. American practice of surgery ; a complete system of the science and art of surgery . uous pain is a latemanifestation. An attempt to differentiate duodenal from gastric ulcer is made by a con-sideration of the tune of onset of this pain. In gastric ulcer the pain commences 716 AMERICAN PRACTICE OF SURGERY. soon after eating, while in the ulcer under consideration the pain does notappear until some hours after eating—, until the gastric contents pass fromthe stomach into the duodenum. The taking of food into the stomach relievesthe pain of duodenal ulcer because of the closure of the pylo
. American practice of surgery ; a complete system of the science and art of surgery . uous pain is a latemanifestation. An attempt to differentiate duodenal from gastric ulcer is made by a con-sideration of the tune of onset of this pain. In gastric ulcer the pain commences 716 AMERICAN PRACTICE OF SURGERY. soon after eating, while in the ulcer under consideration the pain does notappear until some hours after eating—, until the gastric contents pass fromthe stomach into the duodenum. The taking of food into the stomach relievesthe pain of duodenal ulcer because of the closure of the pylorus after the ingestionof food; hence frequent meals, good appetite, and increase in weight in earlycases. The pain is usually w^orse at from two to five hours after eating. According to Dr. Christopher Graham, the history of gas formation is almostas valuable as is that of pain, and frequently on this factor alone does a diagnosisdepend. It may come on early and it always becomes prominent with the loss ofmotor power. It is most notable at the time when the pain is greatest. The. Fig. 275.—Diagram Showing the Location of the Sphincter in the Duodenum Below the CommonDuct. (From Dr. A. J. Ochsner, in Annals of Surgery, January, 1906. J. B. Lipijincott Company,Philadelphia, Pubhshers.) S, Sphincter; P, pylorus; D of W, duct of Wirsung; D C, common duct. greater the acidity, the greater the pain and the more marked the gas is relieved, as is pain, by food, drink, an antacid, vomiting, or lavage. Vomiting was a prominent symptom in thirty-two of Grahams forty-sixcases. The regurgitation of bitter acid substance and the formation of gas arecommon in duodenal ulcer. In gall-stone disease the pain is sudden and severeand radiates widely; it occurs soon after the initial symptom and is independ-ent of, and not specially modified by, the taking of food; nor is it so oftentraced to the latter act. No stomach symptoms are present between theshort, well-defined attacks.
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