Interstate medical journal . Fig-. 10.—Peristaltic incisura of caput. A rare phenomenon. peristalsis, antral dilatation, and six-hour residue. Third, incisuramay be present, either single or bilateral; usually small, sharplyoutlined, and occurring in the plane of the ulcer. Fourth, generaldistortions, with sharply outlined projections and incisura-like in-dentations, giving the cap the appearance of finger-like arboriza-tions. This deformity is largely organic; if partly due to spasm,the latter element is unvarying and persistent. In many casesthe whole contour is deformed; in some, only one b
Interstate medical journal . Fig-. 10.—Peristaltic incisura of caput. A rare phenomenon. peristalsis, antral dilatation, and six-hour residue. Third, incisuramay be present, either single or bilateral; usually small, sharplyoutlined, and occurring in the plane of the ulcer. Fourth, generaldistortions, with sharply outlined projections and incisura-like in-dentations, giving the cap the appearance of finger-like arboriza-tions. This deformity is largely organic; if partly due to spasm,the latter element is unvarying and persistent. In many casesthe whole contour is deformed; in some, only one border or thebase is decidedly irregular. The above-mentioned types are direct evidences of duodenal ulcerand are conclusive. The indirect findings, such as (a) gastric hypertonia, hyper-peristalsis, and hypermotility, (b) six-hour gastric residue, (c) 944 INTERSTATE MEDICAL JOURNAL. Hubeny: Gastrointestinal Roentgenology 945 dilatation of antrum pylori, (d) gastro-spasm, (e) duodenal diver-ticulum, are strong corroborative evidences of ulcer. Hypertonus may be due to a spastic increase of tone, or to anattempt to compensate for a beginning stenosis. Hyperperistalsis is present in about 60 percent of cases, althoughsometimes seen in gallbladder disease or appendiceal involvement. Hypermotility is the logical result of hypertonus and hyperperis-talsis, and, when this triad is present, ulcer is strongly is also found in gastric cancer, achylia, and the diar-rheas. A six-hour gastric residue without unbroken outline should firstsuggest duodenal obstruction, secondary to duodenal ulcer. If withthis we get hyperperistalsis, the diagnosis is almost certain. Dilatation of the antrum is a late manifestation, and shouldsuggest an obstructive lesion. Gastric spasms, such as migratory incisura or spastic hour-glasscontractions, are merely inferential.
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