File:Medical diagnosis for the student and practitioner (1922) (14598017799).jpg

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

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Fig. 439.—(See Fig. 440.) Chronic duodinal ulcer. on an inaccessible part of the cap. When, however, a normal cap is clearlyseen either on screen or roentgenogram, a negative diagnosis is justified. Failure to visualize the cap should not be accepted as evidence of ulcer.Here one must rely upon secondary gastric signs such as (1) hyper peristalsis KXAMINATION OF THE DUODENUM and (2) delayed emptying lime, to make a probable diagnosis. The differ-entiation usually lies between duodenal ulcer and gallbladder disci Gallbladder disease may cause cap deformity, either by direct pressureof an enlarged gallbladder or by adhesions. Such deformities have not.
Text Appearing After 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-

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