Post-Graduate Volume 23 (Paperback)

This historic book may have numerous typos and missing text. Purchasers can download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1908 Excerpt: ...Syphilis and tuberculosis may cause a stenosis, but rarely will the diagnosis be made. In the absence of all other causes and the presence of a well marked history, it might be justified to suppose such an etiology. Obstruction of the duodenum below the papilla of Vater, usually causes the continued presence of bile in the stomach. If there is a stenosis in the upper jejenum, the obstruction pain does not appear until late--one and a half to two hours after meals. Such cases usually do not have retention, but may show an hypertrophy of the stomach. Mechanical distortions of the stomach may be made out by inflation or radioscopy. It may be remarked here that there are three groups of facts to be considered when studying retention of food by the stomach: 1. Retention is indicated by the finding in the stomach of large amounts of food before breakfast. 2. Retention indicates obstruction of the pylorus, if there is neither myasthenia nor acute dilatation. 3. Only by studying the previous history in its details can the diagnosis of the etiology be made. When with these simple tests a mechanical obstruction has been demonstrated, it is-necessary, in planning the line of treatment, to keep in mind that chronic stenosis is a mechanical obstruction continually and progressively threatening life by starvation; and the removal of the mechanical obstruction can be accomplished only by mechanical or surgical means, which, therefore, is the procedure of choice. If the stenosis is due to a benign cause, the pylorus should be enlarged by some plastic method, such as proposed by Finney or Heineke-Mikulicz. If there is malignant disease causing the obstruction, it must be excised and that, too, as soon and widely as possible. When, however, none of these methods can be emplo...