294 The Abdomen 



PART IV 

 THE ABDOMEN 



THE transverse measurement of the abdomen (abdo, I conceal) is 

 greater below than it is just beneath the diaphragm and especially so 

 in women ; but in children, on account of the imperfect development 

 of the pelvis, the superior transverse diameter is the greater. 



The boundaries are, laterally and anteriorly, the false ribs and 

 diaphragm, and the oblique, transverse, and straight muscles ; pos- 

 teriorly, the lumbar spine, the diaphragm, the lower ribs, quadratns 

 lumborum, and the lamellae of the transverse muscle. The expanded 

 ilia also help to enclose the cavity and support the viscera. 



Though the diaphragm affords a definite limit above, the abdomen 

 is separated from the pelvic cavity only by the shifting planes of peri- 

 toneum, which, under the name of false ligaments, slope to the bladder 

 and rectum. Were the partition between the abdominal and pelvic 

 cavities less movable, the ascent of the distended bladder and of the 

 pregnant uterus would be impeded, and the descent of the coils of 

 small intestine into the pelvis, when those viscera are empty, could 

 not take place. 



In cancer of the oesophagus or pylorus, on account of the emptiness 

 of the alimentary canal, the front of the abdomen is flat ; and in tuber- 

 cular meningitis, because of the irritability of the nervous system, the 

 bowels being empty and contracted, the depressed surface of the ab- 

 domen is * boat-shaped.' 



For palpation of the abdomen, the patient should be lying on his 

 back, with the knees drawn up so that the abdominal wall may be 

 relaxed to the utmost, and when a very thorough examination is 

 to be made, precaution should be taken that the stomach, bowels, 

 and bladder are empty. When a tumour descends with inspiration and 

 rises with expiration its seat is in one of the abdominal viscera, and 

 not in the abdominal wall. 



A line drawn around the trunk from the base of the ensiform 

 cartilage to the tenth dorsal spine suggests the upper limit of the 

 abdominal cavity, which ascends a good deal beneath the dome of the 

 diaphragm and under cover of the ribs and the base of the lungs. 



