Medical Semiology Guide of the Digestive System

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Medical Semiology of the Digestive System Part I
Copyright
About the Author
	MANUELA STOICESCU
Motto
Thank you all my students!
Scientific Activity
	ACCOMPLISHMENTS
		Publications 51
	PUBLICATIONS 56
		CONFERENCES 2018
		CONFERENCES 2019
Introduction
	The History of the Patient
	1 PERSONAL DATA
	2 PLACE OF BIRTH AND HOME (ADDRESS)
	3 ALLERGY?
	4 THE REASON FOR HOSPITALIZATION
		4 Example No. 1
		4 Example No. 2
		4 Example No. 3
		4 Example No. 4
	5 THE HISTORY OF THE CURRENT DISEASE
	6 FAMILY HISTORY
	7 PERSONAL PATHOLOGICAL HISTORY
	8 PERSONAL PHYSIOLOGICAL ANTECEDENTS
	9 LIFE CONDITIONS
		A The housing conditions
		B Eating
		C Toxic consumptions
			C Alcohol consumption
			C Smoking
			C Coffee
			C Drugs
	10 WORKING CONDITIONS
	11 GENERAL MANIFESTATIONS
1. The Semiology of the Oral Cavity
	1.1 Questionnaire
	1.2 Symptoms
		1.2.1 Bad Taste
		1.2.2 Glossodynia
		1.2.3 Dysphagia
		1.2.4 Hypersalivation
		1.2.5 Hyposalivation
	1.3 The Objective Examination of The Oral Cavity
		1.3.1 The Normal Oral Cavity
			1.3.1.1 Halitosis
			1.3.1.2 The Normal Leeps and Teeth
				1.3.1.2.1 Normal image of the lips and teeth
				1.3.1.2.2 Hyperpigmentation of the lips, gums, and teeth in Addison disease
				1.3.1.2.3 Herpes of the upper lip
				1.3.1.2.4 Herpes of the upper and lower lips—crusting phase
				1.3.1.2.5 Herpes of the upper lips after tearing vesicles
				1.3.1.2.6 Swelling of the upper lip—Quincke allergic swelling after bee sting
				1.3.1.2.7 Cyanosis of the lips and a hemangioma on the lower lip
				1.3.1.2.8 Cyanosis of the lips
			1.3.1.3 The Tongue and Tonsils
				1.3.1.3.1 Normal image of the tongue and teeth
				1.3.1.3.2 Cyanotic tongue
				1.3.1.3.3 The lips with crusting and roughness—important sign of dehydration
				1.3.1.3.3 The lips with crusting and roughness—important sign of dehydration
				1.3.1.3.4 Rough tongue and crusting—important sign of dehydration
				1.3.1.3.5 Cyanosis of the tongue and white spot deposits on the tongue—Candida albicans
				1.3.1.3.6 Cyanosis of the tongue and loaded sign of central cyanosis
				1.3.1.3.7 Cyanosis of the tongue and lips—sign of central cyanosis
				1.3.1.3.8 The tongue of a patient with jaundice
				1.3.1.3.9 Jaundice can be seen under the tongue
				1.3.1.3.10 The normal color is pink
				1.3.1.3.11 The lacquered tongue appears in Biermer anemia
				1.3.1.3.12 Acute erythematous tonsillitis
				1.3.1.3.13 The oral cavity—coated tongue
				1.3.1.3.14 Tongue—Candida albicans
			1.3.1.4 The Gumps, Leeps and Teeth
				1.3.1.4.1 Normal lips and teeth
				1.3.1.4.2 Dry lips and crusting—signs of dehydration
				1.3.1.4.3 Dry lips, dry tongue, and crusting—signs of dehydration
				1.3.1.4.4 Hyperpigmentation of the gums in Addison disease
				1.3.1.4.5 Hyperpigmentation spots of the upper and lower gums in Addison disease and hyperpigmentation lines on the teeth
				1.3.1.4.6 Hyperpigmentation spots on the mucosa of the oral cavity—Addison disease
