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
In a thin woman the vermiform appendix may sometimes be felt through
the abdominal wall; and in cases of pain and inflammation in the right
iliac region it is sometimes important to determine whether or not
the trouble has started in the vermiform appendix or in the Fallopian
tube. In order to palpate the vermiform appendix the examiner should
stand upon the right side of the woman, who is lying upon her back,
and should place the tips of the fingers of the right hand at about
the junction of the upper and middle thirds of a line drawn from the
middle of Poupart’s ligament to the umbilicus. By pressing backward
firmly and gently, pulsations of the right common iliac artery may be
felt; and then by drawing the hand directly outward it will pass over
the different structures in this region lying between the palpating
hand and the posterior abdominal wall. The appendix may often be felt,
especially if it is indurated by inflammation.
_Percussion_ of the abdomen should be performed with the woman in the
dorsal position; though, if the examiner suspects the presence of free
fluid in the peritoneum, or ascites, much may be learned by percussing
in different positions and noting the accompanying changes in the
percussion-note.
Percussion should then be performed with the woman upon her back, upon
the right side, upon the left side, sitting up, and upon the hands and
knees. An encysted fluid accumulation will give practically the same
result in percussion in all positions, while free fluid will gravitate
to the most dependent portion.
_Auscultation_ of the abdomen is best performed with the stethoscope.
By it we may hear fetal heart-sounds, uterine souffle, placental
bruit, peritoneal friction sounds, and the peristaltic sounds of the
intestinal tract. All of these sounds are of importance, and the
presence or absence of any of them may have an important bearing upon
the diagnosis of the case.
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