316 



The Peritoneum 



On account of the close proximity of the peritoneum and pleura, 

 pleurisy sometimes sets up peritonitis. The intestines being inflated, 

 the diaphragm is so greatly raised that the heart and lungs work with 

 difficult)', and the patient is thereby much distressed. Sibson advised 

 that in such conditions a long flexible tube be passed into the stomach 

 or colon, or that gas be removed by puncture of bowel. 



The pains of colic may be relieved by pressure, but in peritonitis 

 even the weight of the bed-clothes may be intolerable. In local peri- 

 tonitis a roughened serous surface, of the liver, for instance, may rub 

 against the parietal layer during respiration and so give rise to a 

 friction-sound. 



The convalescent from peritonitis walks about with a stoop ; 

 standing up straight causes pressure upon the still tender sac. 



Hernial sac. As, with certain exceptions, the whole of the in- 

 testinal canal (in addition to its proper serous 

 coat) is enclosed within the general peritoneal 

 cavity, no knuckle of bowel can escape from the 

 abdomen without taking before it a pouch from 

 the parietal layer ; this constitutes the hernial 

 sac. 



The great omentum, attached above to the 

 stomach and transverse colon, and descending 

 as an apron in front of the small intestine, is apt 

 to form part of the contents of a hernial sac ; it 

 escapes in front of the intestinfc through an 

 abdominal wound. When, at a herniotomy, bowel 

 and omentum are found in the sac, the bowel 

 should be returned first. Omentum is almost 

 certain to enter an umbilical hernia, and it may 

 have to be torn through before the strangulated 

 knuckle of bowel is reached. When the end of 

 the omentum is fixed in a hernial orifice, or has, 

 in some other way, formed an attachment to the 

 abdominal wall, it may strangle a coil of in- 

 testine ; a loop of bowel is sometimes caught in 

 a hole in the omentum. Malignant tumours are 

 apt to start from the pendulous folds. 



Ascites (CUTKOS, a skin bottle) is effusion of 

 serous fluid into the peritoneal cavity. When 

 it is associated with dropsy of the body generally, 

 it is probably due to obstructed flow of blood 

 through heart, lungs, or kidneys. But when 

 peritoneal dropsy is unassociated with cedei 

 in other regions, obstruction is to be suspect< 



in the liver, the serous fluid oozing from the congested capillaries 

 the tributaries of the vena portae. If the amount of effusion 