				1.3.1.4.7 Hyperpigmentation spots of the upper and lower gums in Addison disease
	1.4 The Complementary Investigations
		1.4.1 Pharyngeal Secretions Examination
		1.4.2 Serological Examination
		1.4.3 Hematological Examination
		1.4.4 Biopsy of Tumor Formation
	1.5 Clinical Cases of the Oral Cavity
		1.5.1 Clinical Case No. 1
			Brown Spots on Upper Gum
			Brown Spot on the Mucosa of the Cheek
		1.5.2 Clinical Case No. 2
			Dry Lips and Tongue With Many Desquamations—Fried Tongue
2. The Semiology of the Esophagus
	2.1 Questionnaire
	2.2 Symptoms
		2.2.1 Esophageal Dysphagia
			2.2.1.1 Mechanical Esophageal Dysphagia
			2.2.1.2 Functional Esophageal Dysphagia
			2.2.1.3 Mixed Esophageal Dysphagia
		2.2.2 Odynophagia
		2.2.3 Heartburn
		2.2.4 Esophageal Regurgitation
	2.3 The Objective Examination of the Esophagus
		2.3.1 Inspection
		2.3.2 Palpation
		2.3.3 Percussion
		2.3.4 Auscultation
	2.4 The Complementary Investigations
		2.4.1 Radiological Examination
			2.4.1.1 Achalasia
			2.4.1.2 Stricture scar
			2.4.1.3 Cancer of the esophagus
			2.4.1.4 Diverticulum
		2.4.2 Esophagoscopy
	2.5 Clinical Cases of the Esophagus
		2.5.1 Clinical Case No. 1
		2.5.2 Clinical Case No. 2
3. The Semiology of the Abdomen
	3.1 The Topography of the Abdomen
	3.2 Examples of Cases
	3.3 The Objective Examination of the Abdomen
		3.3.1 Inspection
			3.3.1.1 Shape and Volume of the Abdomen
				3.3.1.1.1 The Normal Abdomen
					The Normal Abdomen
				3.3.1.1.2 Fully Bulging Abdomen
					3.3.1.1.2.1 Obesity
					3.3.1.1.2.2 Ascites
						Fully Bulging Abdomen—Ascites
					3.3.1.1.2.3 Ascites—Paracentesis
						Fully Bulging Abdomen Ascites
						Paracentesis
					3.3.1.1.2.4 The “Orange Peel” SIGN
					3.3.1.1.2.5 Meteorism
					3.3.1.1.2.6 Large ovarian cyst
					3.3.1.1.2.7 Pregnancy
					3.3.1.1.2.8 Abdominal tumor mass
				3.3.1.1.3 Asymmetric bulging of the abdomen
					3.3.1.1.3.1 Right hypochondria- Adenocarcinoma of the liver
					3.3.1.1.3.2 Right upper quadrant bulge- Enlarged lipoma
					3.3.1.1.3.3 Bulging in the right lateral side – Eventration
					3.3.1.1.3.4 Postoperative scar –eventration- after left nephrectomy
					3.3.1.1.3.5 Many bulging suggest lypomatosis and a post operative scar in the left hypochondriac area after splenectomy
					3.3.1.1.3.6 Enlarged hernia – anterior incidence
					3.3.1.1.3.7 Enlarged hernia – right lateral incidence
					3.3.1.1.3.8 Enlarged hernia – left lateral incidence
					3.3.1.1.3.9 Enlarged hernia – up image
				3.3.1.1.4 Abdomen retraction
					3.3.1.1.4.1 Scafoid abdomen – shaped boat
					3.3.1.1.4.2 Flabby belly
					3.3.1.1.4.3 Flaccid abdomen
					3.3.1.1.4.4 Pendent abdomen at multiparous women
			3.3.1.2 The Appearnace of the Skin of the Abdomen
				3.3.1.2.1 Purpura eruption on the skin of abdomen and lower limbs
				3.3.1.2.2 Many nodules on the abdomen in Von Reglinghausen disease (Neurofibromatosis type 1 )
				3.3.1.2.3 Pigmented nevi on the abdomen
				3.3.1.2.4 Staphylococcal skin infection
