Abdomen & Pelvis – Homoeopathy & Surgery


Many and varied are the conditions that may affect the organs of this portion of the body. A proper differential diagnosis of an existing condition is necessary to ascertain whether the individual condition can be cured by homoeopathic remedies. The differential diagnoses in this region may be most confusing, though in the light of present day diagnostic methods there is much to simplify our conclusion.


THE RIGHT ABDOMEN and PELVIS CONSIDERED HOMOEOPATHICALLY vs SURGICALLY The title of this paper has suggested itself to me because of the many puzzling situations arising from right-sided abdominal and pelvic pain. The many and varied conditions that result from pain in this location require careful differentiation.

How many of us have been confronted by a dilemma when a patient states that he has a severe right-sided pain and then places his hand over the right abdomen ? The question immediately arises: Is this going to be a strictly surgical procedure, or one that is amenable to the proper homoeopathic remedy ?.

If all organs remained in their proper anatomical relation, the decision in arriving at the proper treatment of this individual would be less difficult, but when one considers that a gallbladder may be located anywhere from the costal border to a location well within the pelvis, and that a kidney may take a like sojourn, diagnosis both of the condition and remedy is complicated.

In acute conditions with septic temperature the properly selected homoeopathic remedy will forestall the need for surgery in ninety per cent of the instances. Yet many of these conditions, in spite of homoeopathic prescribing, develop into fulminating abscesses with resultant danger of rupture with general peritonitis and death.

RIGHT-SIDED ABDOMINAL PATHOLOGY

Right-sided abdominal pathology requires much more careful differentiation than right-sided chest troubles, where general emergencies are rare. Here, pleurisy may be readily distinguished in right hypochondriac troubles by eliciting friction rub and its location well within the costal border, its aggravation from breathing, and freedom from any rigidity of the abdomen. Sedimentation rate is not affected and seldom is there leucocytosis.

Many and varied are the conditions that may affect the organs of this portion of the body. A proper differential diagnosis of an existing condition is necessary to ascertain whether the individual condition can be cured by homoeopathic remedies.

The differential diagnoses in this region may be most confusing, though in the light of present day diagnostic methods there is much to simplify our conclusion.

Let us consider these conditions differentially, both as to diagnostic findings and remedy indicated.

1. PAIN IN THE RIGHT HYPOCHONDRIUM.

This may arise from any of the following organs:.

Liver and gallbladder.

Duodenum.

Head of the pancreas.

Right kidney.

Appendix.

Colon.

Adnexa.

Intrathorax disease.

Affections of the spine or chest wall.

Subdiaphragmatic abscess.

II. PAIN REFERRED FROM THE RIGHT ILIAC FOSSA.

Appendix.

Adnexa.

Caecum.

Ureter.

Uterus.

Ascending colon.

1. PAIN IN THE RIGHT HYPOCHONDRIUM.

The gallbladder, as previously stated, may have pain arising anywhere from the costal border to the pelvis, its characteristic pain arising in or near the epigastrium, extending into the back and under the right scapula. Yet this pain may be most confusing in the light of the presence of duodenal ulcer. Both conditions have a peculiar gnawing pain which is relieved by eating or soda, and in both conditions pain arises within two or three hours after eating.

Duodenal pain may extend through to the back, though rarely is it extended to the right scapula.

One striking differential point here lies in the fact that duodenal pain does not reach the height of severity that is found in gallbladder disease, especially when there are small stones present in the gallbladder or cystic duct.

Icteric index here becomes of valuable laboratory assistance. It is high in gallbladder disease and normal in duodenal ulcer.

Differentiation may not be possible without x-ray. Blood sedimentation becomes of valuable assistance.

DUODENUM.

Duodenal ulcer often causes deep-seated pain in the right hypochondrium; a gnawing pain, relieved by eating or soda; these pains are sometimes found also in cholecystitis and appendicitis. Differentiation may not be possible without the x-ray. Sedimentation test becomes of valuable assistance. Duodenal ulcer shown slight leucocytosis with normal sedimentation rate. Cholecystitis, on the contrary, shows marked leucocytosis and marked acceleration of sedimentation rate. Phlegmonous appendicitis shows marked leucocytosis with normal sedimentation rate. Adnexitis shows slight leucocytosis and marked acceleration of sedimentation rate.

The percentage of free HCL in the stomach contents is more persistency high in duodenal ulcer than in either appendicitis or gallstones. The presence of occult blood in the faeces would favor ulcer. Perforation or severe haemorrhages from duodenal ulcers demand immediate surgical attention unless the perforation be very limited and the small area affected completely walled off.

