Acute dyspepsia is one of the frequent disorders of the stomach. It
may occur as an early symptom of an infectious disease, but very often
it is due to some non-specific irritation. The usual exciting causes
are errors of diet, over-indulgence in improperly cooked and highly
seasoned food, or food that has been spoiled, such as meat, fish and
milk, or over or under ripe fruit. Food that is either too hot or too
cold may develop an attack. Alcohol is a common cause in those not
accustomed to its use. Overuse of tobacco may bring on an attack. Many
acute “bilious” attacks are brought about by some mental shock or
excitement at the time of taking food, for it has been shown by the
researches of Pawlow that both gastric motion and secretion are altered
by mental irritation during digestion.
Unquestionably osteopathic lesions of the splanchnics and vagi are
important predisposing factors. These lesions produce a lowered
resistance of the tissues, which will frequently explain why certain
exciting factors that will initiate an attack in one individual will
not do so in another. A healthy mucosa will not be so readily irritated
by either indigestible or partly decomposed food.
Osteopathic experimental work reveals that the vertebral and rib
lesions readily affect both the spinal nerves and the sympathetic
ganglia, which is followed by vasomotor and trophic disorder to the
mucous and submucous coats of the stomach, as shown by eccymosis and
hemorrhage of the submucosa and beginning parenchymatous degeneration
of the free ends of the glands of the mucosa. Upon the other hand
irritation of the muscles from dietetic errors always causes more or
less contraction of the muscles in the upper and middle dorsal, which,
in turn, may produce through imbalance of tension and fibrositic
changes, constant interosseous lesions and thus be the cause of the
catarrh becoming chronic. This vicious cycle phenomenon should not be
overlooked. Viscero-motor, viscerosensory and viscerotrophic reflexes
may be factors in the pathogenesis of the osteopathic lesion.
=Pathologically=, the mucous membrane is more or less covered with
mucus. Upon removal of the mucus the membrane is found red and swollen,
and the epithelial cells of the glands are granular. This is especially
noted in the pyloric area. There are minute extravasations of blood and
hemorrhages of the mucous coat, and infiltration of the submucous layer.
=Symptoms.=—Acute gastritis occurs at all ages, so particularly in
children care has to be taken that the attack is not the beginning
of some infectious disease. A careful inquiry into the history, and
examination of the vomitus will usually make the diagnosis clear.
The sudden onset of nausea, vomiting, pain in the epigastric region
referred to the back and head, vertigo in some cases, if the infections
can be ruled out should leave no doubt as to the nature of the disorder.
Other symptoms are weakness, and chilliness which later if the attack
is severe, is followed by fever. The tongue is coated, the lips dry,
and there may be herpes. Belching of gas, constipation in some and
diarrhea in others, and dark colored urine are noticeable. There is
tenderness on palpation over both the stomach and splanchnic areas.
Examination of the stomach contents show deficient hydrochloric
acid, the presence of organic acids, bile and undigested food, and
considerable mucus.
=Diagnosis.=—In young children acute gastric indigestion is common,
though a casual gastritis is rare. In the former prostration,
vomiting, and undigested, greenish stools are noted. In some cases
there is no fever, while in others it may range from 102 to 105
degrees. In all cases care should be taken, as has been stated,
that the attack is not the beginning of some infectious disease.
Appendicitis, acute bowel constriction, pregnancy, uremia, meningitis,
gall-stone colic, and gastric crises of tabes dorsalis should be
differentiated. Most attacks of acute dyspepsia are over in twenty-four
hours. The prognosis depends upon eliminating the cause. The X-ray may
be of value in protracted cases.
=Treatment.=—If the case is seen early, emptying the stomach by induced
vomiting or the stomach tube is the first indication. If several hours
have elapsed and much of the stomach contents have passed into the
intestine, emptying the colon with an enema will commonly give quick
relief. Withhold all food for from twelve to twenty-four hours, or
longer if necessary. In some cases the sipping of hot water will be
beneficial, while in others pellets of ice in the mouth will give some
relief.
Whether or not there existed previous spinal lesions there will always
be found muscular tension and spinal rigidness during an attack of
acute gastritis. These should be corrected for immediate relief, but
what is of greater importance, if these acute lesions are not corrected
the patient’s recuperative forces are interfered with and recovery is
delayed. Then, also, these lesions tend to chronicity and predispose
to future attacks. Treatment should be given daily, or oftener if
special indications arise. Though the most common area that demands
attention is from the fourth to tenth dorsals, still the vagi nerves,
especially the right, should not be neglected. Lesions of the upper
three cervicals are the most frequent disturbances of the vagi.
=Vomiting= is a common and distressing symptom. Pathologically, it is
due to an antiperistaltic contraction of the stomach and a spasmodic
contraction of the diaphragm and the abdominal muscles. It is caused,
usually, by irritation of the vagus in the stomach, or in the pharynx
by irritation along the spine (particularly in the cervical and upper
dorsal regions), or to the sympathetic nerves or to various parts of
the body, or by direct influence of the brain. Relief can usually
be given by inhibition of the vagus in the occipital region or by
inhibition at the fourth or fifth dorsal vertebra on the right side.
In a few instances, placing the patient in the knee-chest position and
gently raising the abdominal organs gives relief. If this does not
suffice the stomach and colon should be emptied, providing the vomiting
is protracted. A frequently effective measure for nausea and vomiting
that can be carried out by the attendant, is the application of hot
fomentations to the dorsal spine.
=Flatulency= may be very distressing. The spinal treatment may be
sufficient to control this condition, or careful direct pressure for a
few minutes over the pit of the stomach. Adjustment of the lower ribs,
especially of the left side, may be effective. Occasionally the gas
can be passed into the intestines by careful inhibitory treatment in
the region of the eighth and ninth dorsals. The inhibitory treatment
causes relaxation of the pyloric orifice; also, inhibition of the left
vagus relaxes the pylorus. Inhibition at the sixth and seventh dorsals
relaxes the cardiac orifice, thus favoring the passing of the gas from
the stomach out through the esophagus.
In all cases subject to gastritis the dorsal spine should receive
considerable attention in order that recovery may be complete. The
habits of the patient should be thoroughly regulated and overfatigue
guarded against. And, also of special importance in recurring attacks,
is the fact that a number of cases present some derangement of the
biliary tract, or duodenum, or the appendix region.
=Diet.=—After twenty-four or forty-eight hours, if the attack has been
severe, albumin water may be given in small quantities; also whey,
milk, bouillon, and chicken or lamb broth. If there is no return of
gastric distress, add junket, custard, cornstarch pudding, gelatine,
dropped eggs, scraped beef, and white meat of chicken; vegetables
purees made with cream or meat stock are usually well borne at this
time. Foods containing much cellulose, fats and sweets should be
withheld until all symptoms have subsided.