Dilatation of the Stomach

A dilated stomach is a stretched stomach having increased capacity, due

to nervo-muscular atony or to pyloric obstruction. Every stomach which

is not retracted when empty is a dilated stomach. A dilated stomach may

occur either as an acute or as a chronic condition, but it is to be

distinguished from temporary distention and a normally large stomach.

=Osteopathic Etiology= and =Pathology=.—The nervo-muscular atony

causing dilatation may be due to obstructive lesions in the stomach

splanchnics, or to a general debility of the spine in the dorsal region

(usually a kyphosis), or to continued overeating and improper food

causing a stasis and fermentation. It may also be due to overdrinking

and various diseases, as phthisis, liver and lung diseases, anemia,

chlorosis, acute fevers and kidney diseases, causing more or less

of a general nervo-muscular atony. Dilatation may result from a

mechanical obstruction, or narrowing of the pylorus or the duodenum,

by a cicatricial contraction of an ulcer; by hypertrophic thickening

due to various diseases, by adhesions and tumors. Occasionally the

pyloric obstruction is congenital. A floating kidney may fall upon the

horizontal portion of the duodenum and thus mechanically obstruct the

passage of food from the stomach, which consequently dilates. Tight

lacing might prevent the liver, when congested, from passing in front

of the kidney, thus luxating the kidney. Dilatation of the stomach

occurs at all ages, although most frequently in middle aged persons.

=Pathologically=, the muscular coat is thinner and paler than normal,

with more or less atrophy of the glandular tissues and an increase

in capacity of the stomach. When obstruction exists at the pylorus,

hypertrophy of the muscular coat may occur.

=Symptoms.=—The symptoms are those of the disease causing the

dilatation plus those of persistent chronic catarrh. The patient

complains of a sense of fullness in the epigastric region and there

is flatulency, eructations and vomiting. The cavity of the stomach

being much enlarged, great quantities which are usually considerably

decomposed are vomited each day or two. There is often lessened acidity

of the vomited mass, though in some cases it is increased. Passage of

the food from the stomach to the intestine is delayed and the bowels

are constipated, the fecal matter being dry and hard. The urine may be

scanty and the skin dry. Anemia, debility and emaciation are always

present to a greater or less extent, and on account of the absorption

of poisonous matter drowsiness may occur.

=Physical Signs.=—=Inspection.=—In some cases the outline of the

distended stomach can be plainly seen. There is prominence of the

epigastric region, the tumefaction being at the pyloric end of the

stomach. =Palpation.=—The resistance upon manipulation of a dilated

stomach is like that of an air cushion. If the patient is made to drink

a half tumbler of water, bimanual palpation will cause a splashing

sound to be heard along the circumference of the stomach at its lowest

point; and by moving the water about by changing the position of the

patient, the outline of the stomach can be made. If the sound is not

heard at the first manipulation, it must not be concluded that the

stomach is normal for the stomach may be so dilated and flabby that it

falls behind the abdominal wall like an apron. =Percussion.=—The note

is tympanitic over the greater part of the stomach until the lower

curvature is reached when the sound is dull (due to the liquid contents

of the stomach), followed by a tympanic sound again when the intestines

are reached. When percussion is made the patient should always be in a

standing position if possible.

When there is =pyloric obstruction= a tumor usually presents itself,

and vomiting is more severe and peristalsis more active than when

the dilatation is due to atony of the walls of the stomach from an

obstructed innervation.

=Diagnosis.=—This is usually easy if due care is taken in making the

examination. Goetz has shown by the use of his spinegraphometer that

in cases of visceral prolapse the spine is commonly posterior in the

dorso-lumbar region. The X-ray is of value in determining the size and

function of the organ.

=Prognosis.=—In a case of nervo-muscular atony the prognosis is

favorable. If due to a malignant disease recovery is usually

impossible. In hypertrophy of the pylorus or the duodenum, recovery is

probable by means of surgical interference.

