5. =Position of Abdominal Organs.= Note situs viscerum inversus,
gastro-enteroptosis, displacements due to spinal curvatures and
deformities, and hernia, anomalies or malformations, locate organs by
usual landmarks (edge of ribs, ensiform, umbilicus, etc.), position
of lower and left borders of liver, gall-bladder, spleen, pylorus and
fundus of stomach, appendix, colon, etc. Malposition of transverse
colon especially common. Note volvulus, ileus, invaginations,
etc. Examine stomach and intestines carefully for perforations.
Differentiate postmortem perforations and those due to pathologic
conditions. (Edges of postmortem perforations soft, slimy, without
evidences of disease.) The appendix should also be carefully examined
at this time. Note also peritoneal surface (color, thickness,
translucency, tubercles, adhesions), color and blood-content of all
abdominal organs before acted upon by exposure to air. In the female
examine pelvic organs. Do not mistake postmortem perforations of
stomach or intestine, postmortem imbibition and diffusion of bile
in region of gall-bladder, postmortem contraction of intestines,
dilatations of lymphatics with lymph or chyle, agonal transudates,
accessory spleens, etc., for pathologic conditions.
6. =Position of Diaphragm.= Normally fourth rib or interspace on
right, fifth rib on left, higher in the young, lower in old age.
Raised in conditions of increased abdominal pressure (pregnancy,
ascites, enlargement of liver or spleen, subdiaphragmatic abscess,
dilatation of stomach, urinary or gall-bladder, tumors of any
abdominal or pelvic organ, especially ovarian cysts, etc.), low
in increase of intrathoracic pressure (pleuritic effusions,
pneumothorax, pericardial effusion, hypertrophy of heart, tumors,
aneurism, etc.).
7. =Mammae.= Condition varies according to age, pregnancy, lactation,
etc. In resting glands the structure is lobulated, connective-tissue
white with yellow fat between; in the white connective-tissue are
small grayish-red nodules of gland-tissue (“breast-grains”). During
lactation the fat disappears entirely or to a large extent, the
entire organ consisting of a more homogeneous grayish-white glandular
tissue, distinctly granular on section, and resembling the section
of a salivary gland. Note size of ducts, presence of secretion
(colostrum or milk) on pressure, congestion, œdema, abscess, fistula,
caseous tubercles or gummata, cysts (milk, “soap,” “butter,”
senile, new growths), neoplasms, atrophy, hypoplasia, hypertrophy,
accessory nipples, parasites (echinococcus). The most common tumors
are adenofibromata and carcinomata. Tuberculosis is not rare. In
the male breast hypertrophy has been noted in association with
malignant chorio-epithelioma of the testis; and in the female with
pseudopregnancy and tumors of the genital tract. Adenofibroma, gumma
and tuberculosis are the most common conditions of the mammæ in males.
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