Localization Of The Ulcer

As above mentioned in speaking of the pathology, the ulcer may be situated at different points of the stomach walls, or at the pylorus, the beginning of the duodenum, the cardia, or the lower end of the oesophagus. The exact site of the ulcer can be determined with certainty only in rare instances. Most frequently we remain in doubt with reference to this point of diagnosis. There are, however, several symptoms which can be utilized with regard to a probable diagnosis as to the situation of the ulcer. 1. Frequently patients experience relief from their pains in assuming a certain position. Thus, for instance, some feel easier in lying on the back, others less uncomfortable when they lie upon their abdomen. Again, some feel no pain in standing, but the latter appears when they assume a recumbent position. In a few, again, this is reversed, the pain appearing in the standing and disappearing in the recumbent position. As a rule, we may assume that the position in which the patient is most comfortable is the one which permits the ulcer to remain above the gastric contents, and to come least in contact with them. Hence an ulcer situated at the lesser curvature will be diagnosed if the patient experiences relief in standing.

Again, an ulcer of the greater curvature will be suspected if the pain is most intense on standing. The site of the ulcer will be suspected to be in the cardiac portion of the stomach if the patient has less pains when lying on his right side, and in the pyloric region if the pains are less severe when he occupies a left-sided position. 2. Pains appearing directly after the deglutition of food, and associated with vomiting immediately after meals, particularly point to an ulcer in the cardiac region or in the lowest part of the oesophagus. 3. Pains appearing two or three hours after meals, referred partly to the right of the epigastric region and associated with melaena (bloody stools), point to the situation of the ulcer either at the pylorus or the beginning of the duodenum.

Prognosis

At first glance it would appear that the prognosis of gastric ulcer is quite good, especially nowadays, when the diagnosis of the affection is usually made at an early date. However, if we take into consideration the tabulated statistics given by Debove and Remond 1 in reference to the outcome of all cases of ulcer, we will become more careful in our favorable predictions. This table gives in a hundred cases of ulcer:

Perfect cme,.......50

Perforations and peritonitis.....13

Fourtroyant haeinatemesis.....5

1 Cited from Debove et Remond: l. c., p. 276.

Pulmonary tuberculosis, .... 20

Inanition,....... 5

Different complications, .... 7