1. =Peritoneum.= Normally the peritoneum is moist-shining, grayish
and translucent. It is cloudy, dry, lustreless, injected, swollen
or covered with exudate in acute inflammation; thickened, hyaline
(“iced” or “Zuckerguss”) in chronic inflammation. Note degree,
character and location of adhesions. The most common pathologic
conditions are inflammation, tuberculosis, secondary carcinoma
and pseudomyxoma peritonei. Lymphomata are found in cases of
typhoid fever and in leukæmia. Primary neoplasms (lymphangioma,
endothelioma, carcinoma, lymphosarcoma, angiosarcoma, etc.) are
rare. Ovarian cysts of the structure of cystadenoma may give rise
to implantation-metastases over the peritoneum. The parasites are
echinoccocus and cysticercus.
2. =Spleen.= Weight 150-250 grms., length 12 cm.; breadth 8 cm.,
thickness 3 cm. Varies greatly in size and weight. Describe shape,
character of borders, number of notches, etc. Accessory spleens
are common in the gastrosplenic omentum. _Capsule_ should be
delicate, smooth, shining and transparent. Note _tension of capsule_
(loose, wrinkled, tense), adhesions, hyaline thickenings, exudates
or neoplasms. _Color_ of spleen through capsule is bluish-red.
Fresh anæmic infarcts appear as yellowish or reddish-yellow areas
surrounded by a darker red zone. Cicatricial depressions on the
surface of the spleen are usually the result of healed infarcts.
_Consistence_ of spleen normally is that of muscle. In acute
hyperplasias and congestions the spleen is softer and more friable
(acute infections, typhoid fever). In chronic hyperplasias and
congestions, atrophy, amyloid degeneration, etc., the consistence is
firmer than normal, even to that of a wooden hardness in advanced
amyloid disease. (Apply iodin test.) The large, firm spleen is
characteristic of leukæmia, splenic anæmia, syphilis and chronic
malaria. On section note the _pulp_, _follicles_ and _trabeculæ_. In
the normal spleen the cut surface is dark red or bluish-red, smooth,
and the trabeculæ and follicles easily seen. In acute hyperplasias
the pulp swells up over, the trabeculæ as a thick red or grayish-red
gruel-like substance. In chronic hyperplasias the pulp is atrophic,
grayish-red, and firm. In subacute hyperplasias the cut-surface often
presents a shagreened appearance. The _color_ of the cut-surface
is blood-red in typhoid fever, grayish-red in septicæmias,
chocolate-brown in potassium-chlorate poisoning and hemosiderosis
due to other causes. In amyloid spleen the amyloid portions are
glassy; when confined to the follicles the latter look like grains
of boiled sago. The _follicles_ are about the size of medium
pin-heads, grayish in color, not elevated and cannot be scraped
out with the knife. They are more numerous and larger in young
individuals than in adults. Note size and number, degenerations,
etc. The _trabeculæ_ appear as fine gray lines, sharply outlined,
increasing in size toward the hilus and capsule. They are more
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