. Radiography and radio-therapeutics . ch persistsas a small bismuth residue after the duodenum is empty. The bismuthshadow is therefore more marked in duodenal ulcer, because a characteristicof all ulcers of this part is the retention of the opaque chyme for a longerperiod than normal, as the result of a mild stasis due to spasm at the duodeno-jejunal junction. The accurate diagnosis of duodenal ulcer by means of the opaque mealis one of the most difficult problems which the radiologist has to with a careful consideration of the history and physical signsit may be possibl
. Radiography and radio-therapeutics . ch persistsas a small bismuth residue after the duodenum is empty. The bismuthshadow is therefore more marked in duodenal ulcer, because a characteristicof all ulcers of this part is the retention of the opaque chyme for a longerperiod than normal, as the result of a mild stasis due to spasm at the duodeno-jejunal junction. The accurate diagnosis of duodenal ulcer by means of the opaque mealis one of the most difficult problems which the radiologist has to with a careful consideration of the history and physical signsit may be possible to indicate that such a condition exists. The evidenceprovided is not always conclusive, and often leaves room for doubt afterrepeated and exhaustive examination. It is easy to understand why suchconflicting and inconclusive evidence may accrue when we consider the duo-denum as part of an organ which has associated with it other organs in closeproximity, having a nerve supply common to all, and liable to be disturbed 358 RADIOGRAPHY. by lesions other than ulcer of the duodenum, situated elsewhere in the imme-diate or even remote vicinity of the duodenum. Thus it is not uncommon tofind alterations in the behaviour of the duodenum caused by a lesion inthe region of the appendix, or in the gall-bladder, stomach, or other particular form of disturbance may cause symptoms simulatingthose of duodenal ulcer, and in some instances may cause the rapid move-ments in the duodenum and appearances indistinguishable from those ofulcer itself. Spasmodic contraction arising from reflex irritation may onthe other hand lead to delay in the passage through the duodenum, leadingto a marked delay in the actual emptying of the stomach, or the presence ofan early growth in the duodenum may at first cause symptoms of , however, when the growth has increased in size, symptoms of obstruc-tion will arise. Moreover, a new growth may ulcerate, and in this case a complication of
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