Gastric pain is not itself a symptom of dilatation; if present it is due to a con comitant disease, such as carcinoma, or is the result of gastralgia or of pyloro spasm.
Constipation is usual, varying in grade, dependent upon the degree of stagnation in the stomach-contents, and, in myas thenia dilatation also, upon the accom panying atony of the bowel.
The urine is diminished in amount, of relative high specific gravity and color, and there is a diminution in chlorides and markedly in urea.
The general health naturally suffers greatly in pronounced dilatation.
Diagnosis. — This is unattended with special difficulty, even though charac teristic vomiting is not a prominent symptom. A mere inspection will often disclose the outline of the dilated stomach before it is distended with gas. Waves of peristalsis passing from right to left, active in cases of stenotic dilata tion, are frequently seen if the stomach is much increased in size; these reaching the pylorus, should this be the seat of a neoplasm, will sometimes outline it. Palpation readily elicits an extensive splash-sound some hours after food or drink has been taken. This, in modi fied degree, is present in simple myasthe nia without increased gastric capacity, although to a less extent and for a far less period. Ordinary percussion and auscultatory percussion will show the in ferior curvature lower than normal, but will not enable a separation to be easily made from gastroptosis, although theo retically in gastroptosis the inferior boundary of the stomach does not fur ther descend with the inspiratory act. The most useful mode of ascertaining dilatation, and separating it from a stomach of normal capacity or of one dropped, is by rapid inflation with air through the stomach-tube, by means of the writer's exhaust and compres sion bulb attached to the exhaust-bottle; the stomach will ordinarily promptly outline itself on the abdominal wall. The writer has never had unpleasant results occur by this method of infla tion, although he has employd it in hundreds of cases in the past ten years.
It is important, not only for diagnostic means, but for therapeutic measures as well, that the patient be quickly habit uated to the use of the tube. After this habituation is acquired, which ordinarily occurs in a day or two, the gastric capac ity may be fairly well ascertained by means of the stomach being distended with water at a temperature agreeable to the patient and entered under low pressure. As much must be borne as can be without painful distension, and that removed measured. This procedure, repeated on one or two occasions and the mean taken, is of value. A measure of the capacity may be also simply made by distension with air, and connecting the stomach-tube to an immersed gradu ated flask containing water. Gastro diaphany the writer has employed con siderably for the past decade, but he re gards it of less value as a means of diag nosis than air-inflation or water-disten sion. It is of little value in the separa tion of dilatation from a dropped stom ach, unless transillumination is practiced through at least a litre of water.
The writer not infrequently sees cases of gastroptosis in which, without any in dication of increase in size of the stom ach, dilatation has been diagnosed by other practitioners, simply because the inferior curvature of the stomach has been found to be lower than normal.
Vomiting of the nature and character before described is a valuable diagnostic sign of simple or of obstructive dilata tion, as is the invariable presence at some period of the disease of semiliquid or liquid contents in the fasting stomach ten or more hours after food has been taken, as in the morning on rising.
The amount present in the fasting emptied stomach at a definite time after a measured amount of food and drink has been taken gauges the extent of the failure of the motor function, and easily separates an abnormally large, though sufficient, stomach (megalogastria) from an insufficient, dilated one. The method of Ewald and Sievers of ascertaining the motor power of the stomach by means of salol is of little value.