The diagnosis and treatment of diseases of the stomach and intestines / by William Fitch Cheney.

  • Cheney, William Fitch, 1866-1941.
Date:
[1936], ©1936
Catalogue details

Licence: Public Domain Mark

Credit: The diagnosis and treatment of diseases of the stomach and intestines / by William Fitch Cheney. Source: Wellcome Collection.

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    ferent in character from those before, though they are apt to become more severe. Pain is the principal complaint, begin¬ ning as is the rule in uncomplicated ulcer, an hour or two after meals, or as late as three or four, but in this complication it is likely to become more constant and less intermittent. Vomiting takes place more frequently after this complication has de¬ veloped, and large quantities may be evacuated, if there is obstruction at the site of constriction with retention in the upper compartment. Weight loss is then the rule, gradual and progressive, just as so often is seen in pyloric obstruction. On physical examination, there is found tenderness, more or less extreme, in the epigastrium or one or the other hypochondrium and not infrequently a palpable tumor, especially when the abdominal wall is thin. In such patients also a peristaltic wave sometimes may be observed running across the stomach from left to right just as in pyloric obstruction. Gastric anal¬ ysis gives a variable secretion, and it may be low in free HC1, because the material obtained comes entirely from the upper compartment. But there is no evidence that makes the diag¬ nosis of this complication certain, except x-ray examination, by fluoroscope and films. This will demonstrate the peculiar configuration of the stomach, if care is taken, though at first it may show only the upper pouch filled with barium. Time is required, if stenosis exists at the site of constriction, to permit the opaque material to pass through into the lower pouch. Previous to the addition of the x-ray to the methods available for the investigation of gastric disease, the diagnosis of this complication was seldom made except by exploratory operation, and this was done usually for pyloric obstruction and not for recognized hour-glass stomach. The only other organic diseases besides chronic gastric ulcer