STOMACH, DISEASES OF THE. The organic diseases of the stomach with constant lesions in clude gastritis (q.v.), ulcer, erosions, and can cer. The 'functional' diseases, with variable lesions. include hyperehlorhydria, ga st rustic corrinea. aehylia gastrica, and isoehymia.
Ulcer of the stomach is usually characterized by a deep circumscribed loss of substance of the mucous membrane lining the stomach, refusing to heal, and occasioning pain, vomiting, and hemorrhage. The cause cannot always be as signed, although the affection is of so frequent occurrence as to be found, either active or cica trized. in about 5 per cent, of all persons who go to autopsy for all diseases (Brinton). It is twice as frequent in females as hi males, and occurs most generally during middle life. Its mortality is most frequent between the ages of forty and sixty. While anemia seems to play some part in the causation of ulcer, it is deemed more probable that hyperacidity of the gastric juice is more often accountable. generally occupy the posterior surface, the lesser curvature, and the pyloric sac. When they heal they leave behind depressed scars with contractile tendency, pro ducing, when at the pylorus. a stricture. When they do not heal, corrosion of neighboring blood vessels may ensue, with hemorrhages. possibly fatal; or there may arise adhesions to neighbor ing organs, or perforations. The symptoms named increase in severity till death occurs from perforation, hemorrhage, or starvation; or, they gradually disappear and the patient recovers. The prognosis is only fair. About half of the cases recover, about 13 per cent. die of perfora tions and peritonitis, about 20 per cent. die of tuberculosis, about 5 per cent. die of starvation, and about 5 per cent. (lie of hemorrhage. The treatment of ulcer includes rest, diet by mouth and by rectal enemata, correction of acidity by proper alkalies. the administration of nitrate of silver or bismuth, and the proper management of the accidents: hemorrhage, peritonitis, and collapse.
Erosions of the stomach consist really of small, superficial ulcers of the mucous lining. They occur commonly in chronic gastritis: often their cause is unassitumble. The symptoms in clude pain, a feeling of weakness, and emaciation. The emaciation is progressive to a certain point, during the earlier part of the attack, but after reaching a certain level the patient grows no thinner, and does not present a eaehexia.
The patient may suffer from erosions for many years. The treatment consists of the use of nitrate of silver, intra-gastric galvanization, diet, general hygiene and out-of-door exercise, condnrango, nux vomiea, and iron.
Cancer of the stomach is more frequent than cancer of any other organ. It is apparently on the increase. Gastric cancer occurs more fre quently at the age of fifty; it is rare before thirty. It is probably equally divided between the sexes. The tendency to cancer is possibly hereditary. It follows trauma and ulcers, and it is probably also due to primary infection with the suspected bacillus which bacteriologists hope to discover as the cause of cancer. The new growth may be an epithelioma, a medullary carcinoma, a scirrhus, or a colloid carcinoma, See TUMOR.
The general symptoms of cancer of the stomach are pain, loss of appetite, vomiting, hemorrhage, tumor, fever, constipation. and a decided eachexia. Examination of the blood reveals a leueoeytosis in some cases during fasting, and an absence of the normal leucocytosis of diges tion. Little can be argued from the urine, al though in some cases the chlorides are diminished and indican is increased, and rarely pep tonuria is present. Examination of the stomach contents after a test meal reveals decrease of the free hydrochloric acid as well as of the total acidity, and the presence of lactic acid. The prognosis is hopeless for cure. If the disease be of slow progress, the patient may gain relief enough from surgical interference to live along several years. When the neoplasm invades the pylorus, resection of this part of the stomach may be made: or excision, if in other parts of the organ. Among palliative operations are gas trotomy and gastro-enterostomy. The former is suitable in cases of cancer of the (esophagus or of the cardiac orifice, the latter in cases of pyloric stenosis. The medical treatment consists of diet, the iodides, conduramro, methyl blue, chloral, and such analgesies as may be expedient.
Of the 'functional' diseases. hyperchlorhydria is a condition in which the gastric juice possesses more acidity and ferments than it should. A test of the stomach contents decides the diagnosis, and the condition is met by hygiene, diet, al kalies, bromides, and in some cases opiates and electricity.
Gastrosurcorrhrra is a periodical and con tinuous production of the normal gastric juice, causing vomiting and intense pain, restlessness, nausea, and a feeling of pressure in the epigas trium. Analysis of the contents of the stomach is the best diagnostic test. The treatment of this rare affection is largely by the use of atro pine, nitrate of silver, galvanization, and lavage.
Achylia gastric° is a condition in which there is a constant absence of gastric juice. accom panied by atrophy of the stomach, and following severe catarrhal disease of that organ. The gas tric contents decide the diagnosis. Lavage, fara dization of the stomach, and attention to diet constitute the treatment.
Isochymia is a distressing condition in which food is always found in the stomach. even when fasting. The stomach is dilated and the me chanical insufficiency of the organ is so great as to fail of emptying the chyme into the intestines. Paresis of the gastric muscular coat or contrac tion of the pylorus is the cause of this condition. Indifferent appetite. thirst, dryness of the throat, oppression. paM, and eructation of gas, together with vomiting of chyme, are among the notable symptoms. Constipation is present and emacia tion becomes pronounced. Ulcer may be the cause of the pyloric stenosis. The course of the condition varies with the etiology. Lavage, diet, nitrate of silver, rectal alimentation, massage, and the administration of alkalies may all be of advantage, as also the galvanic current. See CARDIALGIA: INDIGESTION: SARCINA. Consult Einhorn's Diseases of the Stomach (New York, 1903).