=Abdomen.=—The position for examination of the abdominal viscera is
usually with the patient supine, head slightly elevated, knees drawn up
partially and supported to relieve any muscular strain, and with the
hands at the sides. In this position complete relaxation is obtained.
Observe any enlargements from gas, fluid, or tumor, muscular changes,
color, etc. The patient may, also, be placed upon the side, and in the
knee-chest position for further verification of the diagnosis. Where
the abdominal wall is much relaxed, or there is a pendulous abdomen
with enteroptosis, there will be found a change of relations of the
viscera by these different positions, allowing them to be palpated in
another position. When there is marked tenderness it is often possible
to go deeper with less discomfort with the patient in the knee-chest
position. The Trendelenburg position may also be utilized. Where
ascites is suspected palpation should be made with the patient in
various positions in order to note changes of location of the fluid.
Frequently much can be learned by inspection with the patient standing.
Clues to visceral disturbance can often be had by tracing the nerve
connection from the spinal lesions to the suspected part.
In examining the =liver= care must be taken that any gouging or severe
bruising of the organ does not take place. The liver can be outlined
by percussion and also by palpation of its lower and inner borders
Congestions, atrophy, enlargement or hardening should be noted, also
any change in position.
A rather complete examination can be given the =biliary tract= from the
=gall-bladder= to the =duodenal orifice= of the =biliary duct=. By a
careful inhibitory pressure over the duct the outline of the tract can
be discerned providing the patient is not too stout. When the tract
is swollen considerable tenderness will be present. The patient will
complain of a stabbing or piercing pain upon pressure and manipulation
if the duct is inflamed.
Usually the tenderness is greatest nearer the =duodenal orifice=. The
duodenal orifice is about one and one-half inches diagonally downward
to the right from the umbilicus. In cases of impacted =gall-stones= the
osteopath as a rule has very little trouble in locating the stone.
The =spleen= may be percussed and when in a markedly enlarged condition
its lower border can be palpated. Great care must be used in the latter
condition as there is danger of rupture.
In examining the =stomach= the usual methods of inspection, palpation,
percussion, analysis of the contents, etc., are employed.
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