Varieties.—It is proper and more con venient to include under dilatation (1) gastric ale-ny or myasthenia, occurring in a stomach the capacity of which is not be yond what is considered the normal, but causing symptoms of moderate dilatation. Dilatation in which the gastric capac ity is increased, little or much, not due to pyloric obstruction—atonic dilatation.
(3) Mechanical dilatalion,—that due to obstruction at or beyond the site of the pyloric sphincter.
Symptoms.—With mild atonic dilata tion, constituting merely gastric atony or myasthenia, the symptoms, briefly, are those ordinarily described as so-called atonic dyspepsia: habitually furred, flabby tongue; fcetid breath; more or less anorexia; considerable thirst (in advanced cases); sensations of decided weight and oppression in the stomach after meals; constipation; mental hebe tude, and disturbed sleep. Headache and attacks of vertigo are not uncommon. With these should there be, as is less common, hyperchlorhydria, there is a sensation of burning at the pit of the stomach superadded, occurring two or more hours after a meal and continuing until food is again taken. Gaseous eruc tations may or may not occur in cases of moderate severity.
Examination with the stomach-tube shows considerable delay in the passage of food into the bowel, although no food remnants may be found in the fasting stomach in the morning, about 12 or 14 hours after the evening meal. In many cases of moderate dilatation usually there are only such symptoms as these, and certain of them may be absent ex cepting a sensation of weight and distress after meals.
The employment of ordinary percus sion, auscultatory percussion, distension of the stomach with air and with water, and inspection of the transilluminated gastric area will separately or combinedly generally show, in these cases of atonic the inferior curvature of the stomach to be lower than is normal, and the gastric capacity to be more or less above the normal.
The above symptoms may alone be present, with vomiting quite unusual, and yet a considerable grade of atonic dilata tion be present.
In such cases there is a so well pre served or newly gained (through active treatment) hypertrophy of the gastric muscle and well-developed abdominal muscles, with excellent positive abdom inal pressure, as to tend to prevent a high grade of insufficiency; so that, although stagnation of food occurs, 8 to 10 hours being required for the stomach to thor oughly empty itself after a large meal, which normally should disappear in 6 to 7, it is not sufficient for vomiting to be a symptom, unless the stomach has been habitually overtaxed for some time and the stomach-tube has not been employed.
Vomiting is always a feature in dila tation from obstruction, as it is finally in advanced atonic dilatation, in which decided stagnation of food is usual; so that that eaten the day before is retained at the end of 12 to 14 hours. The strik
ing feature about the vomiting in gastric dilatation is that it is unassociated with much nausea, tends to occur at variable Intervals, and is copious in quantity. The uneasiness, weight, or distress felt after eating, having been dissipated for a short time by an evacuation of the stom ach-contents, recurs and augments even to the point of actual pain as each suc ceeding meal is taken, until, at the end of 36 or 48 hours,—or longer or shorter, as the case may be,—the contents of the stomach are more or less completely and suddenly evacuated. If not completely evacuated, vomiting will recur for a time or two within a short period, as through the night. The amount vomited, should the dilatation be great, is apt to be copious.
If the dilatation is decided, the onward passage of food into the bowel being much impeded, the vomited matter con sists of partially-digested material,—all that has been eaten for perhaps several days. If vomiting occurs at intervals of only four to five days, especially in stenotic dilatation, indications of food eaten before or immediately succeeding the preceding attack may be present, the stomach not having been completely evacuated at that time. The vomited matter may be in a state of advanced decomposition, containing coffee-ground material (altered blood); abundance of lactic and other organic acids, as in car cinoma; or, as in stenotic dilatation from cicatricial ulcer, may consist of quite well-solved ingesta, but little ill smelling, and contain an abundance of hydro chloric acid and the ferments. The varia tion may be all the way from the first to the second described, depending upon the condition underlying the dilatation. Commonly, the vomited matter, allowed to sediment in an appropriate vessel, will promptly separate into three layers: an upper, a brownish, slimy scum, consisting of mucus, fungi, and elements of food of light specific gravity or yeasty material, etc.; a central, more or less colored fluid; and the lowest stratum, consisting of heavier solids in which altered food and blood (as in carcinoma) are more or less recognizable. Usually micro-organisms —such as schizomycetes, yeast-fungi, and sarcinw—exist in the sediment in large number. With the absence of free HCI and the presence of lactic acid, the Oppler-Boas bacillus is apt to abound. Yeast-cells are found in the absence or in the presence of HCI. yen Iriculi, the presence of which in a dilated stomach was formerly regarded as indic ative of carcinoma, are now looked upon as telling in the other direction. Sarcinm seem to thrive best in stomachs in which moderate traces of free II Cl exist.