Gastroenterology Diseases

Multiple hepatic abscesses occurring in the course of a general pyemia may present no distinctive symptoms except an enlarged and tender liver with slight jaundice.

In general the symptoms of liver abscess comprise the following: Fever, which is often high at the outset (103 to 105 degrees F), but may begin insidiously, soon becoming irregular, intermittent, or hectic in type, and interrupted by periods of normal temperature. Chills may precede, and sweats often follow, the exacerbations of the fever. If the case becomes chronic, fever may be absent. There is usually hepatic and right-shoulder pain of a dull aching character, increased and dragging when the patient lies upon his left side. There is jaundice, seldom more than a moderate muddy yellowness of the skin and conjunctivae. Gastric disturbances, often with alternating diarrhea and constipation, or constipation alone, are present. Ascites is rare. If the abscess is sufficiently large the pressure upon the lung through the diaphragm may cause pleuritic symptoms. There is a progressive loss of flesh and strength.

Upon examination the liver is found to be enlarged and tender, and the enlargement, especially if a single abscess of considerable size exists in the right lobe of the liver, is upward and to the right, contrary to the findings in other swellings of the liver. The upper limit of the liver dullness is such cases may lie as high as the fifth instead of the eight rib in the midaxillary line, and at the level of the angle of the scapula posteriorly. It may project below the costal margin anteriorly as much as 4 inches, but in multiple abscesses palpable swelling may be absent. If the liver is accessible, it is found to be smooth and tender, and, rarely, fluctuation is obtained. A friction rub over the hepatic area may be heard upon deep inspiration if the perihepatic peritoneum is inflamed. In fatal cases the typhoid status usually develops.

Butler, G. R. (1901/1909). The Diagnostics of Internal Medicine A Clinical Treatise Upon the Recognised Principles of Medical Diagnosis, Prepared for the Use of Students and Practitioners of Medicine (3rd ed., pp. 893 – 894). New York: D. Appleton & Company.

Created by: Taha Jilani, 06/14/2021

Entered by: Rachel Johnson, 10/05/2021

All swellings of viscera make the abdominal wall thin and weak. When the swellings begin to be localised and form an abscess, pain and fever become severe and high; the tongue becomes very rough; sleeplessness and other symptoms are aggravated; the sense of heaviness becomes great; sometimes there is sensation of hardness and piercing (pain); sometimes sudden emaciation of the body and sudden hollowness of the eyes may appear. When pus is formed, the intensity off ever, pain and pulsation subsides and itching replaces the pain. If there is redness and hardness, the redness lessens and the hardness turns into softness. All the signs of pain subside and heaviness reaches at its height. .When the abscess bursts, the acridity of pus first produces rigor and then fever. Then owing to depletion the pulse becomes broad, unequal, weak, small, slow and infrequent. There is loss of appetite and often the extremties grow warm. The matter (i.e, pus) is discharged through easy passages viz through expectoration or urine or faeces.

Ibn Sina (1993). al-Qānūn fī al-Ṭibb. (Jamia Hamdard Trans.). New Dehli: Jamia Hamdard Printing Press. (Original Work Published in 1025 AD)

Created by: Sara Ahmed, 06/08/2021

Entered by: Rachel Johnson, 07/19/2021

Pain in deglutition is always present in severe inflammation of the esophagus, and in the form which follows the swallowing of strong irritants may prevent the taking of food. A dull pain beneath the sternum is also present. In the milder forms of catarrhal inflammation there are usually no symptoms.

The presence of a foreign body is indicated by dysphagia and spasm with the regurgitation of portions of the food. Later, blood and pus may be ejected. It is surprising how extensive the disease may be in the esophagus without producing much pain or great discomfort, except in swallowing. The intense inflammation which follows the swallowing of corrosives, when now fatal, gradually subsides, and often leads to cicatricial contraction and stricture. […]

A chronic form of esophagitis is described, but it results usually from the prolonged action of the causes which produce the acute form. Associated with chronic heart disease and more frequently with the senile and the cirrhotic liver, the esophageal veins may be enormously distended and varicose, particularly toward the stomach. In these cases the mucous membrane is in a state of chronic catarrh, and the patient has frequent eructations of mucus. Rupture of these esophageal veins may cause fatal haemorrhage.

Osler, W. (1892). The Principles and Practice of Medicine. (pp. 339-340). New York: D. Appleton & Company.

Entered by: Ayushi Chintakayala, 6/12/2020

Acute paroxysmal pain usually in the right hypochondrium, less commonly in the epigastrium or right iliac (appendical) region, is the earliest evidence of the disease. It is shortly followed by nausea, vomiting, abdominal distention, rigidity, and tenderness. The tenderness is at first diffuse, becoming localized, but not always over the site of the gallbladder. Prostration is usually well marked or severe. There may be obstinate constipation or even an apparently complete intestinal obstruction, neither flatus nor feces passing. In the form due to gallstones, jaundice is common; in the non-calculous variety it is seldom present. There may be comparatively mild and recurring attacks of acute cholecystitis without the presence of gallstones.

