Synonyms.—Gastric Catarrh; Acute Dyspepsia; Simple Gastritis.
Definition.—An acute inflammation of the mucous surfaces of the stomach.
Etiology.—The most common causes of acute gastritis are errors in diet or method of eating. We live in age where competition is strong, and travel at a pace incompatible with health. The business man hurries through his meal, only partially masticating his food, and washing it down with large quantities of fluid. Children catch the infection, and hurry through meals in order to reach school or resume play, and this continued rush of American life is productive in a high degree of stomach disorders.
The character of food also must be considered; for tainted food, or that in which the fermentative processes are just beginning, act as irritants. Overloading of the stomach may be an exciting cause, as well as very hot, very cold, or highly-seasoned food. Alcoholic drinks are also responsible for many cases. Where there is a delicate stomach, a cold, with sudden arrest of secretions, may prove the exciting cause.
An attack of cholera-morbus may be attended with vomiting and retching of so violent a character as to be followed by gastritis. Certain diseases are said to predispose to this lesion; such as rheumatism, gout, syphilis, and tuberculosis. Chemical substances taken by design or accidentally must always be considered as irritants.
Pathology.—The changes in the gastric mucosa are similar to those of mucous inflammations of other parts. Beaumont's study of the inflammatory condition, through a gastric fistula in the person of St. Martin, shows a reddened and swollen condition of the membrane, while an increased secretion of mucus bathes the angry-looking, membrane.
The gastric juice is deficient in hydrochloric acid, though lactic and butyric acids are in abundance. The mucous and peptic follicles are swollen, and appear granular, with infiltration of the intertubular tissue. The submucous tissue may become swollen and edematous, and ulceration may occur. Hemorrhage not infrequently occurs. The pathological changes are in proportion to the severity of the inflammation.
Symptoms.—They will depend largely upon the character and degree of the inflammation. In the milder forms, the local symptoms predominate, and are a marked feature in all forms.
In the milder form the symptoms are those of acute indigestion, the patient complaining of an uneasy sensation in the epigastric region; or there may be a burning sensation, or a dull pain with nausea, and sometimes vomiting. There is distention of the stomach, attended by eructations of gas, which give temporary relief. In children, diarrhea attends, though constipation is the rule in adults.
The tongue is coated, breath sometimes offensive, and patient complains of a bitter taste in the mouth. When food and drink are taken, the pain is aggravated.
In the severer form, all the above symptoms are increased, and chilly sensations precede the fever, which is quite active for a few days, the temperature reaching 102° or 103°. The pulse is frequent and hard, skin dry, bowels constipated, and urine scanty, highly colored, and deposits urates. The vomiting is more persistent, and consists of mucus, bile, and undigested food.
Where the gastritis is the result of swallowing the mineral acids, alkalies, corrosive sublimate, arsenic, etc.—toxic gastritis—the inflammation is intense, the pain severe, and vomiting and retching persistent. The burning sensation is felt in the throat and esophagus as well, and thirst is almost intolerable, the gratification of which increases the vomiting.
The pulse is feeble though frequent, the extremities become cold, the surface clammy, the face pinched and anxious, the forerunner of collapse. The breathing is shallow, and attended by pain. The position is dorsal, with limbs flexed to relieve the tension, the abdomen is tumid, and tenderness is marked; finally, in fatal cases, coma comes on, the breathing is shorter, and death ends the suffering of the unfortunate patient.
Diagnosis.—In the milder forms, where there is no fever, the diagnosis is readily made by the local symptoms, but where the disease commences with a chill followed by more or less fever, and there is no previous history of gastric derangement, the disease is readily mistaken for one of the infectious fevers, which mistake is only corrected by later developments. Where the gastritis follows the taking of corrosive salts, mineral acids, or drugs of any character, the diagnosis is readily made by the history and attendant symptoms.
Prognosis.—In the milder cases, commonly known as acute dyspepsia, recovery takes place in from twenty-four to forty-eight hours, while those of a febrile type may persist for several days, and, if followed by indiscretion in eating, the frequent recurrent attacks result in chronic gastritis. Where poisons have been taken, the case is more serious and may terminate in death.
Treatment.—In the milder form, all that will be necessary will be to wash out the stomach by having the patient drink freely of warm salt-water and giving the organ perfect rest for twenty-four or forty-eight hours, to be followed by a diet that is bland and easily digested.
In the more severe type, when the stomach is irritable, after the flushing, the small dose of aconite and ipecac will act kindly:
|Water||4 ounces. M.|
|Sig. Teaspoonful every hour.|
Rhus tox. acts kindly, and where the pulse is sharp, the tongue red, with papilla elevated, rhus replaces the ipecac. Where the nausea and retching are persistent, an infusion of peach-tree bark will often be followed by relief, or bismuth subnitrate one dram, to water four ounces, will afford relief. If the bowels be constipated, they should be opened by an enema, or if the stomach will bear it, a glass of Rubinat condal or Hunyadi may be taken and freely open the bowels. If there be excessive acidity of the stomach, a solution of sodium bicarbonate may be drunk ad libitum.
When poisons have been taken, the patient must be kept quiet in bed, all food by mouth restricted; but mucilaginous drinks may be allowed in small quantities. Ice-cream is grateful to the patient, and may be given sparingly. If the pulse becomes small and thready, and the respiration slow and labored, hypodermic injections of camphor and ether will be called for. This preparation, twenty grains of camphor to an ounce by weight of ether, is one of the most powerful of diffusible stimulants, and can be relied upon in desperate cases.
During convalescence, great care must be taken in the feeding, none but the blandest articles being allowed.