By Hugh Devine (Auth.)
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Additional resources for The Surgery of the Alimentary Tract
Linear pyloric ulcer which caused a rather rapidly occurring pyloric stenosis with a painful emptying dyspepsia. C, Ulcer. These symptoms take the form of cramping colicky pain many hours after meals, when, in the attempt to empty its contents, powerful 50 THE DIAGNOSIS OF SURGICAL DYSPEPSIA peristaltic movements can be seen over the hypertrophied stomach. But all cases of organic pyloric obstruction do not produce colicky pain during the emptying p h a s e ; in one case an organic pyloric obstruction will produce a painful dyspepsia, and in another a painless dyspepsia.
The circulation of the gastric wall and therefore its vitality can also be affected by the congestion caused by heart failure ; and sometimes a dyspepsia may become obvious before signs of heart failure appear. Thus systemic diseases, or local disease in other parts of the body, can cause a gross dysfunction of the stomach by interfering with the vitality of its gastric wall, and thus give rise to dyspeptic syndromes which are often indistinguishable from those due to organic disease of the stomach.
An example of this, taken from my own practice, is as follows. 58 THE DIAGNOSIS OF SURGICAL DYSPEPSIA I operated on a female patient who had a very poor type of nervous system. The operation was an exploratory one for an obscure abdominal condition. At the operation, a very gentle exploration revealed no sign of organic disease. I was most careful to disturb intestines as little as possible, and was able to do this by holding up the abdominal wall with my abdominal operating frame. Notwithstanding this care, the patient developed a paralytic ileus, which was so intractable that in desperation I reoperated, feeling that there must be some organic obstruction.
The Surgery of the Alimentary Tract by Hugh Devine (Auth.)