Objective Symptoms

The physical examination of the abdomen occasionally reveals on inspection a bloated condition and some spots tender to pressure. As a rule, the lower part of the abdomen, particularly the immediate neighborhood of the navel, is slightly painful on palpation. Occasionally there may be found a decided tenderness, either in the right or in the left iliac region. Sometimes this tenderness may be quite pronounced in a line running across the abdomen between the margins of the false ribs (transverse colon). Palpation often elicits gurgling sounds caused by intestinal coils distended with gas and fluid contents. This phenomenon is most frequently observed in both iliac regions.

In patients with thin abdominal walls peristaltic movements of the small intestines may be visible either spontaneously or after palpatory examination.

The urine is voided in small quantities, is concentrated, and often shows Rosenbach's reaction (Burgundy red color after boiling with nitric acid), and also contains indican (this especially if the process involves the small intestine).

Casts and small amounts of albumin are sometimes found in the urine, especially in severer cases (Fischl1).

Fever

In the greater number of instances there is no rise of temperature during the course of this affection. In some cases, however, fever is quite a prominent symptom, and the disease may commence with violent chills and a marked elevation of temperature (104°). The temperature may either fall suddenly on the next day or after the lapse of a few days, but it does not show that regular steady rise which is characteristic of typhoid fever. Fever is especially met with in those cases of acute enteritis which are caused most probably by infection (either pathogenic microorganisms or tainted food).

Localization Of The Catarrhal Process

In order to find out what part of the bowels is especially affected the following points are of value:

A duodenitis may be recognized if the above symptoms are accompanied by icterus. Intestinal catarrh attended with a constant painful sensation in the right epigastric region, which, besides, is also tender to pressure, indicates more or less a continuation of the catarrhal process from the stomach to the duodenum. Pains appearing in the same region after extensive burns of the skin also point to a duodenal affection, even if there be no icterus.

Jejunitis alone or jejunitis and ileitis without any affection of the large bowel can be diagnosed only with difficulty, for the principal symptom of enteritis (namely, that of diarrhoea) is as a rule absent. Small amounts of mucus well mixed with fecal matter, a considerable quantity of undigested food particles, and epithelial cells tinged with yellow bile pigment in the faeces, point to a catarrhal condition of the small intestine. Indicanuria is also often present.

1 Fischl: Prager Vierteljahresschr., 1878, Bd. 139, p. 27.

Acute colitis is characterized by painful sensations and a greater tenderness on pressure over the entire colon. The stools are diarrhoeal and contain large quantities of mucus. The latter as well as the fecal matter may contain undecomposed biliary pigment. Sigmoiditis, described by Mayor 1 and later by Boas2 and Mathews,3 means an inflammatory process involving the sigmoid flexure, and is recognized by special tenderness on palpation of this portion of the bowel, intense backache, and a frequent disposition to go to stool.

Proctitis, or inflammation of the rectum, is characterized by severe tenesmus and colicky pains in the left iliac fossa. The patients have a constant desire to go to the closet, but at each time void only small quantities of fecal matter under the greatest pains. The scybala are surrounded by a layer of mucus which may be tinged with blood. Occasionally the mucous membrane of the rectum prolapses during defecation. It then appears intensely dark red and is extremely painful to the touch. Even if not prolapsed, a digital rectal examination is attended with much pain. The mucous membrane of the rectum feels hot and the examining finger on removal sometimes shows traces of blood.