. Medical diagnosis for the student and practitioner. er. Peristalsis.—In the normal stomach we can observe, usually, but one ortwo superficial peristaltic waves at the same time. They begin near thecardia increasing progressively in depth until they attain the antrum, andare usually seen distinctly only upon the greater curvature. Interruption of peristaltic waves occurs at the site of any gastric tumor orinduration. Spontaneous peristalsis may be wholly absent during an exami-nation, even when no organic disease exists and this is especially true in thepresence of extreme fatigue, nervous de
. Medical diagnosis for the student and practitioner. er. Peristalsis.—In the normal stomach we can observe, usually, but one ortwo superficial peristaltic waves at the same time. They begin near thecardia increasing progressively in depth until they attain the antrum, andare usually seen distinctly only upon the greater curvature. Interruption of peristaltic waves occurs at the site of any gastric tumor orinduration. Spontaneous peristalsis may be wholly absent during an exami-nation, even when no organic disease exists and this is especially true in thepresence of extreme fatigue, nervous depression and certain cases of gastro- EXAMINATION OF THE STOMACH 837 ptosis and atony, though in the latter they are sometimes apparently strongand vigorous. Bulbus Duodeni.—The first or horizontal portion of the duodenum resem-bles stomach more than intestine in roentgenologic appearance as well as inmany other respects (acid contents, motor phenomena, embryology). Asa rule, it is the only portion of the duodenum which can be clearly visualized. Fig. 436.—Early carcinoma of the pylorus. Xote slignt pre-pvloric rilling defect. {Dr. Frank S. Bissell.) with the X-ray. It has been called the cap because of its appearance, The upon the pylorus, or separated from the pyloric end of the stomachby the sphincter pylori. While the size and shape of the cap may varyconsiderably in different individuals, it is always regular in outline unlessdeformed by ulcer or adhesions. It is often necessary, however, to continueobservations over a long period or to make a large number of roentgenogramsbefore its normal regular contour can be demonstrated. 838 MEDICAL DIAGNOSIS Importantpoints. Tonus. Motility. Effect ofposture. Aid of abdo-minal muscles. Atony. Gastroptosis.—This concomitant of congenital asthenia may exist in anydegree, with or without marked atony and is detected at once by the use ofthe bismuth meal. Even in extreme grades of ptosis, the pylorus is usually found
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