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pelvic wall, where they are crossed by the uterine artery on a level with the internal os, about an inch from Zantac 300 Mg the lateral border of the cervix, two inches from the ureteral openings. From the point of crossing, the uterine artery accompanies the ureter for one or two inches through the base of the broad ligament, to a point on the pelvic wall just above the spine of the ischium, where they turn upward on the pelvic wall covered by peritoneum, some- times in Purchase Zantac front and sometimes behind the internal Zantac Mg Cheap Zantac iliac to the pelvic brim, where they leave the pelvis through the infundibular pelvic ligament behind the ovarian artery. The right ureter is more often in front of the division of the common iliac, the left one behind it. The ureters are often outlined on the anterior wall by the ureteral ridges. In 1880 Pawlick catheterized the ureters using the' ridges as Zantac 150 landmarks. TECHXIC OF PALPATION To palpate the ureter from the bladder to the base of the broad ligament Zantac 150 Mg to orient the position imagine a line from a point, about half an inch in front of the cervix, to a point half way between the lateral border of the cervix and the lateral pelvic wall. The point half an inch in front of the cervix where the ureter enters the bladder, varies with the position of the cervix. The point half way be- tween the lateral border of the Where To Buy Zantac cervix and the lateral pelvic wall, is where the uterine artery crosses the cervix and is fixed. The vaginal fingers are introduced into the an- terior lateral vault of the vagina. Counterpressure is made downward through the abdominal wall. The fingers are drawn forward. As the tissues slip through the fingers, the ureter is palpated 300 Mg Zantac as a flattened cordlike Zantac Buy body, smaller than a goose quill, displaced in its bed of loose cellular tissue, as it slips through the fingers. It can be rolled from side to side under the palpating fingers by moving •Read before the American Association of Obstetricians and Gynecologists, Atlantic City, N. J.. September 21, 1920. the fingers toward the bladder, or toward the broad ligament. The ureter is Zantac 75 Mg felt from the bladder to the Purchase Zantac Online base of the broad ligament. Posterior to the broad ligament it is felt just above the spine of the ischium, covered by Order Zantac Online the peritoneum, to the pelvic brim, by palpating it against the pelvic wall. It may run as high as an Zantac Online inch above the ischial spine, ludd ( 1 ) advises sweeping the fingers above its lo- cation, bending the fingers as in picking a guitar. In the latter part of pregnancy the ureters do not follow the pelvic wall to the spines of the ischium, but after accompanying the internal iliac artery they pass beneath the broad ligament just below the pelvic brim. EXAMINATION OF THE URETER BY RECTUM The finger is inserted to the bifurcation of the iliac artery, which is located and traced downward with the tip of the finger. The palpation is done behind, at the side, and in front of the artery. The ureter can be followed in its course until it passes under the broad ligament. The normal ureters never cause pain. If diseased, they are enlarged from the size of a goose quill to that of a lead pencil, or larger ; if tender, pressure brings an intense desire to urinate. The tuberculous ureter Online Zantac feels like a string of beads. Calculus, pyelitis, tuberculous kidney, gonorrhea, cervicitis, lacerations, and infections from the cervix cause urethritis, periureteritis and stric- ture, and because of the nerve plexus of the abdom- inal sympathetic, pain is diffuse and causes symp- toms in adjacent abdominal viscera, bladder, uterus, ovary, appendix, stomach, gallbladder and other Order Zantac organs. If irritation passes over the intercostal nerves, pain in the abdominal wall results ; if over the lumbar plexus, pain in the Buy Zantac Online inguinal hypogastric and external genital regions ; over the sacral plexus, pain in external genitals, rectum, thigh, legs ; the uterine plexus where artery crosses ureter, pain in uterus ; ovarian plexus to ovaries, gastric to stomach, mesentery to intestines. Bladder symptoms following hysterectomy, in which the cystoscope shows a normal bladder, are due to ureteritis and not Zantac 150mg to cystitis. Sanger in 1886 reported cases of ureteritis treated for long periods as cystitis. Judd reported a case of early pregnancy with ureteritis and spotting, which was mistaken for ectopic pregnancy. Hunner has reported a large number of strictures of the lower ureter, which were mistaken for all sorts of abdominal conditions. The !Mayos report that most of the cases of kidney and ureteral stone which they encountered have been mistaken for other abdominal conditions and the patients operated upon for Buy Zantac disease of the stomach, gallbladder, ovary or appendix. Kelly (2) states that gonorrhea is a common cause of ureteritis and stricture. Chronic pyelitis and ureteritis cause stricture of the ureter followed by hydronephrosis if the con- dition Zantac Coupon is not treated. Ureteritis due to lacerations and infections of the cervix, if treated early, will

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