Symposium on Right Upper Abdominal Pain

Abstract

DR. BALFOUR stated that pain in the right upper quadrant might be due to lesions in various locations, viz., in the right upper quadrant, elsewhere in the abdomen, in the chest, and to general disease. The most frequent conditions in the right upper quadrant causing pain are lesions in the gall bladder and the duodenum. The more severe the symptoms attributable to these conditions, the greater relief is obtained from surgery. On the other hand, the less severe the symptoms, the less likely is relief to be obtained from surgery. Among the diseases occurring elsewhere in the abdomen the ones most likely to produce pain in the right upper quadrant are those associated with the appendix. The diseases within the chest with which pain in the right upper quadrant is most frequently associated are coronary thrombosis, pneumonia, and pleurisy, especially of the diaphragmatic type. Among general diseases most frequently associated with pain in the right upper quadrant are tabes and herpes zoster. Discussing the treatment of duodenal ulcer, Dr. Balfour showed a series of lantern slides illustrating the various operations for duodenal ulcer. Dr. Kirklin showed a very fine series of lantern slides, illustrating duodenal and gall-bladder diseases, these being the chief conditions in the right upper quadrant which are demonstrable radiologically. He stated that the radiologist should recognize lesions of the duodenum in 100 per cent of the cases, although he might not be able to identify the lesion in all the cases. Duodenal ulcer is recognizable radiologically in 95 per cent of the cases, the fluoroscope being of prime importance in the diagnosis. In acute perforations of the gastro-intestinal tract a diagnostic sign is the presence of gas above the liver and underneath the diaphragm. Acute duodenitis gives characteristic findings, namely, a recticular network of barium in the duodenum, irritability of the first and second parts of the duodenum, and absence of the characteristic crater of an ulcer. A number of characteristic slides of diverticulum of the duodenum were shown. Hypertrophy of the pyloric muscle was shown in a number of slides. The characteristic appearance was an elongated, slightly irregular area of barium connecting the pyloric end of the stomach and the duodenal cap. It is narrow and definitely distinguishable from ulcer and carcinoma. A very complete analysis was given by Dr. Kirklin of his work in cholecystography, in which he uses the oral method. Lantern slides showed the following findings: normal concentration of the dye, irregularities in size of the gall bladder, deficiency in concentration of the dye, gallstones accentuated by the dye, and papilloma and adenoma. In Dr. Kirklin's hands this method is correct in 97.1 per cent in showing poorly functioning gall bladder, is correct in 96.8 per cent in showing non-functioning gall bladder, and is correct in 89.5 per cent in demonstrating normal gall bladder.