PANCREAS.

These conditions may also be confused with pancreatic stone, pancreatitis, or malignant disease, though this differentiation is seldom difficult owing to the fact that in acute pancreatic inflammations or calculus the pain is agonizing, extending through to the back or mostly in the median line, and is accompanied by shock, a normal icteric index, and is not affected by the intake of food or soda.

Malignant disease of the pancreas may cause pain in the right hypochondrium. A deep-seated tumor may be felt and there is often jaundice along with a distended gall-bladder. Acute pancreatitis must be differentiated from perforating ulcer, gallstones and Dietls Crises.

DIETLS CRISES AND RENAL CALCULUS.

Two other conditions of importance arising in the location are Dietls Crises and renal calculus.

Here there are sudden attacks of paroxysmal lumbar pain with nausea and vomiting. There is seldom tenderness on pressure and absence of leucocytosis or acceleration of blood sedimentation. Indications of intermittent hydronephrosis should be looked for; sudden appearing renal tumor with occasional discharge of large quantities of urine; renal attacks occur more during the day, while biliary attacks occur more during the night. Carcinoma in this location would require x-ray. Right renal colic: severe pain in the right hypochondrium or back, extending into groin with frequent urination and urinary tenesmus.

Unfortunately many abdomens have been opened following an attack of Dietls Crises (where an acute appendix had been diagnosed), when a properly fitting kidney pad, with the addition of fat deposits about a detached kidney, would in many instances have eradicated the condition.

Calculi of the common duct or right or left hepatic ducts bear the same differentiation as do those of gallbladder calculi.

PYELITIS

Pyelitis may cause severe pain in the right hypochondrium but is usually diagnosed by urinanalysis. In both pyelitis and renal colic pains usually extend down the abdomen and through the back, thus affording differential diagnosis from gallbladder colic.

Perinephric abscess causes pain in the right hypochondrium and lumbar region, accompanied by septic temperature. Surgery is rarely needed.

OVULATION.

Again, ovulation may be confused with appendicitis or varicocele of the broad ligament, a knowledge of which may save the patient operative procedure. The symptoms most common to ovulation are clear-cut:.

1.–Periodic intermenstrual pain, occurring half-way between the menses. (Any time between the seventh and twenty-first day.) Usually precedes the approaching menses by a definite number of days.

2.–Pain recurrent periodically.

3.–Mostly in women 30 years or younger.

4.–Temperature range usually 101 with a leucocytosis of 12,000.

5.–No abdominal rigidity.

6.–General pelvic tenderness elicited by bimanual examination, though usually more marked on one side.

7.–More pelvic than abdominal tenderness.

8.–Bloody leucorrhoea, often seen during time of pain.

ECTOPIC GESTATION.

Tubal pregnancies may occur anywhere along the course of the Fallopian tube and may be also ovarian. Also has been known to occur in the accessory horn of the uterus and on the fimbria ovarica. The result is the same regardless of location, namely, rupture. Rarely do the first months of an ectopic gestation pass without symptoms which will direct attention to the pelvis as the seat of trouble. Usually the patient misses a period as early concomitant symptoms of early pregnancy, but soon complains of pain in the lower abdomen; in this instance, the right abdomen.

The pain is cramp-like due to either uterine or tubal contractions, or both. There may be mild pelvic peritonitic symptoms. After a few weeks irregular bloody vaginal discharges appear, which are usually mistaken for threatened abortion. On the occasion of a jar, strain, coitus or an examination, a sudden severe pain is felt; the patient usually becomes faint or dizzy; may vomit or be nauseated; symptoms of shock may appear. The symptoms of rupture of the sac are pain on the affected side, sudden, usually excruciating, soon spreading over the lower abdomen. There is evidence of shock and internal haemorrhage.

This symptom picture gives conclusive evidence of ectopic gestation. Surgery is the only answer.

PERITONITIS.

Peritonitis is the end result of many of the foregoing conditions where rupture following any infection within the abdomen or pelvis, namely; perforated gastric or duodenal ulcer, gangrenous or abscessed appendix, perforated intestine from whatever cause, ruptured pyosalphinx, twisted ovarian cyst pedicle, ruptured liver, acute haemorrhagic pancreatitis.

C.P.Bryant
C. P. BRYANT, M. D.
Seattle.
Chairman, Bureau of Surgery