File:The diagnosis and treatment of diseases of women (1907) (14781281821).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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hand may be sunk deeply into the abdomenbetween the separated recti muscles (Fig. 131). B. Abdominal Prominence from Something in Intestines. Gas (tj^mpanites). This may cause marked prominence when associated withrelaxation of abdominal wall. There is no distinct mass felt on palpation. Per-cussion shows hyper-resonance over all the abdomen. There are usually symptoms indicating gastric orintestinal indigestion.Tympanites is fre-quently associatedwith enteroptosis.Fig. 132 shows tym-panites which the pa-tient mistook for preg-nancy. Fecal Impaction.Fecal impaction maycause localized promi-nence in any part ofthe abdomen but it isusually situated alongthe course of the colon.The diagnosis dependslargely on the exclu-sion of other causesof enlargement, thehistory of constipationand the effect of treat-ment directed toward clearing out the intestinal tract. Have the patient takea purgative until free bowel movements are secured, then a large enema and thenreturn for another examination.
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Fig. 133. Ascites. A moderate amount of fluid in a relaxed abdomen.Notice how the abdomen spreads out at the sides. (Kelly—Operative,Gynecology.) C. Abdominal Prominence from Something in the Peritoneal Cavity. General Ascites. This may be slight (Fig. 133) or marked (Figs. 134,135,136, 137). In ascites, i. e. free fluid in the peritoneal cavity, the abdomen isinclined to spread out at the sides and flatten at the top. There is usually a dis-tinct fluid wave, obtained as previously explained (Fig. 35), which may be dis-tinguised from a fat wave as shown in Fig. 36. When the patient is turned onthe side or when she sits or stands, the area of dullness changes, because thefluid seeks the lowest part of the peritoneal cavity. (Figs. 185, 189, 190). PROMINENCE FROM ASCITES 127 Another diagnostic point is that in some cases where there is free fluid in the peri-toneal cavity, when the patient stands there is decided protrusion of the umbili-

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