. Modern surgery, general and operative. heredin the dilated gullet about the scar. The vomited matter is not bloody. The Stricture of the Esophagus 1063 patient feels weak, hungry, and thirsty, becomes exhausted and emaciated, andsuffers from flatulence, gastralgia, and constipation. There is occasionally slight uneasiness or even pain in the region of thestricture, possibly about the epigastrium or between the shoulder-blades(The Surgery of the Alimentary Canal, by Maylard), If there is cer-tainly no aneurysm and if blood has never been brought up, the flexible bougiemay be used first and th
. Modern surgery, general and operative. heredin the dilated gullet about the scar. The vomited matter is not bloody. The Stricture of the Esophagus 1063 patient feels weak, hungry, and thirsty, becomes exhausted and emaciated, andsuffers from flatulence, gastralgia, and constipation. There is occasionally slight uneasiness or even pain in the region of thestricture, possibly about the epigastrium or between the shoulder-blades(The Surgery of the Alimentary Canal, by Maylard), If there is cer-tainly no aneurysm and if blood has never been brought up, the flexible bougiemay be used first and then the solid tipped sound, in order to find a stricture may be located by auscultation over the spine on a line with thesupposed obstruction. While a patient is swallowing water, the arrest ofthe fluid at the seat of stricture may be audible. Even if the fluid passes,it will be delayed for a time and the duration of deglutition is thus order to determine the time of deglutition put the ear just below the angle. Fig. 677.—Cicatricial stricture of esophagus. of the left scapula, or else between the left sternocostal margin and the xiphoidcartilage, place a finger on the patients Adams apple, and hold a watch inthe other hand. Have the patient take a drink of water. Count the timefrom the moment the Adams apple begins to rise until the fluid is heard togurgle into the stomach (Ogstons method). It ordinarily requires four secondsfor fluid to pass from the mouth into the stomach (Maylard, Ibid.). Thea;-rays are used to diagnosticate stricture and to locate it. They are valuablein diagnosis. An emulsion of bismuth or barium sulphate is swallowed and askiagraph is taken. The metallic salt is seen on the plate as a black massextending above the seat of constriction (Fig. 677). A fluoroscopic examina-tion shows the bismuth or barium through a constriction. A bougie can bepassed until it reaches the block and a skiagraph may be taken with bougie inposition. I
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