. Physical diagnosis . on Rings. G, G, G, G. Bismuthin Gut. position. There should be then no bismuth residue in the presence of any such residue is strong evidence that stasis and,therefore, some of the causes of stasis,—gastric cancer, peptic ulcer(gastric or duodenal), adhesions or ptosis, are present. Immediately after this test for stasis, a second bismuth meal isgiven and the patient is then radiographed at frequent intervals there- THE STOMACH, LIVER, AND PANCREAS 359 after in search of departures from the normal shape assumed by thebismuth shadow under these conditions and
. Physical diagnosis . on Rings. G, G, G, G. Bismuthin Gut. position. There should be then no bismuth residue in the presence of any such residue is strong evidence that stasis and,therefore, some of the causes of stasis,—gastric cancer, peptic ulcer(gastric or duodenal), adhesions or ptosis, are present. Immediately after this test for stasis, a second bismuth meal isgiven and the patient is then radiographed at frequent intervals there- THE STOMACH, LIVER, AND PANCREAS 359 after in search of departures from the normal shape assumed by thebismuth shadow under these conditions and corresponding to theoutline of the stomachs interior during peristalsis. If the patient isradiographed lying down, great care should be taken to avoid pressureupon the stomach through the abdominal wall. By such pressurethe gastric shadow may be so deformed as to simulate hour-glassstomach and other abnormalities. .The tube is to be focussed in allcases upon the third lumbar vertebra, and neither this focus nor the D. Fig. 209b.—Radiograph of Stomach After Bismuth- Meal,outline due to score and exudate from chronic ulcer. P. Pylorus. A. Loss ofD. Duodenum. patients position must change; great distortion of the picture andmany false inferences result from failure to follow these rules. In a satisfactory picture of the stomach one should be able to makeout the unbroken outline of the organ indented only by one or twocontraction waves. The pyloric sphincter and portion of bismuthjust beyond it in the duodenum (the Bishops cap) should be visible(see Fig. 209a). If these are not to be made out, or if there is a markedinterruption of the normal outline of the stomach shown in the sameplace in all the plates taken, cancer or ulcer may be suspected (seeFig. 209b. The changes to be found in peptic ulcer are not yet thoroughlyworked out though in most cases a bismuth residue is visible at theend of six hours, and this fact, together with the history and the otherdata of physical and
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectdiagnos, bookyear1912
