Identifier: diseasesofkidney01kell (find matches)
Title: Diseases of the kidneys, ureters and bladder, with special reference to the diseases of women
Year: 1922 (1920s)
Authors: Kelly, Howard A. (Howard Atwood), 1858-1943 Brödel, Max, 1870-1941 Burnam, Curtis Field, 1877-
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Publisher: New York, London : D. Appleton and company

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tly posed, and in such casesdistention can be secured by the administration of an anesthetic, which bringsabout a greater relaxation. Where it is desirable to get a maximum distentionof the bladder it is better to see that the bowels are emptied beforehand, andto avoid making the examination with a full stomach. Once in a while anexcessively stout patient is found who cannot be satisfactorily examined inthis way. Elevated Dorsal Position.—If the patient has recently passedthrough an operation, or is old and feeble and cannot stand the knee-breastposture, she can then be examined in the elevated dorsal position. This is best 250 EXAMINATION OF THE URINARY TRACT IN WOMEN done on a table wliere the patient can be elevated to any degree, thirty or fortyor more, with suitable supports at the shoulders to keep her from slipping down,while the pelvis remains at the very edge of the table. If the elevation is highenough the viscera tend to gravitate to the upper abdomen, and, on introducing
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Fig. 123.—Sagittal Section of Adult Female Pelvis, Taken in Knee-breast Posture.Showing dilatation of bladder, vagina and rectum, due to the air distention owing tothe posture; the intestines gravitate downward in the direction of the abdominal walland the diaphragm, acting like the piston of a force-pump on the pelvic viscera. the speculum, the bladder distends with air. A distention in this posture isnever so complete as in the knee-breast posture, as there is no drop of theviscera into the flaccid anterior abdominal walls. In this posture, too, a littleurine rapidly accumulating in the bladder is apt to cover the ureteral orificesand demands removal with the suction apijaratus from time to time. INSPECTION. 251 & iivo) n P nstar e.—^Dr. J. A. Sampson, while resident in Johns HopkinsHospital clinic, fonnd the plevated Sims posture a satisfactory way of exam-iniiii;- tlic air-distciidcd l)l;i<ldcr in patients who were too feehle to take theknee-breast posture, and especial

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