Medical diagnosis for the student and practitioner (1922) (14598019059)

Identifier: medicaldiagnosi00gree (find matches)

Title: Medical diagnosis for the student and practitioner

Year: 1922 (1920s)

Authors: Greene, Charles Lyman, 1862-

Subjects: Diagnosis

Publisher: Philadelphia, Blakiston

Contributing Library: The Library of Congress

Digitizing Sponsor: The Library of Congress

Text Appearing Before Image:

Fig. 372.Fig. 43Q and 440.—Chronic duodenal ulcer. Note irregularity of birfbus duodeni, con-stant in a series of roentgenograms. (Dr. Frank S. Bissell.) as a rule, the usual characteristics of ulcer deformities,assume one of the following forms: (a) Incisura—single or multiple. (b) Excavation—basal or on posterior wall. (c) Niche or accessory pocket. The latter usually 844 MEDICAL DIAGNOSIS 2. A diverticulum, when observed, is distinctive evidence of perforatingduodenal ulcer. Minor or confirmatory signs of duodenal ulcer are: (i) Hypermotilitywith speedy clearance of the stomach. (2) Lagging of bismuth in the duodenumeven after the stomach is empty. This is especially significant if it is associatedwith a (3) tender pressure point. (4) Intestinal hypermotility, which may occurwith duodenal irritation despite normal or increased acidity of gastric contents.(5) Gastric hypertonus. (6> Hyperperistalsis. (7) Spasmodic hour-glass con-

Text Appearing After Image:

Fig. 441.— (See Fig. 442.) Old duodenal ulcer. tractions of the stomach which are occasionally produced by intense duodenalirritability. (8) Delayed gastric evacuation resulting in a six-hour residue fre-quently occurs in duodenal ulcer. It should be noted that hyperrnotility or rapid clearance may occur induodenal ulcer without obstruction, whereas delay occurs when spasm oradhesions interfere with evacuation. The writers experience has convinced him that it is not safe to make a EXAMINATION OF THE DlODKNI M S45 diagnosis of duodenal ulcer upon any of these minor symptoms but that thepresence of either one of the major signs is conclusive. The gastric hyperperistalsis observed in duodenal ulcer is probablya reflex from duodenal irritation. It varies in intensity from a slightexaggeration in wave depth to most energetic, cramp-like contractions.The lesser curvature participates in these contractions so that the waves appearin symmetrical pairs. Three or even four of these may be obs

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1922

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