Page:Lectures on the diagnosis of abdominal tumors (microform) - delivered to the post-graduate class Johns Hopkins University, 1893 (IA cihm 01686).pdf/31

 20 THE DIAGNOSIS OF ABDOMINAL TUMORS.

geration and prolongation of the expiratory murmur, there are no changes to be noted in the lungs.

Abdomen.—There is a slight prominenca in the right hypo- chondrium, and on inspiration a tumor mass can be seen to descend ia the parasternal line. On palpation in this region, just below the costal margin, there is a hard, rounded mass, the outline of which can be pretty clearly made out toward the median line, but toward the right it is apparently continuous with the margin of the liver, It is superficial, nodular, bard, and very painful, On deep inspira- tion, it descends almost to the level of the navel, and ihe fingers ean be then placed between the tumor and the liver margin, and it can be held down. Gas can be felt bubbling through the mass. On percussion, there is a flat tympany. When quiet and in repose uo peristalsis can be seen as a rule, When the patient turns over on the left side the mass falls forward and to the left, and ean readily be grasped between the hands. The epigastric region is a little flattened; sometimes distinctly depressed. The lower umbili- eal region, on the contrary, is full.

On dilatation with tartaric acid and bicarbonate of sodium, the stomach is seen to be depressed and dilated. The lesser curvature passed just at the level of the navel; the greater curvature at a dis- tance of seven centimetres below. Waves of peristalsis were then seen in the stamach walls passing from left to right, and sometimes the organ showed an hour-glass contraction.

The test breakfast showed the presence of the organic acids, al- sence of free hydrochloric. Material washed out was dark in color and smelled very sour,

The liver is not enlarged; the spleen not palpable; no enlarge- ment of the external glands.

Case X. Enormoxs Dilatation of the Stomach, forming a Visible Tumar; Ridge-like Thickening ta the Pylorie Region.— Emma H., aged thirty years, colored, admitied (to the gynacolog- ical ward and transferred) April 28, 1808, complaining of swelling of the abdomen, nansea, and yomiting. Nothing of any moment in the family history. She was healthy until abont eight months ago, when she began to have dyspepsia and distress after eating. She has not infrequently had attacks of vomiting, Lately she has been much nauseated afier eating, and has hed pain uud swelling of the

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