Duodenal Ulcer

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The liver dullness is not impaired, but percussion of the liver, or indeed of any part of the abdomen, is deeply resented by the patient. The symptoms I have described are those due to the perforation, to the sudden onset of the rupture in the ulcer; they are ample to permit of an assured diagnosis of some perforation, and of a probable diagnosis of duodenal perforation, being made. By degrees, however, and as a rule speedily, the symptoms alter, as pathological changes are set going by the esc...ape of fluid through the opening at the base of the ulcer. The chief of these, and the most significant, is the steady, uninterrupted rise in the pulse-rate. As the frequency increases, the quality becomes poorer. If observed from hour to hour, the change is always for the worse, unless morphine be given, when a temporary betterment 1 68 Duodenal Ulcer is noticed. The abdomen, though it never, or only at the last, when there is profound toxaemia, loses its ri- gidity, becomes fuller until a uniform and tight distension is found.

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