Relation of lesions of the small intestine to disorders of the stomach and cap as observed roentgenologically / by Lewis Gregory Cole, M.D., Professor of Roentgenology in Cornell University Medical College.

  • Cole, Lewis Gregory, 1874-1954
Date:
1914
Catalogue details

Licence: In copyright

Credit: Relation of lesions of the small intestine to disorders of the stomach and cap as observed roentgenologically / by Lewis Gregory Cole, M.D., Professor of Roentgenology in Cornell University Medical College. Source: Wellcome Collection.

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    examination. A roentgenogram of the whole abdomen is made to determine how far the meal taken the night before has progressed. This information can usually be obtained from the fluoroscopic examination, which is made simultaneously; but if any doubt exists the plate should be developed immediately in order to ascertain with certainty whether or not the ileum is empty. If food still remains in the ileum the same examination is repeated bi-hourly until the ileum is completely evacuated, then the patient takes bismuth or barium suspended in buttermilk. After the passage of the ingesta through the esophagus has been observed fluoro- scopically the stomach is examined by combined fluoroscopy and serial roentgenography. Serial Roentgenography of the Stomach. Twelve roentgeno¬ grams are made in the prone posture, four to six in the lateral direction, two posteriorly, and twelve with the patient erect, after which the patient at once eats a meal of meat, potatoes, and bread. Two hours later another series of six to twelve roentgeno¬ grams is made, two of them stereoscopic roentgenograms of the entire gastro-intestinal tract. As this series often gives the most valuable information, we are therefore increasing the number of exposures made at this time. If further details concerning the progress of gastric digestion seem desirable, another series of roentgenograms is made four hours after ingestion. A pair of stereoroentgenograms is invariably taken six hours after the bismuth meal. If at this time the fluoroscope reveals an appreciable gastric retention, five or six roentgenograms of the stomach are made. Examination of Ileocecal Region. As the condition of filling in the ileocecal region is of prime diagnostic importance at this time, two small stcreoroentgenograms (8 x 10 inches) are made of this portion of the tract, and if marked stasis or any other unusual finding is observed fluoroscopically, six to eight small roentgenograms of this region are made. Two hours later, i. e., eight hours after ingestion, one plain roentgenogram or a pair of stereoroentgenograms is made. This completes the examination for that day. At nine o’clock the next morning, i. e., twenty-four hours after the ingestion of bismuth and buttermilk, another roentgenogram is obtained. If there is evidence of colonic stasis or constipation a roentgenogram is made every twenty-four hours until the colon is evacuated. In case the patient habitually depends upon a cathartic, it should be allowed as usual, but an active purgative is undesirable. After the examination just described there remains to be made an examination of the gall-bladder for possible calculi, and also an examination of the colon, while mechanically distended, for the purpose of discovering any spasmodic or organic lesions not detected when the bismuth passed through from above. The night before this examination an active cathartic is adminis-