SEMIOLOGY OF THE DIGESTIVE APPARATUS. 119 



or sporozoic diarrhoea), and intestinal haemorrhage. The last-named may- 

 be of varying degrees of acuteness, from the passage of simple drops or 

 streaks of blood, distributed over almost normal excreta, to the passage 

 of unchanged blood in liquid jets or in clots. 



Macroscopic examination. Macroscopic examination takes cognis- 

 ance, firstly, of the quantity (40 to 80 lbs.), consistence (firmness or soft- 

 ness), colour (olive green, blackish green, greyish black, sooty, or tarry) 

 and odour (normal, foetid, putrid, etc.) of the faeces. 



Sometimes the excreta are moulded and covered with glairy mucus, 

 or contain such abnormal products as undigested food (a sign of 

 chronic diarrhoea), false membranes, false membranes due to pseudo- 

 membranous enteritis, fibrinous clots, or parasites like liver flukes, taeniae 

 and strongyles. 



Microscopic examination. Microscopic and bacteriological examina- 

 tion is sometimes useful ; and even when macroscopic examination has 

 revealed nothing, it is possible to detect the presence of the eggs of 

 parasites like flukes, strongyles, hooked worms, etc., the presence of 

 sporozoa (as in intestinal coccidiosis) and of specific microbes, as in the 

 diarrhoea of calves, etc. 



It is only by the synthesis of methodically collected signs that 

 one finally succeeds in exactly diagnosing the numerous diseases which 

 may affect the intestine : intestinal congestion, invagination, volvulus, 

 intestinal strangulation (mesenteric or diaphragmatic herniae, etc.), 

 atresia of the anus, acute or haemorrhagic enteritis, or intestinal 

 helminthiasis. 



Liver. The liver is situated in the right sub-lumbar region. It is 

 fixed behind the diaphragm and under the hypochondriac region, and 

 extends from the ninth to the thirteenth rib. It can be examined by 

 palpation through the last intercostal spaces and behind the thirteenth 

 rib. In health it is difficult to pass the fingers sufficiently under the 

 hypochondriac circle to reach the liver; but in case of morbid hyper- 

 trophy it extends more or less beyond the last rib, and palpation be- 

 tween .the last ribs sometimes reveals abnormal sensibility. 



Percussion better than palpation enables one to delimit the space 

 occupied by the liver, particularly towards the back, where there is no 

 interposed layer of lung. Percussion is especially useful in detecting 

 hypertrophy due to cancer, tuberculosis, echinococcosis of the liver, etc., 

 or hepatic atrophy. In isolated cases icterus may exist, confirming the 

 conclusions otherwise arrived at. 



Pancreas. The pancreas is situated rather deeply in the right sub- 

 lumbar region, below the kidney, behind the liver, above the floating 

 colon, and within the duodenal loop. It is therefore very difficult to 

 examine ; moreover, the diseases which affect it are still little understood. 



V 



OF THE ^A 



^^NIVERSITY ) 



