File:The diagnosis and treatment of diseases of women (1907) (14597944557).jpg

Identifier: diagnosistreatmecros (find matches)
Title: The diagnosis and treatment of diseases of women
Year: 1907 (1900s)
Authors: Crossen, Harry Sturgeon, 1869-
Subjects: Genital Diseases, Female Gynecology Gynecology Women Generative organs, Female
Publisher: St. Louis : Mosby
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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k becoming resonant.When the patient stands, the fluidagain shifts, seeking the lowest part,and the outline of dullness changes tothat shown in Fig. 190. Notice thatin all positions of the patient, thefluid occupies the lowest part of the DULLNESS FROM ASCITES 159 peritoneal cavity, and the upper margin of the fluid is approximately horizontal.Of course the height of the area of dullness varies in different cases, depending onthe amount of fluid in the cavity. The illustrations already referred to indicatethe dullness in the cases of ascites of moderate severity. If there is only a smallamount of fluid in the cavity, there may be only a small area of dullness appre-ciable in each flank, as the patient is lying on her back. When the patient turns onthe side, the area of dullness increases appreciably in the lower side and disap-pears entirely in the upper flank. When the patient stands, there may be a smallarea of dullness in lower abdomen just above the pubes, or there may be no dull-
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Fig. 191. A case of Extreme Ascites. Same patient as sliown in Fijiwlien the patient is on lier Back. The liglit area is all that is resonant. 135. Showing the Area of Dullness ness appreciable anywhere in the abdomen, because the amount of fluid is sosmall that it is all concealed in the depth of the pelvic portion of the peritonealcavity. On the other hand, in exceptional cases the amount of fluid is so greatthat it fills the peritoneal cavity and raises the abdominal wall above the intestines(higher than the mesentery will permit the intestines to float), giving dullnessabout the umbilicus as well as elsewhere. This does away with the coronaof resonance about the umbilicus, which is so characteristic a feature of ordinaryascites. Fig. 135 shows a patient sent to me with a supposed ovarian cyst. The general 160 GYNECOLOGIC DIAGNOSIS appearance was very much like that of a cyst distending the abdomen. Thearea about the umbiUcus was dull, excluding ordinary ascites. In percussing care

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