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None of the known methods of clinical studies rules out any other. Only combination of various methods can give a complete picture of the present disease.






PERCUSSION

Percussion of the abdomen is only relatively informative. Percussion of the anterior abdominal wall at points of projection of the intestine gives tympany of various character which depends on the uneven distribution of gaseous, liquid or solid intestinal contents.

AUSCULTATION

Auscultation gives information about the motor function of the in­testine. During gastric digestion and movement of the chyme along the small intestine, long periodic rumbling can be heard. Rhythmic intestinal murmurs can be heard in the caecum 5—7 hours after meals. In mechanical obstruction of the intestine, its peristalsis is resonant (in large waves). Peristalsis disappears in paralytic obstruction of the intestine; the abdomen is absolutely " silent" in perforation of the ulcer with secondary paralysis of the intestine; peritoneal friction can be heard in patients with fibrinous peritonitis during respiratory movements.

Laboratory and Instrumental Methods

X-RAY STUDY

X-ray studies are used to determine the morphological and functional properties of the small intestine. Contrast substance (100 g of barium sulphate in an equal quantity of water) is used for the purpose. The patient takes the barium meal and 2.5 hours later the suspension enters the caecum. Earlier or delayed entrance of the suspension from the small in­testine to the caecum indicates its upset motor function. The relief of the mucosa in the small intestine has a feather-like pattern, which becomes disfigured in its inflammatory affections. Shallow horizontal ridges be­tween accumulations of liquid and gas in the intestinal loops can sometimes be seen in hypersecretory disorders. Small protrusions and diverticula oc­cur sometimes along the course of the small intestine. Tumours of the small intestine have no specific X-ray signs.


X-ray study of the large intestine is carried out after giving the patient a barium meal by mouth or administering the suspension by enema (per rec­tum). If barium is given per os, it reaches the caecum in 2.5—4 hours. The ascending portion of the intestine is filled in 3-6 hours. The transverse col­on is filled with barium in 12 hours. In 24 hours the large intestine can be seen along its entire course. This roentgenological study of the large in­testine gives information on its motor function, length, position, shape, tone, and haustration.

Giving a contrast substance per rectum (200 g of barium sulphate suspension in 1.5 litres of water) ensures a more detailed information on possible constrictions and adhesions in the large intestine and also the relief of its mucosa.






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