Butler, G.R. (1901). The Diagnostics of Internal Medicine: a Clinical Treatise upon the Recognised Principles of Medical Diagnosis(pp. 804-805). D. Appleton & Company. Pg. 804-805.

Entered by: Ayushi Chintakayala, 6/18/2020

In some cases there have been premonitory attacks of pain which may be general or in the upper part of the abdomen and suggest gastric ulcer or gallstones. The onset is very sudden with severe pain usually referred to the epigastrium and in some cases very severe in the lower dorsal region of the back. It is continuous but paroxysms of greater severity come at intervals. Vomiting soon begins and is frequent. There is constipation and no sounds of peristalsis can be heard. In the most acute cases there is a condition of shock. The symptoms of the attack are those of a very acute abdominal condition suggesting the perforation of an ulcer or sudden intestinal obstruction. Examination shows fullness and tenderness in the upper abdomen and usually increasing distention. The tenderness may be specially marked across the epigastrium and there may be a distinct sense of resistance over the region of the pancreas. Bluish discoloration about the navel and greenish discoloration in the loins have been noted (Turner). There is not likely to be any tumor mass felt until at least the third day. There may be marked leucocytosis. The temperature is rarely elevated may be subnormal; the pulse is rapid. The most acute cases, termed fulminating, show a very severe onset with marked shock and collapse. This has been explained as probably due to pressure on the celiac axis. In these cases there is profuse hemorrhage into the pancreas and death usually follows in two or three days.

In acute cases of average severity, the onset is sudden, but less severe than in preceding. Only part of the pancreas may be damaged by the process and the most greatly damaged part may go on to necrosis and gangrene. Suppuration may follow, giving the picture of an acute suppurative pancreatitis. There may be a single abscess or numerous small ones. […] The course of the suppurative form is likely to be chronic. Jaundice, diarrhea, and glycosuria have occurred but are rare. A tumor mass in the epigastrium may result. In less acute forms the process may be limited to only a part of the pancreas, usually the head, and the hemorrhage is slight. The main symptoms are pain in the abdomen with nausea and vomiting, but the pulse and temperature show no change and the condition may be overlooked, especially as it is often associated with cholecystitis.

In gangrenous pancreatitis, complete necrosis of the gland, or part of it, may follow hemorrhage or hemorrhagic inflammation and in exceptional cases may occur after suppurative infiltration or after injury or perforation of an ulcer of the stomach. Symptoms of hemorrhagic pancreatitis may precede or be associated with it. Death usually follows in from ten to twenty days, with symptoms of collapse. The pancreas may present a dry necrotic appearance, but as a rule the organ is converted into a dark slaty-colored mass lying nearly free in the omental cavity or attached by a few shreds. In other instances the totally or partially sequestrated organ may lie in a large abscess cavity, forming a palpable tumor in the epigastric region. The necrotic portion may be discharged per rectum, with recovery.

Osler, W. & McCrae T. (1892/1925). The Principles and Practice of Medicine: Designed for the Use of Practitioners and Students of Medicine (10th ed, pp. 595-597). New York: D. Appleton & Company.

Created by: Taha Jilani, 06/14/2021

Entered by: Rachel Johnson, 10/05/2021

In a large proportion of all cases of acute appendicitis the following symptoms are present: (1) Sudden pain in the abdomen, usually referred to the right iliac fossa; (2) fever, often of moderate grade; (3) gastro-intestinal disturbances—nausea, vomiting, and frequent constipation; (4) tenderness or pain on pressure in the appendix region. A sudden, violent pain in the abdomen is […] the most constant, first, decided symptom of perforating inflammation of the appendix. […] In fully half of the cases it is localized in the right iliac fossa, but it may be central, diffuse, but usually in the right half of the abdomen. Even in the cases in which the pain is at first not in the appendix region, it is usually felt here within thirty-six or forty-eight hours. It may extend toward the perinaeum or testicle. […] Some patients speak of it as a sharp, intense pain—serous-membrane pain; others as a dull ache—connective-tissue pain. […] Fever is always present in the early stage, even in the mildest forms, and is a most important feature. […] The fever may be moderate, from 100o to 102o; sometimes in children at the very outset the thermometer may register above 103.5o. […] Nausea and vomiting are symptoms which may be absent but which are commonly present in the acute perforative cases. […] Constipation is the rule, but the attack may set in with diarrhea, particularly in children. […] McBurney has called attention to the value of a localized point of tenderness on deep pressure, which is situated at the intersection of a line drawn from the navel to the anterior superior spine of the ilium, with a second, vertically placed, corresponding to the outer edge of the right rectos muscle. Firm, deep, continuous pressure with one finger at this spot causes pain, often of the most exquisite character.

Osler, W. (1909). The Principles and Practice of Medicine (7th ed.). London: Appleton and Co. Pg. 514-515.

Entered by: Erin Choi, 6/10/2020

Definition.—Jaundice due to swelling and obstruction of the terminal portion of the common duct.

