The diseases of women : a handbook for students and practitioners . Pelvic pregnancy. Fig. 94.—Diagram to indicate the positions of abdominal swellings (A. E. G.). ment of kidney from hydronephrosis or growth—mov-able kidney; enlarged spleen ; omental tumors ; malignantdisease of the intestines; ectopic gestation (Figs. 94, 95). We must begin by excluding the first two conditions:palpation and percussion will generally suffice, especiallyunder an anaesthetic. Ascites is indicated by the absence ofdefinite limits, the dulness in the flanks and hypochondrium D
The diseases of women : a handbook for students and practitioners . Pelvic pregnancy. Fig. 94.—Diagram to indicate the positions of abdominal swellings (A. E. G.). ment of kidney from hydronephrosis or growth—mov-able kidney; enlarged spleen ; omental tumors ; malignantdisease of the intestines; ectopic gestation (Figs. 94, 95). We must begin by excluding the first two conditions:palpation and percussion will generally suffice, especiallyunder an anaesthetic. Ascites is indicated by the absence ofdefinite limits, the dulness in the flanks and hypochondrium DIAGNOSIS. 327 with resonance in the epigastrium, the line of dulness hav-ing* a margin concave toward the umbilicus, and the varia-tions in dulness on altering the position of the patient. Anencysted collection of peritoneal fluid may, however, havefairly definite margins, unaltered by the position of thepatient, and lie excentrically. The next question is, Does the swelling originate in thepelvis ? If so, palpation cannot reach its lower margin ; if. Splenic swelling. Ovarian cyst,pregnancy, 6th mt/i.,or , 5th mth.,or myoma. Pregnancy, 4th mth.,myoma or distendedbladder. Fig. 95.—Diagram to indicate the positions of abdominal swellings (A. E. G.). we find the swelling median and uniform, it is probably agravid uterus, a uterine myoma, or a large ovarian tumor;if arising laterally, it may be a small ovarian tumor, a fibro-myoma, an ectopic gestation, or pelvic inflammation. If, on the other hand, the lower limit can be defined, wehave to do with an abdominal tumor. If left-sided, smooth,passing up under the left costal margin, and superficiallydull, it is probably spleen. If nearer the middle line, and 328 DISEASES OF WOMEN. disappearing under the costal margin, with an area of reso-nance superficial to it, it is probably renal. A movablekidney will be definable above and below. An isolatedand well-defined tumor somewhere near the umbilicu
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