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Ulcer Of The Stomach.

Part 8
4. Appetite Although patients with gastric ulcer partake of very small quantities of food, the appetite per se is by no means decreased. It is merely on account of the pains that the patients are afraid to eat, and avoid substantial meals. Some complain of being constantly hungry, but unable to satisfy their appetite, on account of the distress following the ingestion of food. This fear of taking food is sometimes exaggerated, and the patients get into a habit of partaking of so little that the danger resulting from this source is certainly far greater than that from the original disease. 5. Constipation As a rule, most cases of gastric uicer are accompanied by constipation. Leube' explains this fact in the following manner: He assumes that the peristalsis of the stomach is impaired in gastrie ulcer. As there is a reflex connection between the peristalsis of the stomach and that of the small intestine, the latter will also be retarded, and in this way the constipation would be explained. Leube's theory of the presence of retarded muscular action in gastric ulcer seems to be supported by several results which I have obtained with the gastrograph in a few cases of gastric ulcer, in which the motion of the stomach appeared to be materially lessened. My observations in this respect, however, are yet too few to fully sustain this theory. 1 Leubr: l. c. 6. Amenorrhoea Amenorrhoea is quite frequently met with in women suffering from gastric ulcer. It appears, however, that this symptom is merely the consequence of the anaemic condition of these patients. Sometimes gastric hemorrhages vicariously appear instead of the monthly periods. 7. Cachexia

Although we sometimes meet with robust, healthy persons suffering from gastric ulcer, this is not the rule, and most frequently patients suffering from this trouble present an appearance which would suggest to an observant physician even at a distance the nature of the ailment. In connection with the extreme cachexia, the sharp lines which severe and frequent pains, together with partial starvation, have graven on the patient's face afford almost a characteristic sign of gastric ulcer. The cachexia in gastric ulcer, although at first not well marked, may after a time increase to such an extent that the patient is reduced to a mere skeleton, and emaciation of this kind is very seldom met with in gastric cancer. Condition Of The Gastric Contents Riegel, and later Jaworski and Glusinsky, first signalized the fart that hyperacidity is a concomitant factor of gastric ulcer. Although this is not always the case, as we have mentioned above, the fact remains true that most of the cases of gastric ulcer are characterized by a hyperacid juice. The acidity may reach as high a figure as 130 or even 160 (about three or four times the acidity of normal gastric juice). This high figure, 160, I had the opportunity to observe lately in a case of gastric ulcer near the pylorus combined with stenosis of the latter. The patient had been operated upon, and the diagnosis verified in vivo in this manner. In cases in which there is vomiting the ejected matter should be examined. If vomiting is absent the gastric contents may be obtained for examination with the stomach bucket. The examination of the gastric contents by means of any instrument should be performed with the greatest caution, and only in those instances where the diagnosis of gastric ulcer is doubtful. Whenever there are sufficient symptoms to make the diagnosis pretty certain, the employment of an instrument should be omitted. Most writers are opposed to the application of the tube in gastric ulcer.

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