Interstate medical journal . ts shouldbe forced toward the pylorus. (Case.) Characteristic findings of duodenal ulcers are distortions of thebiilbns duodeni. Occasionally cap deformities, as observed roent-genologically, far exceed the pathologic evidences as determinedby surgery, and therefore the supposition is that intrinsic spasms Hubeny: Gastrointestinal Roentgenology 943 of the caput occur similar to gastric spasma associated with gastriculcer. The usual types of deformity are: first, niche-like cavities. Herewe have the excavation of the ulcer visualized as a barium-filledrecess. The si
Interstate medical journal . ts shouldbe forced toward the pylorus. (Case.) Characteristic findings of duodenal ulcers are distortions of thebiilbns duodeni. Occasionally cap deformities, as observed roent-genologically, far exceed the pathologic evidences as determinedby surgery, and therefore the supposition is that intrinsic spasms Hubeny: Gastrointestinal Roentgenology 943 of the caput occur similar to gastric spasma associated with gastriculcer. The usual types of deformity are: first, niche-like cavities. Herewe have the excavation of the ulcer visualized as a barium-filledrecess. The size may vary from that of a wheat grain to thesize of a pea. Spastic incisura may or may not be present. Second,a bulbar shadow represented by a small compact shadow, with noespecial regularity of contour. Occasionally a steer horn (hyper-tonic) stomach may normally show a similar cap. In some instancesthere is a scant exit of barium through the pylorus, or rapidduodenal clearance. When due to obstructing ulcer, we get hyper-. 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
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