=Treatment.=—When the dilatation is due to atony of the muscular walls

of the stomach from obstructed innervation at the spinal column,

treatment is usually successful. Attention should be given to the

condition of the spinal column in the splanchnic region (fourth dorsal

to twelfth dorsal), the spine being usually posterior. A thorough and

persistent course of treatment must be given, not only to restore the

normal activity of the nerves to the muscular coat and glands of the

stomach, but to build up and restore strength in the weakened spinal

column. Lesions in the spinal column, even higher than the fourth

dorsal, may affect the innervation of the stomach. There are cases

where lesions have been found at the fifth, sixth and seventh cervicals

that interfere considerably with the action of the stomach, causing

nausea, flatulency, eructations, and even vomiting. Such an affection

may be through the fibers of the splanchnic nerves or through fibers of

the vagi nerves.

The vagi nerves have an important bearing upon gastric dilatation as

paralysis of the gastric branches of the vagi arrests the peristalsis

of the stomach and thus tends to favor retention of food within its

cavity. The stomach in such cases becomes enlarged, mainly by the

weight of the food and the presence of gases due to decomposition of

the retained food. Thus lesions may be found higher than the lower

cervicals and cause obstruction and paralysis of the fibers of the vagi

to the stomach.

Direct stimulation over the stomach in the form of thorough

manipulation of the stomach walls causes contraction of the muscular

fibers of the stomach, mainly the circular fibers. This treatment,

with additional treatment of the splanchnic and the vagi nerves, will

tend to build up the weakened plexuses of the stomach. Much time can

be saved by putting the patient to bed and treating him every day for

several weeks. When the stomach is dilated or dilated and prolapsed,

to any extent, it usually requires three to five months treatment at

least; this time can be shortened one-half by keeping the patient in

bed, treating the spine three times a week, and the abdomen every

day. Light food at frequent intervals, upper thoracic breathing, and

frequent drawing up and in of the abdomen should be required. The

patient may also manipulate his own abdomen twice a day to advantage;

teach him to manipulate, draw and pull it upward. There is no danger of

too frequent treatment as long as there is no bruising of the parts;

this, however, does not apply to the spine. It is not an uncommon thing

to correct a dilated stomach or a dilated and prolapsed stomach that

is an inch and a half or two inches below the umbilicus. Care must

be taken in all cases that other viscera are not prolapsed. It is a

common experience to find enteroptosis, which can usually be readily

functionally corrected, with the stomach ptosis. But where the kidney,

or possibly both, is much prolapsed only fair results can be secured

until the kidney is replaced and kept there, and if necessary by

surgical means. Also, note whether the liver is enlarged. (See special

article on Prolapsed Organs).

When the disease is due to cancer and various growths of the pylorus

or the duodenum, nothing can be done but palliate. Such cases require

surgical attention. In all cases it is necessary that care and

preoccupation of the patient should be removed. Baths, changes of air,

a carefully regulated diet and caution in the use of liquids will be of

great aid to the general health of the patient, and thus the weakened

nervous system will be indirectly but greatly benefited. Too great care

cannot be taken of the patient, as there is created in the organism a

special aptitude for the tissues to become inflamed and thus weaknesses

at various parts of the body may occur. Phthisis, typhoid fever and

various diseases are apt to follow dilatation of the stomach, as the

nutritive and resistive process of the body are impaired.

The meals should be taken regularly and with great care, the patient

not eating too quickly nor too much. Solids should be used but little;

the artificially digested foods, such as peptonized milk and beef

peptonoids, probably being the best. Beef juice and scraped beef are

excellent foods, as they are easily digested. Fatty and starchy foods

should be avoided.

Washing out the stomach is useful, but it should not be

indiscriminately employed. Lavage will not be necessary in all cases

of mechanical obstruction. It relieves the distention, by removing the

weight and the fermenting and decomposing material.

In =acute dilatation=, which may be due to prolonged diseases, general

anesthesia, injuries of the spine, and to narrowing of the duodenum,

vomiting, pain and collapse occur. Empty the stomach, and place patient

in knee-chest position. Reach beneath the duodenum and raise this part

of bowel. Start well down, as low as third or fourth lumbar. If this

does not give quick relief stand patient on his head.