Physical Diagnosis: a Guide to Methods of Clinical Investigation

Cover Physical Diagnosis: a Guide to Methods of Clinical Investigation
Physical Diagnosis: a Guide to Methods of Clinical Investigation
George Alexander Gibson, William Russell
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The flanks, the lateral parts, including the hypochondriac, lumbar, and iliac regions, and the hypogastrium, are dull.
Digitized by Google ALIMENTAR Y SYSTEM, 183 This is due to the fluid gravitating to the posterior, lateral, and lower parts of the cavity, the percussion sound over fluid always being dull. If the patient be turned on the side the level of dulness on the dependent side rises, that is, it approaches nearer the middle line, while a tympanitic, or at least a clearer, sound is pres
...ent over the elevated side : this is due to the fluid being free in the abdominal cavity, and changing with the position of the trunk, A similar phenomenon is produced by moving the patient from the recumbent to the sitting posture, the limit of dulness in the hypograstrium then rising higher, that is, towards the umbilicus.
While the foregoing is the result of percussion in the majority of instances, cases are frequently seen in which, notwithstanding the presence of considerable ascites, there is a tympanitic sound on percussion in one or other flank : this is to be explained by gaseous distention of the colon bringing it into contact with the abdominal wall at the part where the tympanitic sound is obtained.


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