The medical diseases of children . ay be seen to pass over into the right is best provoked by administering a feed, but may some-times be set up by stroking the abdominal wall with the finger. Itis to be noted that in some cases no peristaltic waves are seen untilthe patient has been under treatment for two or three days. In suchcases a thickened and contracted stomach may be visible and palpableunder the abdominal wall. * Lancet, Dec. 14, 1907. HYPERTROPHIC PYLORIC STENOSIS 267 The pyloric tumour is best felt while peristalsis is proceeding, asduring this the stomach is stra
The medical diseases of children . ay be seen to pass over into the right is best provoked by administering a feed, but may some-times be set up by stroking the abdominal wall with the finger. Itis to be noted that in some cases no peristaltic waves are seen untilthe patient has been under treatment for two or three days. In suchcases a thickened and contracted stomach may be visible and palpableunder the abdominal wall. * Lancet, Dec. 14, 1907. HYPERTROPHIC PYLORIC STENOSIS 267 The pyloric tumour is best felt while peristalsis is proceeding, asduring this the stomach is straightened and the pylorus other times the pylorus lies close to the vertebral column, tuckedaway behind the body of the stomach (Fig. 50). For this reason itis necessary that the palpating hand should be placed well downin the right flank, pressure being made in an upward and inwarddirection towards the spine. Unless this be done, the thickened gastricwalls which lie over the pylorus will prevent the recognition of the. Fig. 53 Hypertrophic Pyloric Stenosis : Showing gastric peristalsis. In the upper two pictures the irregular outline of the stomach is seen ;in the lowest typical peristaltic waves passing across into the right flank are shown. tumour. The pylorus feels like an enlarged gland, hard but freelymovable, lying slightly above the level of the lower border of the liver,by the side of the spine. Examination for the pyloric tumour is not unlikely to promotevomiting. Where then this sign has once been found to be definitelypositive, it is unwise, if the childs condition be serious, to endeavourto elicit it again. 268 DISEASES OF THE DIGESTIVE SYSTEM Diagnosis.—The symptoms of this disease—those of vomiting,constipation, and wasting—may be simulated in two conditions in veryyoung children. Firstly, in cases of severe constipation, emaciationmay be extreme, but by the comparative mildness of the gastricsymptoms, and the absence of peristalsis and pyloric
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectpediatrics, bookyear1
