Diseases of the pancreas and their surgical treatment / by A.W. Mayo Robson and B.G.A. Moynihan.

  • Robson, A. W. Mayo (Arthur William Mayo), Sir, 1853-1933.
Date:
1902
Catalogue details

Licence: In copyright

Credit: Diseases of the pancreas and their surgical treatment / by A.W. Mayo Robson and B.G.A. Moynihan. Source: Wellcome Collection.

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    loses flesh and strength, a diagnosis of cancer of the head of the pancreas will probably be correct. The diagnosis will be made more certain if there is an absence of tenderness below the right costal margin associated with a tumour opposite to or above the umbilicus, having communicated pulsation and not moving with respiration. On distending the stomach with C02 it will be found that the tumour, at the best rather indefinite, be- comes hidden behind the resonant stomach, and that the distended gall bladder becomes pushed to the right. If cholelithiasis has preceded the onset of cancer, the gall bladder will not be enlarged, but the rapid deterioration of health and the presence of anasarca and ascites will, as a rule, leave no doubt of the nature of the disease. In common duct cholelithiasis there is practically always a preliminary history of gall stone attacks, though it may have been years previously. The jaun- dice will have come on after pain and is probably never absolute, for some bile nearly always escapes past gall stones into the duodenum. The bile soon becomes infected and then ague-like seizures follow and an irregular temperature, at times almost re- sembling pyaemia. In place of distended gall bladder a rigid right rectus will be felt which often makes it difficult to examine the parts beneath. A tender spot will usually be found an inch above and to the right of the umbilicus and the pain will be found to pass backwards to the mid-scapular region or to a spot beneath the right shoulder-blade. Whereas