Symptoms.—There may be neither pain nor distress, and the patient’s friends may first notice the yellow tint, or the patient himself may observe it in the looking-glass. In other instances, there are dyspeptic symptoms and uneasy sensations in the hepatic region or pains in the back and limbs. In the epidemic form, the onset may be more severe, with headache, chill, and vomiting. Fever is rarely present, though the temperature may reach 101°, sometimes 102°. All the signs of obstructive jaundice already mentioned are present, the stools are clay colored, and the urine contains bile-pigment. The jaundice has a bright-yellow tint; the greenish, bronzed color is never seen in the simple form. The pulse may be normal, but occasionally it is remarkably slow, and may fall to forty or thirty beats in the minute. The liver may be normal in size, but is usually slightly enlarged, and the edge can be felt below the costal margin.

Occasionally the enlargement is more marked. The duration of the disease is from four to eight weeks. There are mild, cases in which the jaundice disappears within two weeks; on the other hand, it may persist for three months. The stools should be carefully watched, for they give the first intimation of removal of the obstruction.

Osler, W. (1892). The principles and practice of medicine: Designed for the use of practitioners and student of medicine. New York, NY: D. Appleton and Company.

Entered by: Kate Holder, 7/17/2020

Catarrhal, simple, or acute stomatitis is a mild disease, characterized by redness and swelling of the mucous membrane and by increased secretion of saliva. It is produced by irritants […] Catarrhal stomatitis is present in many infectious diseases, partly as a result of the same cause, partly because of decomposition of food in the mouth, lack of care, etc. […] It is also present, either alone or as an accompaniment of other forms of stomatitis, after the use of certain drugs, such as mercury, iodides, lead, bromides, bismuth, and arsenic. […] There is moderate pain, which is increased on the ingestion and mastication of food […] The saliva is increased in quantity and becomes sticky or pasty. The sense of taste is impaired; the appetite diminishes; and […] there may be fever, and at times even emaciation. Examination of the mouth reveals swelling and redness of the mucosa; the tongue is tooth-marked; the interdental processes of the gums are enlarged, red, and thickened. The mucosa is covered with a tough, whitish saliva, usually in patches. In severe cases the papillae of the tongue are prominent and bloody at their tips (papillitis). The breath is offensive.

Osler, W. (1908). The principles and practice of medicine: Designed for the use of practitioners and student of medicine (pp. 45-46). New York, NY: D. Appleton and Company.

Created by: Sonia Khan, 09/30/2021

Entered by: Rachel Johnson, 11/30/2021

Description 1

The appetite is variable, sometimes greatly impaired, at others very good. Among early symptoms are feeling of distress or oppression after eating, which may come aggravated and amount to actual pain. When the stomach is empty there may also be a painful feeling. The pain differs in different cases and may be trifling or of extreme severity. When localized and felt beneath the sternum or in the precordial region it is known as heart-burn or sometimes cardialgia. There is pain and pressure over the stomach, usually diffuse and not severe. The tongue is coated, and the patient complains of a bad taste in the mouth. The tip and margin of the tongue is very often red. […] Nausea is an early symptoms and is particularly apt to occur in the morning hours. […] Eructation of gas, which may continue for some hours after taking food, is a very prominent feature in cases of so-called flatulent dyspepsia, and there may be marked distension of the intestines. […] Vomiting, which is not very frequent, occurs either immediately after eating or an hour or two later. […] The vomit consists of food in various stages of digestion and slimy mucus, and the chemical examination shows the presence of abnormal acids such as butyric, or even acetic, in addition to lactic acid, while the hydrochloric acid, if indeed it be present, is much reduced in quantity. The digestion may be much delayed, and on washing out the stomach as late as seven hours after eating, portions of food are still present. The prolonged retention favors decomposition, the stomach becomes distended with gas, and this, with the chronic catarrh, may induce gradually an atony of the muscular walls. Constipation is usually presence, but in some instances there is diarrhea and undigested food passes rapidly through the bowels. […] Of other symptoms headache is common, and the patient feels constantly out of sorts, indisposed for exertion, and low-spirited.

Osler, W. (1909). The Principles and Practice of Medicine (7th ed.). London: Appleton and Co. Pg. 461-462.

Entered by: Ayushi Chintakayala. 6/18/2020

Edited by: Erin Choi. 6/19/2020

Description 2

It is attended with a fixed pain and burning heat in the stomach; great restlessness and anxiety; a small, quick, and hard pulse; vomiting, or at least a nausea and sick ness; excessive thirst; coldness of the extremities; difficulty of breathing; cold clammy sweats; and sometimes convulsions and fainting fits. The stomach is swelled, and often feels hard to the touch. One of the most certain signs of this disease is the sense of pain, which the patient feels upon taking any kind of food or drink, especially if it be either too hot or too cold. When the patient vomits everything he eats or drinks, is extremely restless, has a hiccup, with an intermitting pulse, and frequent fainting fits, the danger is very great.

Buchan W. (1793). Domestic Medicine, or, a treatise on the prevention and cure of diseases by regimen and simple medicines. (14th Ed., pp. 236). Boston : Printed by Joseph Bumstead, for James White, and Ebenezer Larkin.

