A system of practical medicine. By American authors. Vol. 4 : $b Diseases of the genito-urinary and cutaneous systems. Medical ophthalmology, and otology
Science
A system of practical medicine. By American authors. Vol. 4 : $b Diseases of the genito-urinary and cutaneous systems. Medical ophthalmology, and otology
Medicine -- Practice
SYMPTOMATOLOGY.--There is great variety in the kind and amount of
effect which the movable kidney exercises on the general organism and
the local effects it produces. Neither the local nor the general
symptoms are necessarily proportionate in severity to the amount of the
displacement.
It may be said in advance that, contrary to what might be expected, the
symptoms are not usually connected with any disturbance in the urinary
function, and, although exceptions are not unknown, the rule is for a
displaced kidney to be an otherwise healthy one. Cystitis and uterine
affections have been observed in this connection, but it is doubtful if
any relation other than coincidence or a mutual dependence upon
impaired general nutrition and overwork exists between them. The
partial stoppages which might be supposed to arise from the twisting of
the ureters are not frequently observed.
Hysteria and hypochondriasis have been frequently attributed to this
lesion, and might undoubtedly find their exciting cause in anxiety
about a tumor of unknown character and origin; but there seems no good
reason to connect them in any other relation of causation. It is
undoubtedly true that many pains and discomforts exist in these cases
which are neither satisfactorily explained nor gotten rid of by being
called hysterical. These abdominal pains, especially of a dragging
character, and also the sensation as of something falling or moving
about in the abdomen, particularly when the patient assumes the upright
posture or makes unusual exertions, are very naturally connected with
the existence of the actual condition which is likely to give rise to
them. Müller Warnek has recorded the frequent coincidence of flatulent
dyspepsia and dilatation of the stomach depending on retention, and its
consequent fermentation, in connection with the movable kidney and its
supposed pressure on the duodenum. It is not probable, however, that
all the symptoms are to be explained so simply, but it is quite as
likely that the dragging and tension of the pedicle may have a remoter
effect through the renal and sympathetic nerves.
Severer attacks occasionally occur with violent colic and inflammatory
symptoms, the tumor formed by the misplaced organ becoming exceedingly
sensitive to pressure. These have been attributed to some {24}
incarceration, but there is no evidence that this accident occurs, and
it has not been found after death. They are probably due to a localized
peritonitis of the investment of the kidney, or perhaps to simple
neuralgia. Icterus and hepatitis, consequent upon a circumscribed
peritonitis set up by the pressure of the movable kidney upon the
liver, have been observed.
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