. A practical treatise on medical diagnosis for students and physicians . IVER. 1081 they may continue; often there is only constipation with the passage ofmucus and hardened feces. In an obscure case a study of the stoolsshould be made, as the detection of amoebae in the mucus or in the fecesmay point to the true conclusion. Locally there is pain over the liver, which may be referred to theregion of the right or the left lobe. It may be seated in the fifth or sixthinterspaces anteriorly, or at the ninth and tenth ribs posteriorly. Theremay be pain in the right shoulder mechanism. The pain may
. A practical treatise on medical diagnosis for students and physicians . IVER. 1081 they may continue; often there is only constipation with the passage ofmucus and hardened feces. In an obscure case a study of the stoolsshould be made, as the detection of amoebae in the mucus or in the fecesmay point to the true conclusion. Locally there is pain over the liver, which may be referred to theregion of the right or the left lobe. It may be seated in the fifth or sixthinterspaces anteriorly, or at the ninth and tenth ribs posteriorly. Theremay be pain in the right shoulder mechanism. The pain may be paro-xysmal, or it may be intense and persistent. Physical Signs. (Plate XLIL, Fig. 1.) The enlargement may beuniform if the abscess is central; on the other hand, the enlargement mayextend chiefly upward in the anterior, the axillary, or the posterior the convex surface of the right lobe of the liver is affected, theenlargement is usually upward. An abscess in the lower portion of theright lobe produces a downward enlargement, and the lobe of the liver. Intermittent fever in abscess of the liver. can readily be detected on palpation. When the abscess is limited to theleft lobe of the liver, and is situated about the suspensory ligament, theenlargement may be seen below the xiphoid cartilage. The mass mayextend to the umbilicus and project forward; sometimes it is sufficientlyilarge to cause eversion of the ribs of each side and render the entire|epigastrium unusually prominent. The surface may become reddenediiand cedematous. Over the tumor, which is hard at first but later becomesSoft, there is tenderness on palpation, and there may be, as in other situa-tions, fluctuation. 1082 DISEASES OF THE LIVER, SPLEEN, AND PANCREAS. The irregular enlargement is made out by percussion. The outline may-be difficult to map out on account of secondary pleural effusion, or secon-dary pleural inflammation with the development of hepatopulmonary fis-tula, causing dulness poste
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