. The diagnosis and treatment of diseases of women. Fig. Indicating the point to seek for Appendix Fig. 151. Palpating for Tenderness or a Mass inthe Appendix Region. TENDERNESS IN ABDOMEN 137 with tympanitic distension and with marked hyperesthesia, it may cause thecondition known as phantom tumor/ whicli has led to so many serious mis-takes in abdominal diagnosis. The administration of a purgative to clear out theintestines and diminish the tympanites and of some nerve sedative to diminishthe hyperesthesia and nerve irritability, may remove the tension sufficiently toadmit of
. The diagnosis and treatment of diseases of women. Fig. Indicating the point to seek for Appendix Fig. 151. Palpating for Tenderness or a Mass inthe Appendix Region. TENDERNESS IN ABDOMEN 137 with tympanitic distension and with marked hyperesthesia, it may cause thecondition known as phantom tumor/ whicli has led to so many serious mis-takes in abdominal diagnosis. The administration of a purgative to clear out theintestines and diminish the tympanites and of some nerve sedative to diminishthe hyperesthesia and nerve irritability, may remove the tension sufficiently toadmit of a satisfactory examination. If not, the patient should be examinedunder anesthesia, provided the symptoms are serious enough to make a positivediagnosis necessary at once. Under anesthesia the tension of the abdominalwall disappears, and deep palpation may be made in the affected region and thepresence or absence of an abnormal mass Fia:. 152. Palpating for the Appendix itself, todetermine whether or not there is any appreciableinfiltration and thickening of it. When thickened, theappendix is felt as a small tender roll, deeply placed. Fig. 153. Another method of palpating the near the umbilicus, the fingers are carried indeeply and then brought slowly outward toward theanterior superior iliac spine. As the appendix passesunder the examining fingers, it is felt as a small rollbetween the fingers and the posterior abdominal wall. TENDERNESS IN ABDOMEN. For the purpose of studying the significance of tenderness in the abdomen, it isconvenient to divide thecavity as previously explained,into nine regions: the right,left, and central portions of the lower abdomen; the right, left and central por-tions of the upper abdomen; the central portion of the abdomen (umbilicalregion); and the right and left lumbar regions (Fig. 30). In any of these, a local tenderness takes on particular significance. Again
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