. Physical diagnosis . lower edge of the mass and allow them todescend with it while the patient takes a full breath. To make surethat an actual descent occurs, one must sight the mass (and the hand)against some motionless object in the room beyond, else one may bedeceived by the movement of the abdominal walls over the tumor, 344 PHYSICAL DIAGNOSIS while the tumor itself remains motionless or nearly so. Tumors con-nected with the stomach, omentum, liver or spleen move about twoinches with a forced inspiration. Kidney tumors move less, seldomas much as an inch. Pancreatic and retroperitoneal t
. Physical diagnosis . lower edge of the mass and allow them todescend with it while the patient takes a full breath. To make surethat an actual descent occurs, one must sight the mass (and the hand)against some motionless object in the room beyond, else one may bedeceived by the movement of the abdominal walls over the tumor, 344 PHYSICAL DIAGNOSIS while the tumor itself remains motionless or nearly so. Tumors con-nected with the stomach, omentum, liver or spleen move about twoinches with a forced inspiration. Kidney tumors move less, seldomas much as an inch. Pancreatic and retroperitoneal tumors havescarcely any mobility. Those connected with the. intestine vary con-siderably in respiratory mobility, according to the presence and degreeof adherence to other parts, but their excursion is rarely an inch. Peritoneal crepitus is a grating, rubbing sensation experienced onlight palpation, and due—supposedly—to the presence of a plastic,peritoneal exudate similar to that which produces the friction sounds. Fig. 205.—Diastasis recti. in pericarditis. Over an enlarged spleen (, in leukaemia) peritonealcrepitus may be due to local perisplenitis, and in perigastritis, peri-hepatitis, and perienteritis similar crepitus occurs. Dipping refers to a sudden displacement of the abdominal wall andwhatever lies close beneath it, by a swift poke of the finger tips, whichmay succeed thereby in touching a solid organ or tumor which gentle,gradual palpation misses. Thus one may reach and mark out anenlarged liver through a layer of ascites which would prevent ordinarypalpation. THE ABDOMEN IN GENERAL 345 Percussion.—Abdominal percussion is less valuable than tho-racic. A lighter blow is used, and the distinction between dulness andtympany is easy. It is of value chiefly to determine the presence offluid free in the peritoneal cavity, and to ascertain whether a tumor isdue to or covered by gaseous distention. (a) Free fluid (ascites, peritonitis, hsemoperitoneum, rupturedcy
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