				3.3.1.2.5 Hyperpigmentation of the umbilicus - Addison disease
				3.3.1.2.6 Postoperative scars
					3.3.1.2.6.1 In the right hypocondrian area after colecistectomy for gallbladder stones
					3.3.1.2.6.2 In the subombilicala area after caesarean
					3.3.1.2.6.3 In the subombilicala area – hysterectomy
					3.3.1.2.6.4 After stomach resection and colecistectomy
				3.3.1.2.7 Massive ascites and subcutaneous edema – The sign of orange peel
				3.3.1.2.8 The orange peel sign
					The Orange Peel Sign
					The Orange Peel Sign
				3.3.1.2.9 Pearly white stretch marks after pregnancy and delivery
				3.3.1.2.10 Breaking elastic fibers in the derm
				3.3.1.2.11 Abdomen skin fold – flaccid abdomen
				3.3.1.2.12 Persistent skin fold - flaccid abdomen
				3.3.1.2.13 Pearly white stretch marks during pregnancy –left side
				3.3.1.2.14 Pearly white stretch marks during pregnancy–right side
				3.3.1.2.15 Pearly white stretch marks -Flaccid abdomen after 8 (eight) pregnancy and delivery
					Flaccid Abdomen After Eight Pregnancies and Deliveries
					Flaccid Abdomen After Eight Pregnancies and Deliveries, With Pearly White Stretch Marks
					Flaccid Abdomen After Eight Pregnancies and Deliveries, With Pearly White Stretch Marks
				3.3.1.2.16 White stretch marks – pregnancy in six month
					Pregnancy in Sixth Month
				3.3.1.2.17 Red stretch marks
					Red Stretch Marks
					Red Stretch Marks
					Red Stretch Marks
					Red Stretch Marks
					Red Stretch Marks
					Red Stretch Marks
					Red Stretch Marks
					Red Stretch Marks
					Red Stretch Marks
					Red Stretch Marks
					Red Stretch Marks
					Red Stretch Marks
				3.3.1.2.18 Collateral venous circulation
				3.3.1.2.19 Collateral venous circulation – B Virus positive cirrhosis
				3.3.1.2.20 Collateral venous circulation at a patient with alcoholic liver cirrhosis
			3.3.1.3 The Position and Shape of the Umbilicus
				3.3.1.3.1 Normal appearance and position of umbilicus scar
				3.3.1.3.2 The umbilical hernia
				3.3.1.3.3 Ascites and umbilical hernia
				3.3.1.3.4 The umbilical hernia increase in volume after a cough
				3.3.1.3.5 The umbilical hernia – reducible hernia after pressure with the thumb
					The Umbilical Hernia
					The Umbilical Hernia
					The Umbilical Hernia
				3.3.1.3.6 The umbilical hernia in a cachectic woman, smoker with lung cancer
					Umbilical Hernia In A Cachectic Woman, Smoker With Lung Cancer
				3.3.1.3.7 Umbilical hernia in a cachectic woman, smoker with lung cancer and a few pigmented nevi on the skin of the abdomen
				3.3.1.3.8 Umbilical hernia in a cachectic woman, a few pigmented nevi and collateral circulation
				3.3.1.3.9 Enlarged umbilical hernia in a patient with ascites, Hepatitis C virus Cirrhosis of the liver
				3.3.1.3.10 Enlarged umbilical hernia – increase in volume after cough in a patient with ascites, hepatitis C virus Cirrhosis of the li ...
				3.3.1.3.11 Enlarged umbilical hernia – increased in volume after cough in a patient with ascites, hepatitis C virus Cirrhosis of the l ...
