Relation of lesions of the small intestines to disorders of the stomach and cap as observed roentgenologically / by Lewis Gregory Cole.

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

Licence: In copyright

Credit: Relation of lesions of the small intestines to disorders of the stomach and cap as observed roentgenologically / by Lewis Gregory Cole. 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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    Usual Findings of the Jejunum. From the horizontal duo- denum the ingesta pass into the jejunum in the upper left quadrant of the abdomen, where they are broken up into finely comminuted particles. Roentgenographically these fragments present the flocculent appearance which distinguishes the jejunum from the rest of the small intestine (Figs. 2 and 3). Usual Findings of the Ileum. As the chyme reaches the centre of the small intestine and occupies the ileum it begins to form into coagulated masses. Upon reaching the terminal portion of the ileum these coagulated masses collect in long, worm-like coils, and as they near the cecum they fill the lumen of the gut, so that frequently one can identify several continuous convolutions of the ileum, especially if the roentgenograms are studied stereo- scopically. The ileum, therefore, is recognized roentgenographically by its location in the right lower quadrant of the abdomen and the coagulated appearance of the contents in its upper portion (Fig. 2), and the well-defined worm-like coils in its lower portion (Figs. 2, 10, 15, and 16). Physiology of the Small Intestine as Observed Roentgeno- graphically. The characteristic roentgenographic findings by which the various portions of the small intestine may be thus iden- tified are the result of certain physiological phenomena, expressed roentgenologically in terms of motor activity. Motor Phenomena of the Duodenum. The descending duo- denum obtains the ingesta by means of broad peristaltic contractions (Fig. 3), which withdraw the chyme from the reservoir cap, where it collects after being expelled through the pyloric sphincter during the systole of each gastric cycle. Duodenal peristalsis occurs periodically, but not coincidentally with or at the same rate, as gastric peristalsis. The chyme is thus propelled through the duo- denum in the finger-like masses described by Holzknecht (Fig. 3). During the early stage of digestion this process takes place very rapidly, because the contents of the cap are only slightly acid and mostly fluid, having been expelled through a more or less tightly contracted sphincter. Motor Phenomena of the Jejunum. Roentgenographic ob- servations have proved that the name jejunum was well chosen by the ancients from their postmortem investigations, for the peristalsis of this portion of the tract is so rapid that the jejunal lumen is seldom seen dilated or even filled. Motor Phenomena of the Ileum. The ileum retains the food longer than any other portion of the small intestine. It lodges here temporarily, after being passed rapidly through the cap, duodenum, and jejunum. Roentgenologic Appearance of Small Intestine Partly Due to Consistency of Contents. The flocculent appearance of the jejunum, coagulated appearance of the upper ileum, and worm-like coils of the lower ileum are probably caused, in part