A Text-book of Diseases of WomenPenrose, Charles B. (Charles Bingham)
Science
A Text-book of Diseases of Women
Penrose, Charles B. (Charles Bingham)
Women -- Diseases
The dimensions of the vesical triangle are subject to individual
variations. The triangle is usually equilateral, its sides varying
from 1 to 1½ inches in length. The vesical orifices of the ureters are
therefore situated at points lying from ½ to ¾ of an inch from the
median line--a useful fact to remember in opening the bladder through
the vagina.
The vascular supply of the bladder is intimately associated with that
of the uterus--a fact that explains the sympathetic disturbance of
the bladder in uterine disease. The interior of the normal bladder is
of a dull gray-red color. When distended, as in making an endoscopic
examination, the minute arteries and veins may be plainly seen upon the
surface.
The pressure of the urine in the bladder may be determined by the
manometer. In the erect posture the intra-vesical pressure has been
found to vary from 12 to 16 inches of mercury. In the recumbent posture
the pressure is reduced to from 4 to 6 inches.
=Cystitis.=--Cystitis, especially of the subacute or the chronic form,
is a common disease in women. The pathological changes resemble those
seen in inflammation of mucous membrane in other parts of the body.
In the acute stage the mucous membrane is swollen and relaxed, and of a
deep-red or hyperemic appearance. Partial exfoliation takes place. The
surface may be covered with thick, tenacious mucus or pus.
In the chronic stage the mucous membrane is of a muddy gray color, and
may be more or less covered with a muco-purulent secretion. Ulceration,
superficial or deep, may occur. The ulcer is sometimes deep and ragged
and extends into the muscular wall.
In chronic cystitis we often find on the surface of the mucous membrane
small localized areas of inflammation varying in size from ½ inch to
2 inches in diameter, and presenting a congested, granular, or eroded
appearance, while the rest of the mucous membrane appears perfectly
normal. These areas of inflammation bleed readily when touched. They
are most often found in the base of the bladder, though they may occur
in any part. When chronic cystitis is limited, it is usually confined
to the vesical triangle.
The outer coats of the bladder may be involved in the inflammatory
process, and become much thickened and hypertrophied. The ureters and
the kidneys may become in time affected, through direct extension of
the inflammation in the form of a ureteritis and pyelitis, or through
obstruction of the vesical orifice of the ureters from inflammatory
thickening. The alteration in the character of the urine is usually
marked except in the mild forms of chronic inflammation. The specific
gravity is low, varying from 1005 to 1018. In the chronic disease the
urine is alkaline and ammoniacal. It contains blood, mucus, pus, and
epithelial cells from the vesical mucosa.
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