Hepatitis and hepatic abscess : their aetiology, diagnosis, and treatment / by G. Harrison Younge.

  • Younge, George Harrison.
Date:
1889
Catalogue details

Licence: Public Domain Mark

Credit: Hepatitis and hepatic abscess : their aetiology, diagnosis, and treatment / by G. Harrison Younge. Source: Wellcome Collection.

Provider: This material has been provided by Royal College of Physicians, London. The original may be consulted at Royal College of Physicians, London.

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    iaitation caused by the pus often excites inflammation of the pleura covering the diaphragm. When this occurs, a distinct friction sound is heard, and there may be oegophony over the attachments of the diaphragm. In the diagnosis of these cases great care is necessary to distinguish them from primary diaphragmatic pleurisy. During the initial stage of hepatitis the respiratory movements on the right side are limited, owing to the pain caused by full inspiration. If, however, the patient is persuaded to take a full breath the liver descends freely. When an abscess has formed, not only are the movements of the right side limited, but the liver does not descend on forced inspiration. As the hepatic dulness increases the right side becomes perceptibly enlarged. When the abscess is in the thin edge of the liver this can easily be felt below the costal arch, and it communicates a sensation of dense elastic resistance to the hand. When it is situated deeply below the ribs the inter- costal spaces bulge, becoming distinctly convex outwards. Percussion over the bulging intercostals gives a sensation of marked resistance to the finger. When examining a ■ patient for enlargement of the side and bulging of the intercostals it is best to do so from a distance, as from the foot of the bed. From this position an enlargement, which would probably escape notice if examined in the ordinary way, will often be detected. Careful measure- ments are of course necessary to determine the exact degree of enlargement present. In doing this it should not be forgotten that the right side is naturally a little larger than the left. Tension of the right rectus muscle has been described as an important sign of hepatic abscess. It is of little value, however, as it,is present in all painful diseases of the liver. Fluctuation is rarely detected in an acute abscess, and then only when the pus has been allowed to burrow extensively. A friction sound may bo heard on auscultation over an acute