				3.3.1.3.12 Missing umbilicus – scar after surgery
				3.3.1.3.13 A scar after surgery – umbilicus was removed
				3.3.1.3.14 Red stretch marks in Cushing Syndrome
					Red Stretch Marks in Cushing Syndrome
					Red Stretch Marks in Cushing Syndrome
					Red Stretch Marks in Cushing Syndrome
					Red Stretch Marks in Cushing Syndrome
					Red Stretch Marks in Cushing Syndrome
					Red Stretch Marks in Cushing Syndrome
					Red Stretch Marks in Cushing Syndrome
					Red Stretch Marks in Cushing Syndrome
				3.3.1.3.15 Whitish pink stretch marks after pregnancy and delivery
					Whitish Pink Stretch Marks After Pregnancy and Delivery
					Whitish Pink Stretch Marks After Pregnancy and Delivery
					Whitish Pink Stretch Marks After Pregnancy and Delivery
				3.3.1.3.16 White stretch marks after pregnancy
					White Stretch Marks After Pregnancy
					White Stretch Marks After Pregnancy
				3.3.1.3.17 White stretch marks in obesity
					White Stretch Marks in Obesity
					White Stretch Marks in Obesity
					White Stretch Marks in Obesity
					White Stretch Marks in Obesity
					White Stretch Marks in Obesity
					White Stretch Marks in Obesity
					White Stretch Marks in Obesity
					Vesicles on the Abdomen
				3.3.1.3.18 Vesicles on the abdomen
				3.3.1.3.19 Edema of tabdominal walls – orange peel sign
					Edema of the Abdominal Walls—Orange Peel sign
					Edema of the Abdominal Walls—orange peel sign
					Edema of the Abdominal Walls—Orange Peel sign
					Edema of the Abdominal Walls—Orange Peel sign
					Edema of the Abdominal Walls—Orange Peel sign
					Edema of the Abdominal Walls—Orange Peel sign
					Edema of the Abdominal Walls—Orange Peel sign
					Edema of the Abdominal Walls—Orange Peel sign
			3.3.1.4 The Pulsations of the Abdomen
				3.3.1.4.1 The pulsations of the normal abdominal aorta
				3.3.1.4.2 The pulsation of the abdominal aneurism of the abdominal aorta
			3.3.1.5 The Peristalsis Movements
				The Peristaltic Movements
			3.3.1.6 Abnormal Participation in Respiratory Movements
				3.3.1.6.1 The inspiratory phase - increase in volume
					3.3.1.6.2 The expiratory phase - decrease in volume
		3.3.2 The Method of Palpation of the Abdomen
			3.3.2.1 The Tehnique of Palpation
				3.3.2.1.1 The Superficial Palpation of the Abdomen
				3.3.2.1.1.1 Superficial bimanual palpation of the abdomen
				3.3.2.1.1.2 Monomanual palpation
				Pinching abdominal skin plica
				Persistent abdominal skin fold is a sign of dehydration
			3.3.2.1.2 Deep Palpation of the Abdomen
				3.3.2.1.2.1 Monomanual deep palpation of the abdomen
					Monomanual Deep Palpation of the abdomen
					Monomanual Deep Palpation of the Abdomen
					Monomanual Deep Palpation of the Abdomen
					Monomanual Deep Palpation of the Abdomen
					Monomanual Deep Palpation of the Abdomen
		3.3.3 The Method of Percussion of the Abdomen
			3.3.3.1 The Wave Sign
			3.3.3.2 The Bell Sign of Mendel
			3.3.3.3 The Blumberg Sign
				The Blumberg Sign
		3.3.4 The Auscultation of the Abdomen
		3.3.5 Induced Pain – The Abdominal Pain Points
			The Abdominal Pain Points
			3.3.5.1 The subxiphoidian point
			3.3.5.2 The epigastric point
			3.3.5.3 The solar point
			3.3.5.4 The cystic point
			3.3.5.5 The mesenteric points
				The Mesenteric Points
			3.3.5.6 The tubo-ovarian right point
			3.3.5.7 The left tubo-ovarian point
			3.3.5.8 The Apendiceal Points
				3.3.5.8.1 The Mc Burney Point
				3.3.5.8.2 The Morris point
				3.3.5.8.3 The Lanz point
					The McBurney Point
					The Morris Point
					The Lanz Point
					The Appendiceal Points—The McBurney Point
