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.

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    stenosis. Some of them think that it is the cause of hypertrophic pyloric stenosis and others speak of them as if they were the same thing. Per¬ sonally, I believe that pyloric spasm may occur as an entity. I also believe that it increases the symptoms in true hypertrophic pyloric sten¬ osis, often accounts for the variation in their intensity and is responsible for their sudden onset in some cases. Pure spasm is, however, relatively uncommon in comparison with hypertrophic stenosis. The vomiting appears either earlier or later, usually later, in spasm than in stenosis. It may be explosive, but is usually not as constant. Constipation is, as a rule, less severe and the stools contain more food residue than in stenosis. Malnutrition is usually not as marked. Visible peristalsis may be, and often is, just as marked. Ordinarily, there is no palpable tumor. If there is a tumor, it is usually smaller and not as hard. Finally, it may be intermittent and vary in size. Fluoroscopic examination or Roentgenographs taken after a bis¬ muth or barium meal are sometimes of great assistance in the diagnosis between stenosis and spasm. Nor¬ mally, of course, the food begins to leave the stomach at once and the stomach is empty in about three hours. In spasm, nothing may leave the stomach for some time or only a little at long intervals, but eventually, if the meal is not vomited, the pylorus relaxes and the food passes out. In stenosis, nothing leaves the stomach Fig. 18.—Hypertrophic stenosis of the for hours or, at best, Only a little trick- pylorus. Taken immediately after an les through, the pylorus never relaxes and eventually, the meal is vomited. Chronic indigestion is sometimes mistaken for pyloric stenosis. It should not be, however, as the symptomatology of the two conditions is quite different. The vomiting of indigestion may begin at any time, is not explosive, usually occurs several times after the same feeding and depends on the character of the food. The vomitus almost always shows evidences of indigestion. The bowels may be constipated, but the stools always contain milk remains and are usually undigested. There is no visible gastric peristalsis and, of course, no tumor. Examination with the Roentgen ray shows that food begins to leave the stomach at once. Another condition which is sometimes mistaken for hypertrophic pyloric stenosis is that in which vomiting occurs as the result of lack of tone in the cardia. In this condition the vomiting usually occurs soon after the food is taken, but, as a rule, onfy when the baby moves or cries. The vomiting is never explosive, the stools are composed of milk residue, there is no visible peristalsis or tumor, the nutrition is little, if at all, impaired. The Roentgen ray shows no signs of obstruction at the pyloric orifice. Prognosis and Treatment.—Many authorities believe that this is a self-limited condition and that, if a baby can be tided over a few months,
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