Created by: Sara Ahmed, 06/08/2021

Entered by: Rachel Johnson, 07/19/2021

Prior to the occurrence of characteristic symptoms, probably in most cases the liver is more or less enlarged. When, however, certain symptomatic effects are manifested, the liver is generally diminished in volume. […]

The symptomatic effect which especially characterizes the affection is hydroperitoneum. In the great majority of the cases of peritoneal dropsy, when local, that is, not a component of general dropsy, it depends on cirrhosis of the liver. […] Gastro-intestinal disorders—impaired appetite and digestion, diarrhea in some cases, uneasiness or dull pain in the right hypochondrium—deeply colored urine with an abundant deposit of the urates, loss in weight, general debility, and sometimes jaundice, the patient having been for a long time addicted to the use of spirits, point to the existence of affection. […]

Another symptomatic effect is hemorrhage from either the stomach or intestinal canal. […] Persistent serous or watery diarrhea is a symptomatic effect in some cases. […] A diagnostic sign which is sometimes conspicuous, is enlargement of the superficial abdominal veins, especially on the right side. […] The spleen is often, but not invariable, enlarged. Jaundice is an occasional, not a frequent, effect.

Flint, A. (1879). Clinical medicine: a systematic treatise on the diagnosis and treatment of
diseases ; designed for the use of students and practitioners of medicine. London: Churchill. Pg. 376-377.

Entered by: Erin Choi, 6/22/2020

Description 1

The organ becomes hard, and often contracted, as a result of interstitial fibrous overgrowth. The most frequent case is an extension into the pancreatic duct of a chronic gastro-duodenitis or catarrh of the bile passages; next most frequently it is a result of alcoholism and syphilis. It is often associated with diabetes.

The symptoms are not distinctive. There may be evidences of chronic catarrhal gastritis with occasional attacks of deep-seated pain in the epigastric region, faintness, anxiety, and moderate fever. Jaundice, due to pressure upon the common bile duct by the fibroid changes in the head of the pancreas, may be present, so also fatty diarrhea, and fat and sugar in the urine. A sense of resistance over the epigastrium has been observed. Nevertheless an ante-mortem diagnosis is rarely, if ever, possible without exploratory operation.

Butler, G. R. (1901/1909). The Diagnostics of Internal Medicine A Clinical Treatise Upon the Recognised Principles of Medical Diagnosis, Prepared for the Use of Students and Practitioners of Medicine (3rd ed., pp. 902). New York: D. Appleton & Company.

Created by: Taha Jilani, 06/14/2021

Entered by: Rachel Johnson, 10/05/2021

Description 2

It must be confessed that the clinical picture is very obscure. Cammidge describes four types: (a) The dyspeptic, in which the disease is due to morbid conditions of the bowels and the symptoms are mainly referred to the digestive organs. (b) The cholelithic, associated with the presence of gallstones in the common duct; there is usually chronic jaundice and the dominant symptoms are hepatic. (c) A miscellaneous group in which the pancreatitis is secondary to a malignant disease, etc. (d) The diabetic group with glycosuria, into which the preceding groups may merge in time.

Symptoms of pancreatic insufficiency are generally present but cannot be regarded as distinctive, as biliary disease is so often present. Anorexia is common and occasional vomiting may be noted; there may be discomfort after meals but pain is not often present though colic may occur in the absence of gallstones. Jaundice may be found, due to obstruction of the common duct from stone or pressure from the pancreas if it surrounds the duct. Occasionally the pancreas can be felt; sometimes it is tender. Diarrhea is common with bulky fetid stools containing excess of fat. There is marked loss of fat and nitrogen in the stools. There is a large amount of unsplit fat present. The extent of digestion of cell nuclei is of some value. Glycosuria occasionally results. The general health may suffer and emaciation result. Death may be due to exhaustion.

Osler, W. & McCrae T. (1892/1925). The Principles and Practice of Medicine: Designed for the Use of Practitioners and Students of Medicine (10th ed, pp. 598). New York: D. Appleton & Company.

Created by: Taha Jilani, 06/14/2021

Entered by: Rachel Johnson, 10/05/2021

This is a congenital deformity, consisting of one of more fissures in the upper lip, resulting from an arrest of development. The fissure is not in the median line, but corresponds to the line of junction between the intermaxillary and superior maxillary bones. Harelip may be single or double.

Osler, W. (1908). The principles and practice of medicine: Designed for the use of practitioners and student of medicine (pp. 45). New York, NY: D. Appleton and Company.

Created by: Sonia Khan, 09/30/2021

Entered by: Rachel Johnson, 11/30/2021

Congenital diverticula, of which Meckel’s is the type, may cause strangulation or obstruction.

Acquired diverticula, commonly hernial protrusion of the mucous and serous coats, occur anywhere in the intestinal tract. In the small bowel they rarely cause symptoms [...]. The site of election of the common form is the sigmoid flexure near the junction with the rectum and the clinical interest in the frequency with which they are the seat of inflammation—diverticulitis, perisigmoiditis [...]. The evaginations of the mucosa are usually the result of high intra-colic pressure with gas or faeces in the aged [...]. The symptoms may not permit of more than a tentative diagnosis. Pain in the left lower quadrant with tenderness, rigidity and a mass in a person over sixty, who has been constipated, should suggest diverticulitis as well as cancer. The absence of blood in the stools, the long history of pain in the lower left quadrant, tumor formation and perhaps later disappearance, negative sigmoidoscopy, slight fever and good nutrition or even obesity are in favor of the former.

