Page:Lectures on the diagnosis of abdominal tumors (microform) - delivered to the post-graduate class Johns Hopkins University, 1893 (IA cihm 01686).pdf/41

 performed for ovarian tumor, The cnurmoug dilatation, as shown in Figs. 9 and 10, with paralytic distention and absenco of the poristaltic waver, might, and indeed did, - whon the stomach was very full, simulate ascites, but no serious difliculty coult arise in the differentiation. Tumors of the colon, causing obstruction, lend to great distention of the Jarge bowel, in which active waves of peristalsis may be seen passing from right to left. Usually the abdo- men is distended more uniformly or chiefly in the epigus- trie zone, and intestinal, not gastric, symptoms have been present, and the inflation of the stumach alone, or, if practicable, combined inflation of the stomach ard colon, will usually give information upon which you may base a definite conclusion. A dilated stomach, causing a prominent tumor of the _ abdomen, is almost invariably due to stenosis of the pylo- rus, As already mentioned, in all of the cases a tumor was evident, and in all the condition was that to which the term dilatation of the stomach is more correctly limited. In rare instances a prominent tumor may be caused by mus- cular insufficiency, ag it ig called, or atony of the stomach, and ocensionally, by change in the position of the organ, the so-called descensus ventriculi. The differential diag- nosis of these conditions you will find fully given in the special works above mentioned. I may, however, remark that only in very exceptional instances of atony of the stomach or of descensus ventriculi are the peristaltic waves scen, In women who have borne many children, and who have the extromely relaxed abdominal walls, the condition which Glénard has termed onteroptosis may be associated with great depression and enlargement of the stomach. In some cases the decision is very difficult. I show you here the stomach outlines of o patient who at first we thought had dilatation of the stomach from pyloric obstruction, The organ reached nearly to the

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