fibrin-content, few flocculi, and relatively small number of white
cells. Inflammatory exudates are turbid, often foul-smelling, usually
acid, specific gravity over 1.016, high albumin-, fibrin- and
urea-content, numerous thick flocculi and numerous cells. In early
peritoneal tuberculosis the fluid may be clear and resemble that of
a transudate. Milky and opalescent fluids are found in diabetes,
lipæmia, new-growths of the peritoneum, obstruction or rupture of
thoracic duct or receptaculum. Hemorrhagic exudates may be traumatic
(rupture of spleen, liver, intestines, extra-uterine pregnancy,
etc.), inflammatory (severe acute peritonitis), or due to new-growths
or tuberculosis of the peritoneum, extreme portal stasis, perforation
of gastric or typhoid ulcers, severe intoxications, chronic icterus,
etc. Red effusions may be due to diffused hæmoglobin. In such cases
there is no settling of the color, and coagulation may not occur.
When red cells are present settling takes place on standing. Rupture
of gall-bladder or bile-ducts may lead to presence of free bile
in the peritoneal cavity. Postmortem diffusion of bile through
the gall-bladder wall should not be mistaken for a pathologic
condition. In normal conditions there is just enough fluid in the
peritoneal fluid to make the surfaces moist, and about a teaspoonful
in all may be collected from the flanks and pelvis. The amount
may be greatly increased just before death in all cases of slowly
progressive cardiac weakness. Note character of peritoneum (normally
moist-shining, grayish, translucent, cloudy, dry, lustreless,
thickened, hyaline (“iced” or “Zuckerguss”) in chronic inflammation.)
4. =Omentum.= Note position of lower border, amount of fat, condition
of blood-vessels, dry or moist-shining surface, adhesions (to
appendix, cæcum, oviducts), indurations, contractions (edges rolled
up), character of lymphnodes, cysts, tubercles, secondary tumors,
snared-off tumors from ovary or uterus (parasitic cysts, fibroids),
encysted foreign bodies, etc., exudates on surface, fat-necrosis,
accessory spleens, encysted parasites, hernia, etc. Most common
pathologic conditions are inflammation (secondary to appendicitis,
salpingitis, etc.), metastic carcinoma and tuberculosis.
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