Osler, W. & McCrae T. (1892/1925). The Principles and Practice of Medicine. (10th ed, pp. 550 - 551). New York: D. Appleton & Company.

Entered by: Sonia Y. Khan, 6/22/2020

Edited by: Taha Jilani, 7/14/2021

Cholelithiasis occurs mainly in women (75 per cent), especially those who have borne children. The patient is usually between 40 and 60, rarely under 25 years of age. Other predisposing causes are excessive eating, sedentary occupation, constipation, tight lacing, enteroptosis, and nephroptosis. While small concretions may form in the liver itself, the great majority of gallstones which cause symptoms originate in the gallbladder. Calculi may, and usually do, remain in the gallbladder for an infinite period without giving rise to symptoms. If a calculus leaves the gallbladder and enters the ducts, symptoms […] of these various events are as follow:

1. Hepatic Colic - The attack is sudden, with excruciating cutting pain, usually localized in the right hypochondrium, whence it may spread over the abdomen and lower thorax, and in some cases be referred to the right shoulder and arm. There are often vomiting, drenching sweats, a feeble and rapid pulse, and occasionally syncope. Rather frequently there is a chill with fever (101oto 103o). The liver may become enlarge and noticeably tender, the gallbladder swollen, tender, and palpable, and the spleen also may swell moderately. Jaundice appears in about one half of the cases, usually within 24 hours after the beginning of the attack and while the stone is passing through the common duct. Ordinarily it is slight and of brief duration, but may be either absent or intense […]. The urine may contain bile pigment and albumin. Palpitation, precordial oppression, and an acute mitral murmur have been noted. The duration of the attack is variable, lasting from a few hours to a week, or even longer, with remissions and exacerbations, until the stone is finally expelled. Possible but rare accidents are convulsions, fatal syncope, and rupture of the duct followed by a lethal peritonitis.

2. Impacted Gallstones in the Cystic Duct
The distended organ can usually be felt below the costal margin as an elastic gourd-shaped, ovoid, or rounded tumour, ordinarily of moderate size […]. It may not be sufficiently tense to be palpable. It moves with respiration. Gallstone crepitus may be perceived. Jaundice is not present in obstruction of the cystic duct alone. […] Acute cholecystitis, either catarrhal, suppurative (empyema), or phlegmonous […] may arise as a consequence […].

3. Impacted Gallstones in the Common Duct
[...] presence of jaundice, of variable intensity, for more than one year, with the persistent or intermittent presence of bile in the stools; fever; enlargement of the spleen; absent or slight enlargement of the liver or distention of the gallbladder; and the absence of ascites.

4. Other Sequelae and Complications of Gallstones
The stone may ulcerate, with the formation of a biliary fistula, through the gall bladder or common or cystic ducts into the stomach (rare); duodenum (more common); colon (not uncommon); abdominal cavity (not uncommon); bladder (occasional); lungs (not uncommon), in which case bile may be coughed up; or an external communication (most common) may be established in the right hypochondriac or epigastric regions, by which the stone escapes.

Butler, G.R. (1901). The Diagnostics of Internal Medicine: a Clinical Treatise upon the Recognised Principles of Medical Diagnosis. D. Appleton & Company. Pg. 805-808.

Entered by: Ayushi Chintakayala, 6/18/2020

Edited by: Sonia Y. Khan, 8/4/2020

Description 1

The external integument, or skin, immediately encircling the verge of the anus, is liable to be distended by a deposit of fluids in the cellular membrane, connecting it with the parts beneath. This distension, which may be produced by an effusion either of blood or serous fluid, or both, constitutes the hemorrhoidal tumor.

This kind of tumour, sometimes much inflamed, and often excessively painful, may arise from an irritation in or near the lower part of the rectum: it most commonly depends on some obstruction in the circulation through the hemorrhoidal veins. Habitual neglect of the bowels, favouring the accumulation of hardened feces in the rectum; straining to void a confined stool; the pressure of gravid uterus, or of any preternatural tumour; a sedentary life; sudden and violent exertion; lifting heavy weights; have, in their turn, been the means of bringing on this disease, and may be considered some of its most frequent causes.

The first appearance of hemorrhoidal tumour is generally connected with pain and inflammation. The patient usually complains of uneasy sense of weight and fulness, as well as of heat, and out the parts, particularly severe in passing motion. […]

Hemorrhoidal tumours may be numerous, or otherwise. Sometimes a single swelling only exists; more frequently there are several surrounding the anus.

