Gastritis

“ The stools contain bile in English cholera; in irritant poisoning, sometimes blood. Death is rare within three days.
Gastritis.—Acute idiopathic gastritis is so rare in this country as scarcely to need description. Most of the cases recorded of acute gastritis have been found to be due to irritants. We must, therefore, consider the period and order of the occurrence of the symptoms in relation to the last meal. Costiveness of the bowels would point to the presence of gastritis or enteritis, violent purging and vomiting to irritant poisoning. ”

“ Usually other symptoms are present which render possible the diagnosis of the ulcer. There is usually some apparent external or internal cause of chronic catarrhal gastritis, whereas the etiology of ulcer is obscure; in chronic gastritis gastralgic paroxysms and the peculiar fixed epigastric pain of gastric ulcer are usually absent; in chronic gastritis profuse hæmatemesis is a rare occurrence; and in gastritis the relief obtained by rest and proper regulation of the diet, although manifest, is usually less immediate and striking than in most cases of gastric ulcer. ”

“ GASTRITIS—THE SYMPTOMS
The symptoms are usually a dull pain in the region of the stomach and upper intestines, a swollen full feeling, now and then biting pains, followed by a dark [450] vomit, especially when the attack comes late at night.
Gastritis is often confused with gastric cancer, and in diagnosis it is difficult to speak with authority as to whether the case is ordinary gastritis, as above described, gastric ulcer, or gastric cancer. ”

“ In many cases as much as a pint of slimy mucus collects in the stomach during the night. Where the stomach cleansing is impossible, in above manner, the stomach tube should be used.
Chronic gastritis, in any of its phases, is frequently accompanied by constipation, and the diet should be so selected as to be as laxative as possible, without irritating the lining of the stomach. The liquid diet assists the intestines, to a certain extent, particularly if the stomach be cleansed by the water in the morning, as indicated under Mucous Gastritis below. ”

“ Writers and teachers describe and dogmatize, while practical men hesitate at the bedside. There is little doubt but in the background of these febrile manifestations in children there is often an acute erythematous gastritis, which is more successfully treated by a rigid milk diet, small doses of calomel and bismuth, mucilaginous drinks, cooling saline laxatives, and sometimes leeches applied to the epigastrium, than by the heroic doses of quinia so frequently resorted to. ”

“ The Symptoms of chronic gastritis are various and sometimes vague. Among those which are prominent we may mention an irregular appetite. At times it is voracious and the patient will consume every available article of diet, while at others he will experience nausea and disgust at the sight of food. Even when very hungry, one mouthful of food will sometimes produce satiety and cause vomiting. The appearance of the tongue is variable, sometimes natural, at others thickly coated. The desire for drink is capricious, varying from intense thirst to indifference. ”

“ As the disease very often implicates the stomach (gastro-enteritis) , the usual lesions of gastritis will be seen. Most commonly the lesions are best marked in the small intestine, and again in other cases in the colon, but usually there is more or less change in all parts of the intestinal canal. The small intestine is almost devoid of aliments and the mucosa deeply congested in patches or striæ, with at points thickening, softening so that it crushes under the finger, hemorrhagic discoloration, and even ulceration, and necrotic changes. ”

“ The diagnosis is rather difficult, for the condition is very apt to be confused with primary dyspepsia, or with inflammation of the gastric compartments. It might also be mistaken for acute enteritis of the first part of the small intestine; but as gastritis is very often complicated with duodenitis, such a mistake is without serious consequences.
Prognosis. The prognosis is grave, not because death is a frequent termination, but because the disease very often leads to chronic incurable lesions. ”

“ In whatever way the fact as to the existence of idiopathic acute gastritis may eventually be proved to stand, an important criterion of this disease, as of cholera, will be that the sense of burning in the throat, if present at all, does not precede the vomiting. ”

“ Sooner or later, then, gastritis and stomach indigestion develop, with consequent intestinal indigestion. If lie takes strong alcohol, like whisky, oil an empty stomach, he may sooner or later cause serious disease of the mucous membrane of the stomach, first chronic gastritis, and later atrophy of the glands of the stomach. ”

“ Acute Enteritis, as Acute Gastritis, is usually caused by a strong irritant,—either by some food which disagrees, or by a mass of undigested food. A fast of two or three days is the initial dietetic treatment. A free drinking of water not only soothes the irritated intestines but it cleanses the intestinal tract and assists the kidneys in eliminating elements of fermentation ”

“ Gastric ulcer is not a febrile disease. Temporary elevation of temperature may follow profuse gastrorrhagia and may attend various complications, of which the most important are gastritis and peritonitis. ”

“ That the doctrine of gastritis has made a great impression at Paris, that almost every one believes in it, to a greater or less extent, appears undeniable; but there, as well as here, most of the more rational, and moderate minded men are evidently of the only school a physician ought to belong to, the eclectic. ”

“ The symptoms of gastritis come on very suddenly with pain and tenderness in the epigastric region, and with a high temperature which after the onset decreases. There is thirst, loss of appetite, and vomiting. The vomited matter is usually sour and may be streaked with blood. If there is an excessive amount of blood it indicates ulcers. This is rather unusual, however, in small children. Vomiting is excited by anything taken into the stomach. The thirst is intense, although the water will be vomited as soon as taken. The tongue is heavily coated and the breath is foul. ”

“ Gastric ulcer may develop without an apparent cause. As a rule, however, it manifests itself in individuals between the years of fifteen and forty, particularly after prolonged digestional disturbances, especially those accompanied by a hypersecretion of acid. As the disease progresses, anemia is more or loss severe, adding difficulty to the feeding problem. Many of the symptoms are like those of chronic gastritis, such as pain. ”

