Volume 1

Green's Encyclopedia and dictionary of medicine and surgery / edited by J. W. Ballantyne.

Date:
1906-1909
Catalogue details

Licence: Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)

Credit: Green's Encyclopedia and dictionary of medicine and surgery / edited by J. W. Ballantyne. Source: Wellcome Collection.

Provider: This material has been provided by The University of Glasgow Library. The original may be consulted at The University of Glasgow Library.

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    below the iinibilicus. Sometimes the enlarge- ment is chiefly behind, and may ascend high into the pleural cavity; there is also frequently a prominent bulging of the lower portion of the right side of the thoi'ax. A liver abscess is commonly tender to pressure, whereas a hydatid cyst often runs a painless course. Fluctuation or an elastic sensation, according to the depth from the surface, may be obtained over botli abscess and cyst. A peculiar tremulous sensa- tion, known as hydatid thrill, may be con- veyed to the left hand laid flat on an echino- coccus tumour, when the latter is percussed with the fingers of the right hand. This thrill, however, is met with over some ovarian cysts and rarely in cases of ascites. Gummata produce flat or nodular projections of various sizes, and may be associated with cicatricial contractions on the surface of the liver, constituting, in some cases, an irregular nodular mass in the right hypochondrium or epigastrium. Cancer, which is visually a secondary growth, gives rise to great enlargement of the liver, and also to large outgrowths on the surface or at the edge of the liver. These have rounded margins and cup-shaped central depressions. A cancerous growth may be simulated by the irregular syphilitic liver ; but the former under- goes progressive enlargement, ;uid is also dis- tinguished by its association with profomid cachexia, emaciation, and jaundice. The Gall-Bladder.—k. distended gall-bladder gives rise to a superficial, pyriform or globular, tense, elastic swelling which projects beneath tiie costal margin between the right nipple and ]jarasternal lines. Below, its outlines can be defined ; but above, no definite edge can be felt. The swelling may depend on obstruction of the cystic duct by calculi or cancer. IJapid emacia- tion, with or without jaundice, and cachexia, speak for cancer. When the fundus of the bladder is cancerous, the swelling is hard and jierhaps nodular, and is less movable than in simple hydrops. The Stomach.—Two varieties of abdominal swelling occur—one usually small and hard, due to new growth, and the other large and elastic, due to distension of the stomach. The former tumour is usually felt above and to the right of the umbilicus and is due to cancer of the pylorus, for this part is easily dragged down from its normal position at the right costal margin. The mass is usually circumscribed, except on the left, where sometimes it may be felt to shade off gradually into the wall of the stomach. It may or may not be aft'ected by the respiratory movements. In a suspected case of cancer of the pylorus, when there is no obvious prominence, the observer's fingers should be pushed as deeply as jiossible beneath the edge of the right rectus nuiscle, while the patient lies on his back or on one or other side, in this way a small nodule may be discovered which otherwise would liave escaped notice. It is also to be observed—(I) that a tumour may displace the jjylorus to a considerable extent, thus cancer of this part may be situated as far to the left as the hypochondrium, and rarely even below the level of the umbilicus ; (2) that the pulsation of the aorta may be transmitted through the tumour ; (3) that such pulsation, and even the tumour itself, may be felt to-day and gone to-morrow ; (4) that gurgling of gas may be felt thi'ough a pyloric tumour. A tumour in the epigastrium and left hypo- chondrium occurs in cancer of the body of the stomach ; also in such rare conditions as difi'use sarcoma and chronic induration of the wall of the stomach. Dilatation of the stomach, the usual cause of which is pyloric obstruction, may cause disten- sion of any part of the abdomen, except perhaps the epigastrium. Frequently in chronic dilata- tion the stomach occupies a lower position than normal ; and its contour is plainly seen, chiefly owing to the presence of peristaltic waves which pass from left to right; they are often associated with irregular protrusions of the stomach walls. The Intestines.—A portion of the bowel may be found in a state of distension, or it may be the seat of a tumour. The latter is commonly produced by one of foiu- causes, viz. fa'cal accumulation, inflammatory exudation, new growths, intussusception. A fcecal tumow, which may occur in almost any part of the abdomen, is usually cylindrical in shape, has an uneven surface, and feels as if it were situated immediately beneath the abdominal wall. In- flammatory swellings are more commonly situated in the right or left iliac fossa—a swelling on the right side being usually due to appendicitis. These swellings are associated with pain, tender- ness, and symptoms of fel)rile disturbance. Abscesses may form and point in various directions. Cancer of the ca3cum pi-oduces a ; harder and more nodular mass than that due to appendicitis, and is usually a little nearer to Poupart's ligament. If it causes obstruction of the bowel the flanks may be flattened when the rest of the abdomen is much enlarged. Rarely a swelling in the right hypochondrium is caused by cancer of the duodenum or of the hepatic flexure of the colon ; one in the left hypochondrium by cancer of the splenic flexure. But the commonest site for cancer of the bowel is the rectum or sigmoid flexure. In malignant disease of the hepatic, splenic, or sigmoid flexure the symptoms are often referred back i to the caecum, which is liable to become dis- tended and ulcerated. Bubbling of gas may be felt through these tumours, and peristaltic I waves passing from right to left may be seen to 1 travel along the distended portion of colon. In