					The Morris Point
					The Lanz Point
		3.3.6 The Blumberg Sign
		3.3.7 Psoas Sign Javorski—Lapinski Maneuver
		3.3.8 Mondor Sign
		3.3.9 Positive in Retrocecal Appendicitis
		3.3.10 Rovsign’s Sign
			Rovsing’s Sign
			Rovsing’s Sign
			Rovsing’s Sign
			Rovsing’s Sign
			Rovsing’s Sign
			Rovsing’s Sign
			Rovsing’s Sign
			Rovsing’s Sign
			Rovsing’s Sign
			Rovsing’s Sign
			Rovsing’s Sign
			Rovsing’s Sign
		3.3.11 Clapotage Sign
	3.4 Complementary Investigations
		3.4.1 The Peritoneal Puncture
			3.4.1.1 Monroe-Richter line
			3.4.1.2 The serocitrin appearance of peritoneal ascites fluid after evacuation
			3.4.1.3 Serocitrin liquid
				View Image
		3.4.2 Abdominal Paracentesis
			3.4.2.1 The examination of ascites fluid
				3.4.2.1.1 Serocitrin ascites fluid
					Serocitrin Ascites Fluid
				3.4.2.1.2 Serofibrinous ascites fluid
				3.4.2.1.3 Hemorrhagic ascites fluid
				3.4.2.1.4 Chylous ascites fluid
				3.4.2.1.5 Suppurative ascites fluid
					Paracentesis
				3.4.2.1.6 Serocitrin fluid after paracentesis
		3.4.3 The Empty X-Ray Examination
			Pneumoperitoneum
			4.3.1 Dilated loops
				3.4.3.1.1 Small bowel obstruction
				3.4.3.1.2 Large bowel obstruction
				3.4.3.1.3 Hydroaeric level – dilated loops – occlusion of the bowel
					Hydroaeric Level—Dilated Loops—Occlusion of the Bowel
	3.5 Clinical Cases of The Abdomen
		Clinical Case No. 1
			Enlarged Umbilical Hernia Ascites—Liver Cirrhosis
		Clinical Case No. 2
			Fully Bulged Abdomen
			Enlarged Right Ovarian Cyst—Septum Inside And Uterine Fibroma
4. The Semiology of the Stomach and Duodenum
	4.1 Questionnaire
	4.2 Symptoms
		4.2.1 Epigastric Pain
			4.2.1.1 Correlation with alimentation
				4.2.1.1.1 Gastric ulcer – Epigatric pain - After Eating
			After Eating—I Have Epigastric Pain
				4.2.1.1.2 Duodenal ulcer – Epigastric pain - Before Eating
				4.2.1.1.3 Duodenal ulcer - Epigastric pain during the night
				4.2.1.1.4 Small periodicity
			4.2.1.2 Big periodicity
		4.2.2 Belching—Eructation
		4.2.3 Regurgitation
		4.2.4 Heartburn—Pyrosis
		4.2.5 Vomiting
			4.2.5.1 Central Vomiting
			4.2.5.2 Peripheral Vomiting
				4.2.5.2.1 Frequency
				4.2.5.2.2 Timing and rhythm
				4.2.5.2.3 Volume
				4.2.5.2.4 The smell
				4.2.5.2.5 Vomiting content
			4.2.5.3 Questionnaire
		4.2.6 Hematemesis
		4.2.7 Melena—black stools—upper bleeding
		4.2.8 Hematemesis and melena represent the main signs of upper bleeding
	4.3 The Objective General Examination
		4.3.1 “Squat” Attitude
		4.3.2 Muscle Contracture
		4.3.3 Zygomatic Face
		4.3.4 Paleness
			4.3.4.1 Paleness of the face after upper bleeding externalized by hematemesis and melena
			4.3.4.2 Paleness of the palm and the palmar creases
			4.3.4.3 The palm of the examiner compared with the paleness of the palm of the patient—the palm, being a natural hemoglobin meter,  ...
		4.3.5 Emaciation
		4.3.6 Sign of virchow–Troisier
	4.4 The Objective Examination of the Stomach
		4.4.1 The Inspection
			4.4.1.1 Bulging of the Epigastric Region
			4.4.1.2 Retractable Epigastric Region
			4.4.1.3 Sign of Kussmaul
			4.4.1.4 Intermittent Epigastric Tension of Bouveret
		4.4.2 The Palpation
			4.4.2.1 The Superficial Palpation
				4.4.2.1.1 The Superficial Bimanual Palpation
			4.4.2.2 The Deep Palpation
			4.4.2.3 The Gastric Clapotage Sign
		4.4.3 Percussion
			4.4.3.1 The Percussion of the Stomach
		4.4.4 Auscultation
	4.5 The Complementary Investigations of the Stomach
		4.5.1 The Radiological Examination—Barium Swallow Test; Morphological Examination of the Stomach Barium Swallow—Niche Image—Reces ...
