STOMACH, DISEASES OF.
Acute Gastritis.
Synonym.—Acute gastric catarrh.
Symptoms. — The chief symptoms of acute gastric catarrh are loss of appetite, a heavily-coated tongue, foetid breath, perhaps increased salivation, nausea, and usually vomiting, which last, if persist ent, is associated with considerable thirst. There may be constipation or diarrhoea; the faeces are of an offensive odor. In mild cases fever is absent; in the more severe forms, present. Headache and lassitude are usual, and herpes may ap pear on the lips in the course of the malady. The abdomen is usually dis tended with gas and the epigastrium somewhat tender to pressure. Acute pain is often present in the more severe forms. The duration of an attack is variable, but is rarely over a week. The urine is febrile, high colored, scanty, and deposits large amounts of orates. The vomit consists at first of partly digested food, and subsequently of bile stained mucus and of bile. An exami nation of the vomit usually shows ab sence of free HCl, with diminution in the amount of pepsin and of the lab ferment. There are apt to be present, as the result of stagnation of food in the stomach and diminution or absence of secretion of HC1. various organic acids, such as lactic, butyric, and espe cially acetic acid if the attack has been brought on by alcoholic excess.
Diagnosis. — When the attack is of short duration and when fever is absent, there can be no difficulty in diagnosis. The separation of this affection in its more severe forms from typhoid fever, especially abortive typhoid, usually pre sents the only difficulty. But the ab sence of preceding epistaxis, of prodromal symptoms of typhoid, and the charac teristic rise of temperature; of the en larged spleen; and, later, of the typical spots; the characteristic diarrhoea and appearance of the stools, and the absence of the Widal reaction (a point of not ex treme value, since it must be determined early in the disease) severally or jointly enable a separation to be made. Herpes
labialis is against typhoid fever. Certain cases of acute gastritis in which the vari ous dietetic errors before mentioned may seem to be excluded have onset in a man ner to suggest an acute infection. The writer has seen several instances. With severe headache and delirium at the onset—rare, though, in any stage of the disease—meningitis is easily thought of, and is at first difficult to exclude.
Etiology.—As remarked elsewhere by the writer, this affection is dependent upon somewhat varied etiological factors. Among these are: a too-free indulgence in the pleasures of the table; the inges tion of food or drink of irritating quality or of excessive quantity. The former includes very hot, cold, or indigestible food; spices, undiluted spirituous bev erages, or the too-free indulgence in those partly diluted, and certain drugs; all of these originate acute gastritis through their local irritant action on the mucous membrane. Excessive indulgence in alcohol is a very common cause of acute gastritis.
The gastritis may be of an infectious origin due to the action of micro-organ isms or their toxins. In some of the re cent epidemics of grippe the writer has encountered cases in which the stomach alone bore the brunt.
Pathology.—In simple acute gastritis there occurs redness and swelling of the mucosa and of the submucosa, and in the more severe forms small haemorrhages or even superficial erosions may be noted. There is much diminution in the secre tion of hydrochloric acid and in the pep sin and labfermeuts, and mucus in con siderable quantity appears as the result of mucoid degeneration of the columnar epithelial cells. Histologically there is noted a granular swelling of the glandu lar epithelium of the peptic- and acid secreting cells and an infiltration of leu cocytes into the surrounding intertubu lar tissue. The functions of the stomach —the secretory, the motor, and the ab sorptive—are all affected.