Information on the Abdominal Examination.

The Abdominal Examination

At no portion of the body is the skilful application of the hand of more essential service to diagnosis than over the abdomen.  By carefully pressing with the hand (which should be warmed) at various points with a kind of gentle kneading motion, we obtain by the sense of touch information regarding 1) the condition of the abdominal wall; 2) the size, form, consistence, and mobility of certain of the abdominal organs, and whether any tumor be present within the cavity of the abdomen; and 3) if there be general tumefaction of the abdomen, whether such distension is the result of accumulation of gas in the intestines (tympanites), or is due to the presence of serous or inflammatory exudation; and, in -the latter case, whether such exudation be in the peritoneal cavity or be enclosed in a cyst of some kind or another.

The position of the patient is of the greatest importance.

He must lie on his back, with head and neck slightly raised, and with the knees flexed and drawn up towards the abdo men.  In most cases it is well to engage the patient in con versation while palpating the abdomen, as otherwise the abdominal muscles are usually involuntarily contracted, and the glottis closed.  The air in lungs, .retained there by the closure of the glottis, supplies the necessary resistance to this contraction of the abdominal muscles, and if this resistance be removed (as is best done by forcing the patient to open his glottis in speaking) the muscles have nothing to contract upon, and consequently become flaccid.  The relaxation of these muscles may be still further aided by diverting the patient's attention, and should there be niecessity for it, the exhibition of chloroform will allow of a very perfect exploration of the abdominal cavity.

Abdominal Walls, The temperature of the skin, the amount of subcutaneous fat, the presence or absence of oedematous or ephysematous swelling of the subcutaneous cellular tissue (see Chap.  I.) are readily recognized by the palpating hand, and require no special mention here.  Localized swellings of the abdominal wall, due to the presence of tumors, of inflammation or of abscess, may be mistaken for more serious affection of the abdominal organs them selves.  The immobility of such swellings, their position being unaltered by the respiratory movements, or by a change in the position of the patient, will generally suffice to distinguish them.  In reality, the physician has seldom any difficulty in satisfying himself of the seat of the swell ing, whether in the parietes, or in the cavity of the abdo men.  In difficult cases, such, for example, as when a deep seated abscess over the liver simulates a hepatic abscess opening outwards, the history of the case, and the other signs and symptoms, suffice as a general rule to indicate the real seat of the abscess.

The abdominal muscles, and more especially the " recti," present, when contracted, certain inequalities in thickness which are occasionally mistaken by the inexperienced for abdominal tumors.

The various hernial protrusions which are found in the umbilical, femoral, and inguinal regions, belong more es pecially to the domain ot surgery.

---