Identifier: physicaldiagnosi12cabo (find matches)
Title: Physical diagnosis
Year: 1912 (1910s)
Authors: Cabot, Richard C. (Richard Clarke), 1868-1939
Subjects: Diagnosis Chest Diagnosis
Publisher: New York : William Wood and Company
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons and Harvard Medical School

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bove the pubes.The tumor is dull on percussion, and in slight degrees of distentionthis dulness above the pubes may be the only physical sign obtainable.In well-marked cases, which are most common in males, the distendedbladder may reach to the navel or even above it, and the beginner isusually astonished at its dimensions and its firm, resistant surface (see 410 THE BLADDER, RECTUM, AND GENITAL ORGANS 411 Fig. 229). Diagnosis rests on the infrequency of other tumors ofthis region in men and on the result of catheterization or suprapubicaspiration. In females a history of failure to pass urine almostinvariably makes the diagnosis obvious, though occasionally afteroperations distention of the bladder and dribbling of urine may gotogether in women, as they so frequently do in men.The commonest causes of distended bladder are: (1) Prostatic hypertrophy, alone or combined with (2) Old strictures of the urethra.Less common are: (3) Spasm of the urethra in gonorrhoea. (4) Acute prostatitis.
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Fig. 229.—Distended Bladder Reaching Above the Navel. (5) Paralysis of the bladder, from disease or injury, after opera-tion, and in fevers. (6) Tumor or stone near the neck of the bladder. The diagnosis of the cause of distention rests on the history, theresult of attempts at catheterization, the rectal examination, thecondition of the urine, and the physical signs in other parts of thebody. A long history of frequent micturition, especially at night, inan old man, an obvious enlargement of the prostate felt by rectum, 412 PHYSICAL DIAGNOSIS and the passage of ammoniacal urine suggest prostatic obstruction.The information obtained during the passage of a catheter usuallyclinches the diagnosis. Acute retention, with no previous history of frequent micturition orfoul-smelling urine in a young or middle-aged man, who has hadgonorrhoea and may or may not have noticed a diminution in thesize of the stream of urine passed, suggests a urethral stricture. Thecatheter decides. Spasm of the

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