			4.5.1.1 Niche—recess in a wall—direct sign of ulcer
			4.5.1.2 Gap Image – Significant a Solid Mass inside of the stomach
			4.5.1.3 The deformed duodenal “bulb in clover” appears in the chronic duodenal ulcer
			4.5.1.4 Rigidity Segmentation
			4.5.1.5 Stomach dilation - like sink-shaped snowflakes
				Pyloric Stenosis
		4.5.2 The Upper Endoscopy—Gastroscopy
			4.5.2.1 Upper Bleeding
				4.5.2.1.1 Upper Bleeding—Melena
					Upper Bleeding—Melena
				4.5.2.1.2 Rectal Touch
				4.5.2.1.3 Melena—Black Stool
					Rectal Touch
					Black Stool
				4.5.2.1.4 Melena on the Gloved Finger
				4.5.2.1.5 Therapy—nasogastric tube aspiration in a patient with hematemesis
				4.5.2.1.6 Blood in the Pouch After NasoGastric Aspiration
				4.5.2.1.7 Blood Transfusion
					Blood Transfusion
	4.6 Clinical Case of the Stomach
		4.6.1 Clinical Case
			Rectal Touch
5. The Semiology of the Bowel
	5.1 Questionnaire
	5.2 Symptoms
		5.2.1 Pain
			5.2.1.1 Intestinal Colic
			5.2.1.2 Appendicular Pain
				5.2.1.2.1 The Location of Appendicular Pain
			5.2.1.3 Pain from Perforation of the Bowel
				5.2.1.3.1 The Location of Pain in Perforation of the Bowel
			5.2.1.4 Rectal Tenesmus
			5.2.1.5 Pain During Defecation
		5.2.2 Intestinal Transit Disorders
			5.2.2.1 Constipation
				5.2.2.1.1 Pencil Shape
				5.2.2.1.2 The Normal Shape of the Stool
				5.2.2.1.3 Stool SHAPED Like Goat Droppings
				5.2.2.1.4 Primary Constipation
				5.2.2.1.5 Secondary Constipation
			5.2.2.2 Diarrhea
			5.2.2.3 Ileus
				5.2.2.3.1 Mechanical Ileus
				5.2.2.3.2 Clinical Mechanical Ileus
					5.2.2.3.2.1 Abdominal colicky pain
					5.2.2.3.2.2 Vomiting
					5.2.2.3.2.3 Stoppage of the Stool and Gases
				5.2.2.3.3 Paralytic Ileus
		5.2.3 Disturbance of the Gaseous Content and Elimination
			5.2.3.1 Meteorism
			5.2.3.2 Flatulence
	5.3 The Objective Examination of the Bowel
		5.3.1 Inspection
			5.3.1.1 Swelling
				5.3.1.1.1 Meteorism
			5.3.1.2 Asymmetric Swelling
			5.3.1.3 Retraction in Totality of the Abdomen
				5.3.1.3.1 The Scaphoid Abdomen
			5.3.1.4 Peristaltic Movements
		5.3.2 Palpation
			5.3.2.1 Superficial Palpation
				The Superficial Palpation of the Abdomen
			5.3.2.2 Sensibility of the Appendicular Points
				5.3.2.2.1 The Appendicular Points
					5.3.2.2.1.1 McBurney’s Point
					5.3.2.2.1.2 The Morris Point
					5.3.2.2.1.3 The Lanz Point
				5.3.2.2.2 Blumberg’s Sign
				5.3.2.2.3 The Psoas Sign
				5.3.2.2.4 The Mondor Sign
			5.3.2.3 Deep Palpation
				5.3.2.3.1 The Appendicular Plastron
				5.3.2.3.2 Rovsing’s Sign
					Rovsing’s Sign
					Rovsing’s Sign
					Rovsing’s Sign
					Rovsing’s Sign
					Rovsing’s Sign
					Rovsing’s Sign
					Rovsing’s Sign
					Rovsing’s Sign
					Rovsing’s Sign
					Rovsing’s Sign
					Rovsing’s Sign
					Rovsing’s Sign
			5.3.2.4 Intestinal clapotage
			5.3.2.5 Endorectal Palpation—Rectal Touch
				5.3.2.5.1 Normal Color of the Stool—Brown
				5.3.2.5.2 Black Stool—Melena
				5.3.2.5.3 Digital Rectal Examination
				5.3.2.5.4 Inspection of the Anal Region
				5.3.2.5.5 Examination of the Stool on the Glove After Rectal Touch
				5.3.2.5.6 Black Stool—Melena
					Suggests Digested Blood—Upper Bleeding
					Melena—Black Stools Upper Bleeding
					Black Stool—Melena
					Black Stool—Melena
					Black Stool—Melena
		5.3.3 Percussion
