The signs of internal disease, with a brief consideration of the principal symptoms thereof . sily determines itsupper boundary. The inner border of the spleen limits the fundus onthe left. The degree of obliquity of the stomach is still a matter ofdispute, the merits of which we will ignore at present, stating whatwe consider the most accurate views. When the stomach is distended 266 DISEASES OF THE ABDOMEN the fundus and greater curvature rotate to th^ front, and come inimmediate contact with the abdominal wall. This portion is trian-gular in shape, bounded on the right and above by the live
The signs of internal disease, with a brief consideration of the principal symptoms thereof . sily determines itsupper boundary. The inner border of the spleen limits the fundus onthe left. The degree of obliquity of the stomach is still a matter ofdispute, the merits of which we will ignore at present, stating whatwe consider the most accurate views. When the stomach is distended 266 DISEASES OF THE ABDOMEN the fundus and greater curvature rotate to th^ front, and come inimmediate contact with the abdominal wall. This portion is trian-gular in shape, bounded on the right and above by the liver, on theleft by the costal edge as low as the ninth. The free border or greatercurvature can be determined by percussion. Begin above at the edgeof the liver and percuss gently downwards from this line of dullnessuntil a slight alteration in the pitch of the tympanitic percussion noteindicates that the transverse colon has been reached. This line, whichmarks the greater curvature of the stomach, bows downward from thefree end of the tenth rib on the left, crosses the middle line a little. Fig. 66—Normal position of the stomach, according to Rosenheim (solid line).Dotted line, normal position according to ] above the umbilicus (1 to 2), thence curves upward to the edge ofthe thorax where it meets the right parasternal line. ^ The cardiac end or fundus reaches as high as the sixth cartilagebeing behind the heart apex. The cardiac orifice is opposite theseventh left costal cartilage about one inch from the sternum(Treves). The pylorus varies, but its most frequent position is to the rightof the middle line two to three inches below the sterno-xyphoid articu-lation. This point corresponds with the level of the twelfth thoracicspine, DISEASES OF THE ABDOMEN 267 For diagnostic purposes the stomach may be distended either byinflating it with air or by means of an effervescing- powder. Air maybe introduced through the stomach tube by means of a hand powder consis
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Keywords: ., bookcentury1900, bookdecade1900, booksubjectdiagnos, bookyear1906
