. A practical treatise on medical diagnosis for students and physicians . d at the edge of the liver in the usual situation,and may gradually increase to an enormous extent, so that it has beenmistaken for an ovarian cyst. The gall-bladder is often quite movable,and on account of its location and movability, as well as its elongatedshape, has been mistaken for a floating or movable kidney. If the gall-bladder is not too large, it can be felt as a rounded or pyriform masswhen the hand is placed along the margin of the liver, becoming moremarked when the patient takes a full breath. The enlargem
. A practical treatise on medical diagnosis for students and physicians . d at the edge of the liver in the usual situation,and may gradually increase to an enormous extent, so that it has beenmistaken for an ovarian cyst. The gall-bladder is often quite movable,and on account of its location and movability, as well as its elongatedshape, has been mistaken for a floating or movable kidney. If the gall-bladder is not too large, it can be felt as a rounded or pyriform masswhen the hand is placed along the margin of the liver, becoming moremarked when the patient takes a full breath. The enlargement is notattended by any other symptoms except mechanical ones, unless the con-tents of the gall-bladder are purulent. In obstruction with simple en-largement the fluid obtained by aspiration is thin, of a mucoid nature,and alkaline in reaction. It may contain cholesterin-plates, and some-times blood. It must be distinguished from the fluid of a hydatid Simple enlargement of the gall-bladder must be distin-guished from enlargements due to Cancer of pylorus pressing on the cystic duct. Enlargement of the gall-bladder, usually due to cystic obstruction aspreviously mentioned, may be mistaken for floating kidney, for tumor ofpylorus, and for ovarian cyst. Tumors of the gall-bladder from any ofthese causes are recognized by their position and shape, and by the char-acter of the tumor. The position varies. The tumor is usually situatedin the gall-bladder region, but may extend as low as the groin, or maybe so large as to distend the ribs and fill almost the entire abdominalcavity. If, however, the case has been under observation from the begin-ning, the tumor must have been found originally in the gall-bladderregion. This region corresponds to the point where a line drawn fromthe acromion process of the right shoulder to the umbilicus intersects thecostal margin. The tumor grows from this point toward the umbilicusin nearly all the cases. It can be re
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