INTESTINES.
Duodenum, Inflammation of. Synonyms. — Duodenitis; duodenal catarrh.
Symptoms.—While the possibility of isolated inflammation of the duodenum cannot be denied, it is probable that the condition is usually associated with in flammation of the stomach, on the one hand, and of the remainder of the small intestine, on the other hand. Among the symptoms are pain, distress or discom fort in the right upper quadrant of the abdomen, impaired appetite, bad taste, coated tongue, discomfort from two to four hours after taking food, with eruc tations and flatulent distension. There is likely to be nausea and at times there is vomiting, with bilious fluid in the ejecta. As a rule, the bowels are con stipated, though there may be diarrhoea. Often, also, there is jaundice, from ex tension of the catarrhal process to the choledoch-duct and resulting obstruc tion to the flow of bile, with clay-colored stools, etc. There may be, further, weak ening and despondency, and possibly slight elevation of temperature. Acute or subacute attacks may last two or three weeks, chronic attacks for as many months.
The condition is not a serious one, and recovery is usually prompt upon institu tion of the proper therapeutic measures.
Etiology.—The causative influences include, in a general way, irritants gen erated within the body, as from fermen tation or autointoxication; or introduced from without, as milk, food, or by acci dent, or possibly by design.
Treatment.—The treatment consists primarily in a regulation of the diet, with rigid restriction as to both quantity and quality of food, and perhaps temporary abstinence, and recumbency in bed, when the symptoms are acute. From 6 to S ounces of milk, peptonized or pancre atizcd if not well digested without prep aration, may be given every three hours. TJnirritating broths and soups, strained gruels, farinaceous foods, boiled rice and soft-boiled eggs, albumin-water, and barley-water may also be permitted. Solid food, and especially the coarser vegetables and fruits, which leave con siderable residue, are particularly to be avoided. Small doses of calomel, grain, may be given at hourly intervals for a short time, followed by a such as the compound effervescing (Seid litz) powder, sodium phosphate, sodio potassium tartrate; or the saline may have been given alone at the outset.
Counter-irritation, as with a mustard plaster, in the right hypochondrium, may relieve pain and allay nausea and vomit ing. If diarrhoea be present the salts of bismuth will be indicated, of the sub carbonate and subnitrate, from 10 to 20 grains; or the salicylate or subgallate from 5 to 10 grains.
Duodenum, Ulceration of.
Symptoms.—The clinical manifesta tions of ulcer of the duodenum are vari able and but little characteristic. The condition may, in fact, give rise to no symptoms and be discovered only upon post-mortem examination or through the occurrence of hminorrhage, perforation, suppuration, peritonitis, stenosis of the bowel, dilatation of the stomach, or jaun dice.
In duodenal ulcer there are usually three main symptoms: the intestinal haemorrhage, pain, and digestive dis order. The haemorrhage occurs in three varieties: A fulminating or fatal form; an acute form, in which the haemorrhage keeps on recurring and exhausts the patient; and a chronic form, in which the haemorrhage is more or less continu ous, and in which it may not be noticed. Pain is irregular both in situation and intensity; it usually appears two or three hours after a meal, and is situated within a space bounded by a line from the umbilicus to the margin of the false ribs and along the internal border of the reetus muscle and below the anterior border of the liver. Disorders of di gestion are also variable. Dyspeptic troubles are less marked than in gas tric ulcer. Ladevaze (Jour. de Mad. et de Chin Prat., Mar. 25, 1901).
Such symptoms as are present re semble closely those of ulcer of the stomach. The most pronounced and the most distinctive of these is pain in the right hypochondrium, which is usually less acute than that of gastric ulceration, and is likely to appear later after the taking of food, viz.: two or three hours or more.