Volume 2

Differential diagnosis / by Richard C. Cabot.

  • Cabot, Richard C. (Richard Clarke), 1868-1939
Date:
[between 1920 and 1929]
Catalogue details

Licence: In copyright

Credit: Differential diagnosis / by Richard C. Cabot. Source: Wellcome Collection.

    21/732 (page 13)
    DIFFERENTIAL DIAGNOSIS CHAPTER I ABDOMINAL AND OTHER TUMORS The diagnosis of abdominal tumors is in most cases cither easy or impossible; but it is never easy unless one has a considerable knowledge of what tumors are likely to occur in each of the regions of the abdomen, unless one has taken a careful history and made the ordinary manual exploration of the mass. In addition, laboratory examinations and x-ray exposures are sometimes of importance. Of these methods, direct palpation of the tumor may be the most or the least important of all. Sometimes it tells us a good deal, but usually what it tells us is interpreted and enlarged very considerably by what we have learned to expect. For example, an epigastric tumor is almost always cancer of the stomach. Should such a tumor occur in a child, we should, of course, seek some other diagnosis; but, then, such a tumor very rarely does occur in a child. Certain regions of the abdomen are much more prone to contain tumors than others; in other words, the diseases which produce tumor in the abdomen are chiefly those of the pelvis and pelvic or¬ gans, those of the stomach, liver, and kidneys. Tumors of the left hypochondrium are comparatively rare, and almost invariably turn out to be connected with the spleen or left kidney. In the right hypochondrium we have not only those connected with the liver and gall-bladder, but those connected with the hepatic flexure of the colon, with the pyloric end of the stomach, with the right kidney, as well as retroperitoneal and glandular masses which often push the liver forward and are hidden behind it. It should always be remembered that a doubtful tumor, seemingly springing from the liver, may, in fact, be a normal liver pushed downward and forward by some growth behind it. Some of the most humiliating mistakes that I have known have been due to forgetting this point. If ascites is present, our diagnosis is much simplified, as there are comparatively few' tumors often associated with ascites. Such Vol. II *3