			5.3.3.1 Percussion of the Bowel
		5.3.4 Auscultation
			5.3.4.1 The Auscultation of the Bowel
				5.3.4.1.1 Abdominal Silence
				5.3.4.1.2 Sound of Occlusion
	5.4 The Complementary Investigations
		5.4.1 The Stool Examination
			5.4.1.1 Macroscopic Examination
				5.4.1.1.1 Volume
					5.4.1.1.1.1 The Normal Volume and Shape of the Stool
					5.4.1.1.1.2 Stool in Megacolon
					5.4.1.1.1.3 Stool in Constipation
				5.4.1.1.2 Color
					5.4.1.1.2.1 The Normal Color of the Stool
						Normal Color of the Stool
					5.4.1.1.2.2 Black Stool—Melena
					5.4.1.1.2.3 Black Stool—Melena on Pampers
					5.4.1.1.2.4 Yellow color of the Stool—Steatorrhea
					5.4.1.1.2.5 White Color of the Stool—Acholic Stool
				5.4.1.1.3 The Shape and Consistency
					5.4.1.1.3.1 Normal Shape and Consistency of the Stool
					5.4.1.1.3.2 The Shape as a Pencil—Tumor of the Colon
						The shape as a Pencil—Tumor of the Colon
						The shape as a Pencil—Tumor of the Colon
					5.4.1.1.3.3 Stool as “Goat Excrement”
					5.4.1.1.3.4 Schibales
						Schibales
						Schibales
						Schibales
						Schibales
						Schibales
						Schibales
						Schibales
						Schibales
						Schibales
						Schibales
						Schibales
						Schibales
				5.4.1.1.4 Diarrhea
					Diarrhea
					Diarrhea
					Diarrhea
					Diarrhea
				5.4.1.1.5 Fluid Stool, Unformed, Without Shape
					5.4.1.1.5.1 Fluid Stool, Unformed, From a Patient With Subocclusion of the Bowel
					5.4.1.1.5.2 Fluid Stool, Unformed
					5.4.1.1.5.3 Fluid Stool, Unformed, From a Patient With Subocclusion of the Bowel
						Fluid Stool, Unformed
						Fluid Stool, Unformed, From a Patient With Subocclusion of the Bowel
						Fluid Stool, Unformed
						Fluid Stool, Unformed
				5.4.1.1.5.4 The Appearance of the Stool From Anus Against Nature
					The Appearance of the Stool From Anus Against Nature
					The Appearance of the Stool From Anus Against Nature
					The Appearance of the Stool From Anus Against Nature
				5.4.1.1.6 Smell
				5.4.1.1.7 The General Appearance
					5.4.1.1.7.1 Fresh Blood in the Stool
					5.4.1.1.7.2 Black Stool—Melena—Digested Blood
					5.4.1.1.7.3 Melena—Black Stool
						Melena—Black Stool
						Melena—Black Stool
						Melena—Black Stool
					Hematemesis
						Hematemesis
						Black Stool
						Black Stool—Melena
						Black Stool—Melena
						Black Stool—Melena
						Melena—Upper Bleeding, Digested Blood
						Melena—Upper Bleeding, Digested Blood
						Melena—Upper Bleeding, Digested Blood
						Melena—Upper Bleeding, Digested Blood
					5.4.1.1.7.4 Rectorrhagia
					5.4.1.1.7.5 Mucus in the Stool
					5.4.1.1.7.6 Pus in the Stool
					5.4.1.1.7.7 Pus, Mucus, and Fresh Blood
					5.4.1.1.7.8 Parasites on the Stool
			5.4.1.2 Physicochemical Examination
				5.4.1.2.1 Microscopic Examination
					5.4.1.2.1.1 Muscle Fibers
					5.4.1.2.1.2 Fats
					5.4.1.2.1.3 Starch
			5.4.1.3 Bacteriological Examination
	5.5 Other Investigations in Bowel Diseases
		5.5.1 Radiologic Investigations
			Big Hydroaeric Levels—Occlusion of the Colon
			Small Hydroaeric Levels—Occlusion of the Small Bowel
			Small Hydroaeric Levels
		5.5.2 The Endoscopy
	5.6 Clinical Case of the Bowel
		5.6.1 Clinical Case
			Rectorrhagia
Index
	A
	B
	C
	D
	E
	F
	G
	H
	I
	J
	K
	L
	M
	O
	P
	R
	S
	T
	U
	V
	Z
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