Clinical pediatrics / by John Lovett Morse.

  • John Lovett Morse
Date:
1926
Catalogue details

Licence: In copyright

Credit: Clinical pediatrics / by John Lovett Morse. Source: Wellcome Collection.

    35/854 page 35
    the stomach, visible gastric peristalsis and tumor of the pylorus. In the earlier stages, the stomach simply appears more prominent than usual after food is taken. In the later stages, if dilatation has occurred, it can be seen and palpated below the navel. Unless it is below the navel, it is not safe to consider it enlarged. Percussion of the stomach is of little use at this age. If much obstruction has developed, waves of peristalsis can be seen running across the stomach from left to right. These appear soon after food is taken and, in my experience, can always be seen, if they are looked for carefully enough. They can sometimes be started up by stroking the epigastrium or by putting a piece of ice or a cold cloth on it. There may be only one wave or two or three following each other across the stomach. They often make the baby uncomfortable and sometimes make it cry out. They are usually about the size of half an egg. The tumor can almost always be felt, if it is carefully sought for. It is usually palpable about an inch to the right of a point midway between the tip of the ensiform and the navel, but may be found anywhere in the Fig. 17.—Hypertrophic stenosis of the pylorus. Waves of peristalsis. upper right abdomen. It feels like a dressed olive, is movable and is not tender. It does not vary in size. If there is visible peristalsis, the tumor is usually found where the waves stop. Sometimes it is more easily felt when the stomach is full, sometimes when it is empty. If it is not easily felt, the stomach should be filled, either by giving the baby a meal or with a tube. If it is not found, the abdomen should be examined during the relaxation which follows vomiting. It is more easily palpated then than at any other time. Although the tumor can almost always be found, its absence does not absolutely exclude pyloric stenosis, because, in rare instances, it may be situated so high up under the liver that it cannot be felt. Moreover, a certain amount of skill and experience is necessary to recognize it. It is possible to mistake an enlarged gland for it, but not likely, as enlarged abdominal glands are most unusual at this age and the combination of an enlarged gland and the characteristic symptoms of hypertrophic pyloric stenosis would be a most unusual coincidence. Diagnosis.—The symptomatology and physical signs of hypertrophic pyloric stenosis are so characteristic that it is almost impossible to mistake it for anything else. There are, however, a number of conditions which may be mistaken for it. The most important of these is pyloric spasm. Many pediatrists do not believe in spasm of the pylorus as an entity, but think that it occurs only as a complication of hypertrophic pyloric
    digitised image 1
    digitised image 2
    digitised image 3