. The diseases of infancy and childhood. or three feedings and then expel the whole amount. The frequencyof vomiting varies from once or twice to six or eight times a day. Owingto the loss of fluid by vomiting the urine is usually very scanty. There HYPERTROPHIC STENOSIS OF THE PYLORUS 323 is no uniform change in the gastric secretions, but there is frequentlyhyperacidity present. Bowels.—Obstinate constipation is the rule. It is due to the factthat so much of the food taken is vomited. If the pyloric obstruc-tion is complete the stools resemble meconium. Wasting.—Progressive wasting is one of
. The diseases of infancy and childhood. or three feedings and then expel the whole amount. The frequencyof vomiting varies from once or twice to six or eight times a day. Owingto the loss of fluid by vomiting the urine is usually very scanty. There HYPERTROPHIC STENOSIS OF THE PYLORUS 323 is no uniform change in the gastric secretions, but there is frequentlyhyperacidity present. Bowels.—Obstinate constipation is the rule. It is due to the factthat so much of the food taken is vomited. If the pyloric obstruc-tion is complete the stools resemble meconium. Wasting.—Progressive wasting is one of the striking symptoms, and aclose observation of the weight one of our best guides to the progress ofthe case. If the loss amounts to two or three ounces a day the conditionshould be considered most critical. The rate of the loss depends naturallyupon the completeness of the obstruction and it is proportionate to theamount of vomiting and the degree of constipation. General Appearance.—At first nothing abnormal is seen, but soon. Fig. 31.—Gastric Peristalsis in Pyloric Stenosis. (Thomson.)Patient eight weeks old. all the evidences of rapid malnutrition are present, without, however, theother usual symptoms of indigestion, such as might be expected with thevomiting. The tongue is usually clean; the appetite often voracious;there are no eructations of gas; the breath is sweet, and the color usuallygood. Peristalsis.—On examination of the abdomen the epigastrium is usu-ally full and the lower half of the abdomen may be sunken. If the skinis bared and the patient placed in a good light the characteristic peristal-tic waves are seen which are the most diagnostic feature of the should not expect to see them if the stomach is empty; they arebest seen immediately after taking food or water. When not appearingspontaneously they may often be excited by slight friction or tapping ofthe epigastrium. There is seen a slowly moving wave from left to a ball-l
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