. Medical diagnosis for the student and practitioner. 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
. Medical diagnosis for the student and practitioner. 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 lesser curvature participates in these contractions so that the waves appearin symmetrical pairs. Three or even four of these may be observed at oncewhereas normally only one or two relatively superficial ones are Fig. 441 and Fig. 4+ from old duodenal ulcer.(Dr. Frank S. Bissell.) Deformity of bulbus duodeni. True hyperperistalsis rarely, if ever, occurs except in conjunction withdelayed gastric motility, but partial pyloric obstruction due to a lesion onthe gastric side is not accompanied by this symptom. Hence it is apparentthat it is a manifestation in some way dependent upon duodenal it occurs only intermittently, it may be readily overlooked in a given 846 MEDICAL DIAGNOSIS case. When a six-hour retention has been demonstrated, however, persist-ent observation will usually be rewarded. The concomitant occurrence oftrue hyperperistalsis and a six-hour retention is conclusive evidence ofobstructive duodenal ulcer.
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