breath, cyanosis, and in the late stage - in the case of the addition of heart failure - by edema.

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Structure of the human chest

Types of chest

Flat chest shape

Conical chest shape

Cylindrical chest shape

Age and physiological characteristics

The chest and its movements

Types of breathing

Pathological forms of the chest

About body mass index and body types

How to determine your body fat percentage?

Adipose tissue and women's reproductive health

What happens if you lose a lot of weight?

How will excess body weight affect?

Conclusion

How to determine your body type

Wrist measurement

Determination of the epigastric angle

Determination of anthropometric indicators

Determination of body type based on visual assessment

Why do you need to know your body type?

Epigastric angle

How to determine the type of obesity

Type of obesity and metabolism

Body weight and reproductive health

About body mass index and body types

How to determine your body fat percentage?

Adipose tissue and women's reproductive health

What happens if you lose a lot of weight?

How will excess body weight affect?

Conclusion

Respiratory system. Basic research methods for subjective sensations

RESPIRATORY SYSTEM. BASIC RESEARCH METHODS

2.1. Determining the shape of the chest

2.3. Determination of the type, frequency, depth and rhythm of breathing

3.1. Techniques and rules of palpation

3.2. Determination of resistance (elasticity) of the chest

3.3. Definition of the phenomenon of vocal tremors

4.1. Rules

4.2. Method of comparative lung percussion

4.4. Determination of the boundaries of the lungs and mobility of the lower edge of the lungs

How to determine your body type?

Determine your body type! Training mode!

So, let's determine your body type, diet and training regimen.

1. Who is an ectomorph, type of training and nutrition?

2. Who is a mesomorph, type of training and nutrition?

3. Who is an endomorph, type of training and nutrition?