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Vaginal examination
cavity, it is necessary to dip down by sudden but gentle movements 0 fingers to feel whether there is any solid growth lying more deeply.
Percussion
This enables one to decide whether a swelling is in contact with abdominal wall and therefore dull on percussion, or whether bowel' venes between the tumour and the abdominal wall. If the abdom resonant in the centre and dull in the flanks, and the dullness shifts the patient changes her position, free fluid can be diagnosed.
Auscultation On listening with a stethoscope, bowel sounds are normally present, apart from aortic pulsation are the only sounds that can be heard. silent abdomen is an indication of intestinal paralysis, being found in of severe shock, generalized peritonitis and postoperative paralytic'
On auscultation over a tumour two additional sounds may be h (1) The uterine souffle. If the tumour is the pregnant uterus or a fibromyoma it will contain hypertrophied uterine vessels; should stethoscope happen to be placed over one of these, a blowing sound be heard which is synchronous with the patient's heart beat. (2) I tumour is the pregnant uterus the fetal heart sounds can be heard afte 24th week, at a rate of 140-160 beats per minute.
Tile procedure in making a vaginal examination is: (1) inspection 0 vulva; (2) inspection of the vagina and vaginal cervix; (3) palpationo vagina and vaginal cervix; and (4) bimanual palpation of the pelvic 0
There are four positions which are commonly used for vaginal ex tion. Each position has its advantages and disadvantages.
1. Lateral position
After the abdominal examination is fmished the patient simply turns her left side and draws up both knees. It is a comfortable position, is e assumed, does not expose the patient unduly and permits of a reaso thorough examination.
2. Semi-prone or Sims' position
This position, in which the patient lies on the left side with the left behind. her and the right knee drawn up slightly more then the left, a good view of the external genitalia. It is especially useful for ex the cervix and anterior vaginal wall. On passage of a speculum, air the vagina and the anterior vaginal wall falls away. Sims used this p for the exposure of vesicovaginal fistulae.
3. Dorsal position
This position, with the patient lying on a couch on her back with
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