“ The mucous membrane of the stomach is placed in intimate communication with all the vital organs, by means of the nerves of the solar-plexus, hence the sympathy between the stomach and skin, and the morbid condition of the stomach occasioned by disease of other organs.
The Early Symptoms of acute gastritis are a burning sensation in the stomach, accompanied by nausea and frequent vomiting. The respiratory movements are rapid and shallow, the pulse is hard and short, and as the disease progresses, becomes small, frequent, and thready. ”

“ Lactic acid is often present in traces, rarely in notable amount. Secretion of pepsin and rennin is always diminished in marked cases. Mucus is frequently present, and is very significant of the disease. Motility and absorption are generally deficient. Small fragments of mucous membrane may be found, and when examined by a pathologist, may occasionally establish the diagnosis.
4. Achylia Gastrica (Atrophic Gastritis) .—This condition may be a terminal stage of chronic gastritis. It is sometimes associated with the blood-picture of pernicious anemia. ”

“ When a larger quantity of food is taken into the stomach than [Pg 290] it can properly digest within a reasonable time, two conditions immediately follow. The stomach itself is dilated and the food is not thoroughly digested. If the habit is persisted in, indigestion, and later chronic gastritis ensues. The direct symptoms of these conditions are given in detail in another part of this book. Very few individuals, however, appreciate the indirect consequences of overeating and of indiscriminate eating on the general health. ”

“ These facts have important bearings upon the question of alimentation in fevers and the conditions in which there is chronic congestion on the venous side of the circulation. Long-continued passive hyperæmia of the stomach from any cause not only impairs its functional activity, but strongly predisposes to inflammatory complication.
Acute erythematous gastritis is most frequently met with in children. It is a very common form of disease in early life, and the local nature of the malady is frequently overlooked. Few questions in practical medicine are more embarrassing to the physician. ”

“ Indigestion may be considered as a mild form of gastritis, which if not corrected, will be followed by true gastritis, the stomach then being in such condition that nothing is retained, even water being returned immediately after drinking. ”

“ In cases of gastritis, appendicitis, peritonitis, dysentery or typhoid fever, abstinence from food is absolutely imperative. Not even milk should be taken until fever and inflammation have entirely subsided, and then a few days should be allowed for the healing and restoring of the injured tissues. Many of the serious chronic aftereffects of these diseases are due to too early feeding, which does not allow the healing forces of Nature time to rebuild sloughed membranes and injured organs. ”

“ It may be going too far to affirm, as did Broussais, that gastritis sustains a causative relation to all forms of fever, but that gastro-duodenitis is an important secondary condition in all forms of malarious fever, complicating and perpetuating the febrile state, there can be no doubt; and it is equally clear that it constitutes one of the most dangerous complications. Excessive alimentation, with the injudicious use of tonics and stimulants, so often resorted to in the treatment of these fevers in their early stages, only serves to intensify the local inflammation. ”

“ There is no elevation of temperature as in gastritis, and no complete intermissions of pain as in spasmodic colic, but pain is continuous, though worse at one time than another. There is an utter indisposition to eat or drink and if liquids are given by force there is manifest aggravation of the sufferings. As a rule there is no rumbling of the bowels, and though the animal may strain violently, little or nothing is passed, except at the first a few moulded balls of dung. The bowels like the stomach are paralyzed. ”

“ Obstruction has also been described as accompanied by loss of appetite, constipation, the passage of black, coated, fœtid and sometimes blood-streaked fæces, symptoms of chronic tympanites with fœtid eructations and sometimes vomiting. These sometimes accompany hydrochloric acid dyspepsia, a form of chronic gastritis, and, from our standpoint, the stagnation of food in the omasum is only secondary. We therefore interpret the facts in quite a different manner, and believe that only by a rational and physiological interpretation of the symptoms observed can one diagnose the condition. ”

“ Localized hyperplasias occur in chronic gastritis (etat mamelonné) and cannot be smoothed out by stretching. Erosions (common in chronic passive congestion) and ulcers (round or peptic, carcinomatous, due to corrosives, very rarely to tuberculosis and syphilis) are to be carefully examined and described. The different layers of the stomach wall are to be examined with respect to their absolute and relative thickness. Thickening of the submucosa may be caused by œdema, purulent infiltration, increase of connective-tissue, carcinomatous or sarcomatous infiltration. ”

“ Beyond this, little is wanted except careful feeding as regards quantity and quality. Nux vomica 1⁄2 gr. twice a day will serve to restore tone. Further treatment will come naturally under catarrhal gastritis.
ACUTE GASTRIC INDIGESTION IN SWINE. Causes: fermented or putrid swill, spoilt vegetables, frozen aliments, caustic alkalies (powdered soaps) from kitchen, indigestible materials, poisons. Symptoms: dullness, grunting, restlessness, seeking seclusion, colics, vomiting, rumbling, tense, tucked up abdomen, diarrhœa. Treatment: emetic, bland acids, laxative, dieting, bitters, iron. ”

“ In the ulcerative type the condition is more prolonged and there is a greater tendency to hemorrhage which results in a greater amount of blood in the material vomited. Corrosive gastritis is the result of a corrosive poison being taken into the stomach, such as carbolic acid. ”

“ M. Gelle has observed that the most constant symptoms of gastritis are: loss of appetite, arrest of rumination, and abnormal condition of the tongue. If the inflammation be intense, the tongue appears to be contracted, straighter and more rounded than usual, red at the point and along the edges, and the papillæ are elevated and injected. In some intense cases, when several of the viscera are involved, the tongue is yellow or green.
Treatment.—A.A., is the first and principal remedy, and may be given, at first, a dose every half hour or hour. ”