File:Gynecological diagnosis (1910) (14797869063).jpg

Identifier: gynecologicaldia00burr (find matches)
Title: Gynecological diagnosis
Year: 1910 (1910s)
Authors: Burrage, Walter L. (Walter Lincoln), 1860-1935
Subjects: Women
Publisher: New York, London, D. Appleton and Company
Contributing Library: The Library of Congress
Digitizing Sponsor: The Library of Congress

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, is to be noted. Enteroptosis.—In some cases it is advantageousto put the patient in the standing position for thepurpose of inspecting the abdomen; especially isthis desirable in suspected ptosis of the abdomi-nal viscera, a condition often associated withuterine disease. Here we must inspect not the abdomen alone,but the entire trunk. The patient stands, first, facing the phy-sician, entirely nude except for a sheet held by a nurse drapingthe lower limbs and pubic region. Then she stands so that hesees her in profile. In typical enteroptosis one notes a long, nar-row thorax, with flat and sunken epigastric region. The waist islong, the abdomen is prominent, the shoulders are rounded, andwhen seen in profile the lower back is nearly flat instead of pre-senting, as normally, a forward curve, with shoulders and hips wellback and spine bent forward in the lumbar region. There is gen-erally an absence of adipose tissue in these patients and the musclesare apt to be slender and flabby.
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Fig. 19.—TheBody Pose inEnteroptosis. 68 PHYSICAL EXAMINATION 7. Palpation of the Abdomen To palpate the abdomen successfully, the patient should be pre-pared as for inspection, that is, in the dorsal position with the headslightly raised on a pillow, all clothing loosened, the feet supported,and the pubic region, thighs, and legs covered by a sheet. Thephysician, standing on the patients right, places both hands,warmed, and with finger nails cut short, on the abdomen. Noabrupt or rapid movements should be made, and, for the purpose ofdistracting the patients attention and thus favoring relaxation,it is advisable at this juncture to ask some question as to the health,not directly referable to the abdomen. By care and patience the tendency of the abdominal musclesto contract when stimulated by manipulation may be overcome.Oftentimes more than one sitting is necessary to accomplish thisresult, and in this event the diagnosis must be held in abeyanceuntil after a second examination. It

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