The sanguineous hemorrhoidal tumour will be opaque, and of a comparatively dark colour, the blood sometimes shining evidently through the skin; it will usually be of more firm consistence, and more slow formation. The serous hemorrhoidal tumour, on the other hand, will be pale in colour, almost transparent, highly elastic, compressible, and soon produced; the former usually requiring a few days, the latter a few hours only for their production. […]

These complaints, when connected with inflammation, are very painful. The patient can neither walk, ride, not sit; the only tolerable state being that of absolute rest on the reclined position. Should he during the continuence of inflammation be obliged to pass a motion, the distress is extreme. […]

Howship, J. (1821). Practical observations on the symptoms, discrimination and treatment, of some of the most important diseases of the lower intestines and anus: particularly including those affection produced by stricture, ulceration, and tumour, within the cavity of the rectum, and piles, fistulæ, and excrescences, formed at its external opening. Benjamin Warner.

Created/Entered by: Rachel Johnson, 07/22/2021

 

Description 2

The disease of hemorrhoids […] swells outwardly, and the heads of the veins are raised up, and being at the same time bruised by the faeces passing out, and injured by the blood collected in them, they squirt out blood, most frequently along with the faeces, but sometimes without faeces. […]

[…] You will recognize hemorrhoids without difficulty, for they project on the inside of the gut like dark-colored grapes, and when the anus is forced out they spurt blood. […]

Hippocrates (1849). On Hemorrhoids. (Adams, F., Trans.). Syndeham Society. (Original work published 400 BCE).

Created/Entered by: Rachel Johnson, 07/22/2021

This disease is known by a painful tension of the right side under the false ribs, attended with some degree of fever, a sense of weight, or fulness of the part, difficulty of breathing, loathing of food, great thirst, with a pale or yellowish colour of the skin and eyes. The symptoms here are various, according to the degree of inflammation, and likewise according to the particular part of the liver where the inflammation happens. Sometimes the pain is so inconsiderable, that an inflammation is not so much as suspected; but when it happens in the upper or convex part of the liver, the pain is more acute, the pulse quicker, and the patient is often troubled with a dry cough, a hiccup, and a pain extending to the shoulder, with difficulty of lying on the left side, &c. This disease may be distinguished from the pleurisy, by the pain being less violent, seated under the false ribs, the pulse not so hard, and by the difficulty of lying on the left side. It may be distinguished from the hysteric and hypochondriac disorders by the degree of fever with which it is always attended. In warm climates * this viscus is more apt to be affected with inflammation than any other part of the body, from, in all probability, the increased secretion of bile which takes place when the blood is thrown on the internal parts by an exposure to cold; or from the bile becoming acrid, and thereby exciting an irritation of the part.

*Inflammation of the liver, and the diseases consequent thereupon, are indeed affections more frequently to be met with in warm climates than in cold ones, particularly in the East and West Indies, where few Europeans can reside for any length of time without being attacked by them. The liver in warm climates seems to be the seat of disease, nearly in the same proportion that the lungs are in Great Britain. Both acute and chronic hepatitis are frequently met with in persons who come to Europe from the East and West Indies; and in those who have been affected when in those climates, they are very apt to recur by the application of causes which would be likely to have a different effect upon anyone else. Ev.

Buchan W. (1793). Domestic Medicine, or, a treatise on the prevention and cure of diseases by regimen and simple medicines. (14th Ed., pp. 249). Boston : Printed by Joseph Bumstead, for James White, and Ebenezer Larkin.

Created by: Sara Ahmed, 06/08/2021

Entered by: Rachel Johnson, 07/19/2021

It is not always easy to make out the enlargement of this organ. The contracted muscles often prevent the palpation, and even percussion helps but little. Ascitic and gaseous distension add further to the difficulty. But with care and gentle ness in palpation one may overcome the resisting muscles. Even when the edge of the liver cannot be made out, the peculiar sense of resistance conveyed to the exploring hand may reveal the enlarged liver. Other methods may be adopted, such as pushing the liver forward with one hand while the other explores the front. When the muscles relax and the hyperalgesia disappears, there is no difficulty in finding out the enlarged liver, except when there is great distension of the abdomen.

Mackenzie, J., Sir. (1908). Diseases of the Heart. (pp. 122). London: Henry Frowde; Hodder & Stoughton.

Created by: Sara Ahmed, 06/16/2021

Entered by: Rachel Johnson, 07/09/2021

1.     Intussusception

The clinical picture of a case of intussusception is a striking one, and when acute the symptoms are so uniform that, one seen, they can scarcely be overlooked a second time. The patient, usually between six and twelve months of age, is taken suddenly ill with severe pain and vomiting; the pain recurring paroxysmally every few minutes, and the vomiting first being of the contents on the stomach, and afterward bilious. There may be one or two loose faecal stools, then only blood or blood and mucus are passed without any admixture of faeces. The general symptoms are those of great prostration, or even collapse—pallor, feeble pulse, apathy, and normal or subnormal temperature. The abdomen is relaxed. The tumour is present in the left iliac fossa, or it is felt per rectum. Later there is tympanites; the vomiting and pain continue; there is a steady increase in the prostration, and toward the end a rapidly rising temperature, which may reach 105° or 106°F.

Holt, L Emmett. The Diseases of Infancy and Childhood: for the Use of Students and Practitioners of Medicine. Appleton and Co, 1897. Pg. 381-382.

