The surgical significance of abdominal pain / by James P. Warbasse.

  • Warbasse, James Peter, 1866-1957.
Date:
1912
Catalogue details

Licence: In copyright

Credit: The surgical significance of abdominal pain / by James P. Warbasse. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    various directions, generally toward the left subscapular region The right subscapular region may be the seat of the reflex pain if the ulcer is at the extreme right side of the stomach. This pain is increased upon taking food. I he pain does not come on immediately after the ingestion of food but usually about one-half hour; and it seems from a collection of autopsy findings in these cases, that the further away from the cardia the ulcer is located, the later the pain, so that if the ulcer is located near the pyloric end of the stomach, the pain may not begin for two or three hours after the ingestion of food. Epigastric tenderness is usually well marked, and often with rigidity of the recti muscles. This tenderness is definitely localized, as well as the pain and may be given as characteristic of gastric ulcer. Vomiting gives relief to this pain. Spasm of the pylorus with its concomitant symptoms may be induced by the presence of the ulcer and give the peculiar pain of spasm of the pylorus. The typical pain develops gradually. It is a burning or boring pain, and often radiates to the back or up into the precordium. It is regular in its occurrence and may be Expected usually to come on with a fixed regularity after the ingestion of food. The patients speak of the pain pretty definitely as coming on with fairly certain regularity after eating. The tender- ness is pronounced. It is sharply localized in a small area. Diffuse pain usually speaks against ulcer. Exceptionally it may be an aching or dull pain. It may occur only after some particular articles of diet which a patient finds disagree with him or after some dietary indiscre- tion. Pain which is constant or is present before breakfast is rarely due to gastric ulcer. Pain beginning immediately upon taking food is also rarely due to gastric ulcer. In old ulcers the pain may be absent. A practical contribution to the subject will be found in a paper by Dudley Roberts, published in the Medical Record of the 17th of October, 1908. Pain due to cancer of the stomach is variable in its character. It may be absent. There may be only a sense of discomfort after eating which cannot be characterized as pain. It is calculated by collecting large series of cases that pain is present in about 85 to 90 per cent, of the cases of gastric carcinoma. About one-half of the cases suffer severe pain. It may be continous with exacerbations after eating, or it may be present only after eating. In some cases it appears only after the ingestion of solids. In pyloric cancer, that is, the cancer which is producing some obstruction to the emptying of the stomach, peristalsis causes the pain of obstruction which is relieved by vomiting. Usually this pain is referred to the epigastric region, occassionally passing through to the back, or in some cases felt only in the back. Absence of tenderness, as you are aware, in cancer of the stomach, is the feature which is generally counted upon to differen- tiate it from gastric ulcer. Sarcoma of the stomach (the few cases which have been studied) give the symptom of pain quite similar to the pain of cancer of the stomach. In ulcer of the duodenum, the pain may not occur until three or four or even more hours after the ingestion of food which means that the pain is felt when the food is poured through the pylorus and enters the duodenum. Because of the slower digestion in the night, a patient who has taken a meal late in the day, may not suffer the pain of ulcer of the duodenum until more than four hours; six to eight hours may elapse. These patients are awakened in the night with the peculiar