. A practical treatise on medical diagnosis for students and physicians . er organs. It can be distinguished asliver : (1) by recognizing the notch ; (2) by the presence of a tympaniticnote in the normal hepatic region, as loops of intestine lie between the1 Musser. Amyloid Disease of Liver, Penna. State Medical Journal, 1899. FLOATING LIVER. 529 diaphragm and liver ; (3) by the excessive movability of the tumor ; and(4) by the fact that it is possible to replace the liver ; (5) by its size andconsistency. It occurs almost exclusively in women, possibly as theresult of a congenital lengthening
. A practical treatise on medical diagnosis for students and physicians . er organs. It can be distinguished asliver : (1) by recognizing the notch ; (2) by the presence of a tympaniticnote in the normal hepatic region, as loops of intestine lie between the1 Musser. Amyloid Disease of Liver, Penna. State Medical Journal, 1899. FLOATING LIVER. 529 diaphragm and liver ; (3) by the excessive movability of the tumor ; and(4) by the fact that it is possible to replace the liver ; (5) by its size andconsistency. It occurs almost exclusively in women, possibly as theresult of a congenital lengthening of the suspensory ligament, althoughmore likely from relaxed abdominal walls. It may be confounded withovarian cyst, appendicitis with tumor, and movable right kidney withhydronephrosis. Glenards method, or procidS du pouce, sometimes enables the examinerto feel the edge of the liver when ordinary methods of palpation fail toreveal it. The method consists essentially in thrusting the liver forwardwith the fingers of the left hand, while with the thumb in abduction the. tilenards procede du pouce. edge of the liver is felt for, the right hand meanwhile forcing the intes-tines out of the way. The examiner sits on the right side of the bedfacing the patient, who lies on his back with the legs extended and theshoulders slightly raised on a bolster. The liver is pressed forward, withthe fingers of the left hand applied to the lumbar region, while the thumbof the same hand in abduction remains free to palpate the anterior surfaceof the body. The right hand in extreme adduction is then applied to theabdomen and, while deep pressure is made for the purpose of forcing thecoils of intestine up under the liver, the hand is rotated to a transverse 530 PHYSICAL DIAGNOSIS OF DISEASES WITHIN THE MiDOMEN. position on the abdomen. (See Figs. 191 and L92.) The patient nowtakes a deep breath, and at the same time the ball of the left thumbglides upward and outward and from behind forward. The la
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