Entered by: Erin Choi, 7/1/2020

Edited by: Bernardo Galvan, 9/7/2020

The condition may be latent and only met with accidently, post mortem. The first symptoms will be those of perforation. […] Dyspepsia may be slight and trifling or of a most aggravated in character. In a considerable proportion of all cases nausea and vomiting occur, the latter not for two or more hours after eating. Haemorrhage is present in at least one-third of all cases. […]

A patient may feel faint and turn pale and sweat; the next day the stools may be tarry from the blood that has passed into the small bowel. These concealed haemorrhages are more often small, and the blood is not readily seen in the vomitus or stools. […] These small, latent haemorrhages may cause a slowly progressive anaemia. More commonly, the bleeding is profuse, and the blood may be in such quantities and brought up so quickly that it is fluid, bright red in color, and quite unaltered. […]

The vomiting of a large quantity of unaltered blood is very characteristic of ulcer. […] Pain is perhaps the most constant and distinctive feature of ulcer. It varies greatly in character; it may be only a gnawing or burning sensation, which is particularly felt when the stomach is empty, and is relieved by taking food, but the more characteristic form comes on in paroxysms of the most intense gastralgia, in which the pain is not only felt in the epigastrium, but radiates to the back and to the sides. These attacks are most frequently induced by taking food, and they may recur at a variable period after eating. […] Tenderness on pressure is a common symptom in ulcer, and patients wear the waste-band very low. Of general symptoms, loss of weight results from the prolonged dyspepsia. 

Osler, W. (1909). The Principles and Practice of Medicine (7th ed.). London: Appleton and Co. Pg. 473-475.

Entered by: Erin Choi, 6/10/2020

An attack is characterized by pain in the lower part of the abdomen, sudden in onset, and at first severe in character. There is rise of temperature, rapidity of pulse, and intestinal disturbance, indicated by vomiting and local general distension. After the acute pain has subsided, movements of the body are painful, owing to the tenderness of the inflamed parts. There is usually constipation, and pain preceding defecation and during micturition. In subacute and chronic cases, pain in the back, and inability to undergo physical exertion, are the most common and may be the only symptoms, while trifling causes, such as slight over exertion or exposure to cold readily provoke localized acute attacks. Such recurrent attacks are especially apt to occur when the chronic pelvic peritonitis is kept alive by the presence of pelvic suppurations, and serves as a better guide to the diagnosis of pus in the pelvis than does the temperature. In course of time, patients ebcome ill and emaciated, and entirely incapacitated for work of any kind, adn may even become invalid.

During an acute attack of pelvis peritonitis the patient lies on the back, usually with the knees drawn up. The lower part of the abdomen is extremely tender to the touch, and the walls over the area affected, more or less rigid. On vaginal examination, the parts at this stage will be too sensitive to allow of a satisfactory investigation. In there be any depression in the vaginal vault, it will be central and not lateral, owing to the filling up of Douglas’ pouch. There may be tenderness and a sense of resistance on pressing the fingers upwards into one or both lateral fornices, but it will not be possible to map out any definite swelling until the acute symptoms have subsided, after this has occurred, a careful bimanual examination will probably reveal an inflamed Fallopian tube as a fixed, irregular, tender, sausage-shaped swelling, and gradually increasing in size as it extends outwards from the uterine cornu.

Garrett, R. W. (1913). Text book of medical and surgical gynaecology for the use of students and practitioners (p. 317-318). essay, R. Uglow.

Created by: Annika Klein, 06/29/2021

Entered by: Rachel Johnson, 08/29/2021

This may occur in a healthy organ as a result of prolonged vomiting. […] Boerhaave described the first case in Baron Wasennar, who […] “after the most excruciating pain, the elements which he swallowed passed, together with the air, into the cavity of the thorax, and he expired in twenty-four hours” […] The accident has usually occurred during vomiting after a full meal or when intoxicated. It is, of course, invariably fatal. […] In one instance I found the contents of the stomach in the left pleura. The erosion is in the posterior wall and may be of considerable extent.

Osler, W. (1892). The principles and practice of medicine: Designed for the use of practitioners and student of medicine (pp. 343). New York, NY: D. Appleton and Company.

Created by: Ayushi Chintakayala, 10/29/2021

Entered by: Rachel Johnson, 11/30/2021

Acute Stomatitis – Simple or erythematous stomatitis, the commonest form, results from the action of irritants of various sorts. Frequent at all ages, in children it is usually associated with dentition and with gastro-intestinal disturbance, particularly in the ill-nourish, unhealthy subjects; in adults it may follow the abuse of tobacco, or the use of too hot or too highly seasoned food […]. The affection may be limited to the gums and lips or may extend over the whole surface of the mouth and include the tongue. There are at first superficial redness and dryness of the membrane, followed by increased secretion and swelling of the tongue, which is furred and indented by the teeth. There is rarely any constitutional disturbance, but in children there may be slight fever. The condition causes discomfort, sometimes actual distress and pain, particularly in mastication.

