GASTRIC DILATATION, OR GASTRECTASIS.
Acute Dilatation of the Stomach is a very rare and generally fatal malady, the cause of which still remains a mystery, and its treatment must be entirely symptomatic. If vomiting has not occurred the stomach becomes dangerously dilated, or this may even follow shortly after a copious emesis, and in either case the state of paralytic distension must he immediately relieved by passage of the rubber stomach-tube and lavage. Drugs by the mouth are useless; a full hypodermic dose of Morphia should he given with the view of soothing the nervous excitement and possibly of control ling the enormous secretory action of the gastric mucosa. The colon should he flushed out by a large quantity of normal saline solution, and as much of this should be left in the bowel as the patient is able to retain. Saline solution should be injected at several points into the loose sub cutaneous tissue in order to overcome the dehydration of the blood caused 20 by the profuse secretion from the stomach. It may be advisable to transfuse with the saline or to administer defibrinated blood by the veins. Collapse may he relieved by warmth to the surface of the body and sina pisms to the calves of the legs and pit of the stomach. Whiskey or brandy should be administered per rectum. The writer was fortunate in meeting a typical example of this formidable malady which yielded to the above treatment. After the attack has passed off, should the patient survive, the stomach should have complete rest for 48 hours, the rectum being utilised for feeding purposes; the first food permitted should be strong clear soup or peptonised milk in small quantities.
The acute paralytic distension and dilatation of the stomach which sometimes supervenes after abdominal operations appears to be of similar nature. It should be treated by the immediate use of the tube, and a thorough wash out of the organ; or a gastrostomy may be performed, and the paralysed organ thoroughly irrigated through the fistulous opening. Normal Saline or Glucose solution should he injected hypodermically.
The form of dilatation due to loss of tone in the gastric muscular walls is usually secondary to other stomach ailments, to gluttony or the imbibition of large amounts of fluids, or to a true gastric neurosis, and must he met by a scrupulously regulated diet. This should 'consist of small quantities of semi-solid, easily digested or peptonised foods adminis tered every two hours or more frequently, the patient being confined to bed at the commencement of the treatment.
Lavage should he carried out every second night to wash away the remains of all undigested food so as to start afresh with a clean and empty organ. It is imperative that not more than 5 or at most so oz. of fluid should he poured into the stomach at one time before siphoning off the contents. The night lavage gives the organ a long rest before the commencement of feeding on the following morning, and the plan so efficacious in gastric ulcer may be carried out during the first half of the day. This consists in feeding the patient with peptonised milk adminis tered with a spoon, only a single spoonful ( oz.) being allowed at a time so as to cause the liquid to pass directly into the duodenum, and so permit the weakened organ to have the maximum of rest. The dietetic treatment is to be assisted by abdominal massage, hydropathic measures and electrical or vibratory stimulation.
Symptoms caused by delayed digestion may be relieved by Pepsin and IIC1, by Papain, Trypsin or Taka-Diastase and Alkalies; fermentative changes may be retarded by the administration of a 3 to 5 min. Creosote Capsule as in myasthenia gastrica (see Gastric Neurosis). The under lying neurosis may require a course of Weir Mitchell treatment, but this should not be attempted till local treatment has soothed irritability and restored some degree of tone in the weakened walls of the stomach.
Gradually the semi-solid or restricted liquid diet is to be replaced by one of undercooked minced red meat as in the Salisbury dietary, and farin aceous foods may be given at intervals with Papain or Taka-Diastase when the solids are suspended. Liquids must be administered in small quantities at meal-times, and only in moderate amount between meals.
The atonic dilatation which follows dyspeptic conditions, where the patient has acquired the habit of belching. wind-sucking, or swallowing air with his saliva, yields to the above-mentioned treatment only after the pernicious habit has been stopped. Undue importance should not be attached to nervous symptoms in atonic dilatation, as these very often are the result of the abnormal state of the digestive function instead of being the cause of it. I fence in a. case which has started in gluttony or other dietetic error, the nervous phenomena which arise from the enfeebled digestion, if erroneously regarded as proof of the presence of a general neurotic condition, will only he aggravated by a resort to the Weir Mitchell or other antihvsterical treatment.