Aphthous Stomatitis – This form, also known as follicular or vesicular stomatitis, is characterized by the presence of small, slightly raised spots, from 2 to 4 mm in diameter, surrounded by reddened areolae. The spots appear first as vesicles, which rupture, leaving small ulcers with grayish bases and bright-red margins. They are seen most frequently on the inner surfaces of the lips, the edges of the tongue, and the cheeks. They are seldom present on the mucous membrane of the pharynx. This form is met often in children under three years, either as an independent affection or in association with a febrile disease or an attack of indigestion. The vesicles come out with great rapidity and the ulcers may be fully formed within twenty-four hours. The child complains of soreness of the mouth and takes food with reluctance. The buccal secretions are increased and the breath is heavy, but not foul. The constitutional symptoms are usually those of the disease with which aphthae are associated. The disease must not be confounded with thrush. […] In severe cases it may extend to the pillars of the fauces and to the pharynx, and produce irritating ulcers which are difficult to heal.

Ulcerative Stomatitis – This form, also known as fetid stomatitis, or putrid sore mouth, occurs particularly in children after the first dentition. […] Insufficient and unwholesome food, improper ventilation, and prolonged damp cold weather seem to be predisposing causes. Lack of cleanliness of the mouth, the presence of various teeth, and the collection of tartar favor the occurrence of the disease. […] The process begins at the margins of the gums, which become swollen and red and bleed readily. Ulcers form, the bases of which are covered with a grayish-white, firmly adherent membrane. In severe cases the teeth may be loosened and necrosis of the alveolar process occur. The ulcers extend along the gum-line of the upper and lower jaws; the tongue, lips, and mucosa of the cheeks are usually swollen, but rarely ulcerated. There is salivation, the breath is foul, and mastication is painful. The submaxillary lymph-glands are enlarged. An exanthem may appear and be mistaken for measles. The constitutional symptoms are often severe, and in debilitated children death sometimes occurs.

Parasitic Stomatitis (Thrush) – this affection, most common in children, is dependent upon a fungus, Oidium albicans. […] Improper diet, uncleanliness of the mouth, fermentation of remnants of food, or the occurrence, from any cause, of catarrhal stomatitis predispose to the growth. […] Robust, well-nourished children are sometimes affected, but it usually occurs in enfeebled, emaciated infants with digestive or intestinal troubles, in whom the disease may persist for months. It is not confined to children, but is met with in adults in the final stages of fever, in chronic tuberculosis, diabetes, and in cachectic states. The disease begins on the tongue and is seen in the form of slightly raised, pearly-white spots, which increase in size and gradually coalesce. The membrane can be readily scaped off, leaving an intact mucosa, or, if the process extends deeply, a bleeding slightly ulcerated surface. The process spreads to the cheeks, lips, and hard palate, and may involve the tonsils and pharynx. In very severe cases the entire buccal mucosa is covered by the grayish-white membrane. It may even extend into the esophagus and to the stomach and cecum. It is occasionally met with on the vocal cords. […] In this condition the mouth is usually dry, in striking contrast to the salivation with aphthae.

Gangrenous Stomatitis – An affection characterized by a rapidly progressing gangrene, starting on the gums or cheeks, and leading to extensive sloughing and destruction. […] disease is seen only in children under very insanitary conditions or during convalescence from the acute fevers, especially measles, more rarely scarlet and typhoid fever. […] The mucous membrane is first affected, usually of the gums or of one cheek. The process begins insidiously, and when first seen there is a sloughing ulcer of the mucous membrane, which spreads rapidly and leads to brawny induration of the skin and adjacent parts. The sloughing extends and in severe cases the cheek is perforated. The disease may spread to the tongue and chin or invade the bones of the jaws and even the eyelids and ears. In mild cases an ulcer forms on the inner surface of the cheek, which heals or may perforate and leave a fistulous opening. The constitutional disturbance is great, the pulse rapid, and the prostration extreme, and death usually takes place within a week or ten days. The temperature may reach 103 or 104 degrees F. Diarrhea is usually present, and aspiration pneumonia is a common complication.

Osler, W. & McCrae T. (1892/1925). The Principles and Practice of Medicine. (10th ed., pp. 453-456). London: Appleton and Co.

Created by: Taha Jilani, 06/09/2021

Entered by: Rachel Johnson, 07/16/2021

1.     Intussusception

This affection, which clinically is characterized by diarrhea, is often regarded wrongly as a form of dysentery. […] The ulceration may be very extensive, so that a large proportion of the mucosa is removed. The lumen of the colon is sometimes greatly increased, and the muscular walls hypertrophied. There are instances in which the bowel is contracted. Frequently the remnants of the mucosa are very dark, even black, and there may be polypoid outgrowths between the ulcers. […] They are characterized by diarrhea of a lienteric rather than of dysenteric character. There is rarely blood or pus in the stools. Constipation may alternate with diarrhea. […] Perforation occasionally occurs. […] Pain occurs in many cases, either of a diffuse, colicky character, or sometimes, in the ulcer of the colon, very limited and well defined.

Osler, W. (1909). The Principles and Practice of Medicine (7th ed.). London: Appleton and Co. Pg. 501-502.

Entered by: Erin Choi, 20/28/2020