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DIGESTIVE
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DIGESTIVE See also:ORGANS Bacillus lactis may be found where the See also:child is See also:bottle fed. If there is trouble with the first dentition and See also:food is allowed to collect, staphylococci, streptococci, pneumococci and See also:colon bacilli may be See also:present. Even in healthy babies Oidium albicans may be present, and in older See also:children the pseudo-See also:diphtheria bacillus. From carious See also:teeth may be isolated streptothrix, leptothrix, spirilla and fusiform bacilli. Under conditions of See also:health these micro-organisms live in the mouth as saprophytes, and show no virulence when cultivated and injected into animals. The two See also:common pyogenetic See also:organ-isms, Staphylococcus albus and brevis, show no virulence. Also the pneumococcus, though often present, must be raised in virulence before it can produce untoward results. The foulness of the mouth is supposed to be due to the colon bacillus and its See also:allies, but those obtained from the mouth are in-nocuous. Also to enable the Oidium albicans to attack the mucous membrane there must be some slight inflammation or injury. The micro-organisms found in the See also:stomach gain See also:access to that organ in the food or by regurgitation from the small See also:intestine. Most are relatively inert, but some have a See also:special fermentative See also:action on the food (see See also:NUTRITION). Abelous isolated six-teen distinct See also:species of organism from a healthy stomach, including Sarcinae, B. lactis, pyocyaneus, subtilis, lactis erythrogenes, amylobacter, megatherium, and Vibrio rugula. See also:Hare-See also:lip, cleft See also:palate, See also:hernia and imperforate anus are See also:physical abnormalities which are interesting to the surgeon rather than to the pathologist. The See also:oesophagus may be the seat of a diverticulum, or See also:blind pouch, usually situated in its See also:lower See also:half, which in most instances is probably partly acquired and partly congenital; a See also:local weaknesa succumbing to pressure. Physical See also:Hypertrophy of the See also:muscular coat of the pyloric region abnormatltlrs. is an infrequent congenital gastric See also:anomaly in infants, preventing the passage of food into the bowel, and causing See also:death in a See also:short See also:time. Incomplete See also:closure of the vitelline duct results in the presence of a diverticulum-Meckel's-generally connected with the ileum, mainly important by See also:reason of the readiness with which it occasions intestinal obstruction. Idiopathic congenital See also:dilatation of the colon has been described. See also:Traction diverticula of the oeso- phagus not uncommonly occur as sequels to suppurative inflamma- tion of cervical lymphatic glands. More frequently dilatation of a See also:section is met with, due as a See also:rule to the presence of a stricture. The stomach often diverges from the normal in See also:size, shape and position. Normally capable in the adult of containing from fifty to sixty ounces, either by reason of organic disease, or as the result of functional disturb- ance, its capacity may vary enormously. The writer has seen See also:post mortem a stomach which held a See also:gallon (16o ounces), and again one holding only two ounces. See also:Cancer spread over a large See also:area and cirrhosis of the stomach See also:wall cause diminution in capacity; pyloric obstruction, weakness of the muscular coat, and See also:nervous influences are associated with dilatation. A See also:peculiar distortion of the shape of the stomach follows cicatrization of See also:Numbers of bacterial forms habitually infest the alimentary See also:canal. Many of them are non-pathogenic; some develop patho- genic characters only under provocation or when a suitable environment induces them to See also:act in such a manner; others may See also:form the materies morbi of special lesions, or be casual visitors capable of originating disease if opportunity occurs. Apart from those organisms associated with acute infective diseases, disturbances of See also:function and physical See also:Vegetable parasites. See also:Males. See also:Females. Both Sexes. Organ or See also:Tissue in Per- Organ or Tissue in Per- Organ or Tissue in Per- See also:Order of Frequency. centage. Order of Frequency. centage. Order of Frequency. centage. I Stomach . 22.56 I Stomach . . 22.37 I Stomach . . 22.49 2 Lip . 12.94 2 Rectum 17.24 2 Rectum 13.I2 3 Rectum . . II.57 3 See also:Liver . . . 15.50 3 Liver 10.02 4 See also:Tongue . . 11.36 4 Peritoneum 7.86 4 Lip 9.89 5 Oesophagus 10.90 5 Oesophagus 5'33 5 Oesophagus 9.29 6 Liver . . 7.80 6 Sigmoid 4.53 6 Tongue 8.96 7 See also:Jaw 6.38 7 See also:Pancreas . . 3.52 7 Jaw . . . . 5.65 8 Mouth . . 2.88 8 Tongue . . . 3.12 8 Peritoneum 2.94 9 Tonsils 2.09 9 Omentum . . 2,98 9 Sigmoid . . 2.56 10 Sigmoid flexure 1.77 10 Lip . . . . 2.57 Ia Mouth . . . 2.40 II Parotid II Jaw . 1.97 I1 Pancreas 1.80 12 Pancreas I 10 12 Colon . . 12 Tonsils . . . 1.35 13 Caecum . 1 13 See also:Abdomen . 1'84 13 Omentum . 1.25 14 Peritoneum. 0.94 14 Intestine . . 1.56 14 Parotid . 15 Colon . 0.89 15 Caecum 1.37 15 Colon 1.12 16 Pharynx . . 16 Mouth . . . 1 18 16 Caecum 1.08 17 Intestine (site 0.79 17 Parotid 17 Intestine unknown) . 18 Splenic flexure o•98 18 Abdomen . I'oo 18 Abdomen . . 0.71 19 Jejunum and 19 Pharynx . . 0.62 19 Mesentery ileum . . . 0.78 20 Mesentery 0.52 20 Omentum . 0.55 20 Tonsils . 0.68 21 Jejunum and 21 Hepatic flexure o•39 21 Pharynx . . l 0.40 ileum . - • 0.44 22 Submaxillary . 22 Hepatic flyexure 22 Hepatic flexure See also:land . 0.31 23 0'20 23 Slenic o•28 23 Jeju num and 24 Submaxillary 24 Submaxllarye . ileum . . 25 Duodenum . 25 Duodenum 0.22 24 Duodenum . . 0.23 25 Splenic flexure 0.15 See also:Note.-The figures where several organs are bracketed apply to each organ separately. lesions may be the result of abnormal bacterial activity in the canal; and these disturbances may be both local and See also:general. Many of the bacteria commonly present produce putrefactive changes in the contents of the See also:tract by their metabolic processes. They render the See also:medium they grow in alkaline, produce different gases and elaborate more or less virulent toxins. Other species set up an See also:acid See also:fermentation, seldom accompanied by See also:gas or toxin formation. The products of either class are inimical to the See also:free Per- Per- Per- Males. centage. Females. centage. tentage.• See also:Total. i Mouth and I Intestines 28.9 1 Oesophagus and pharynx . 37.85 2 Oesophagus and stomach 31.78 2 Oesophagus and stomach 27.7 2 Mouth a n d stomach . . 33.46 , 3 Liver 15.5 pharynx . . 30'27 3 Intestines 17.04 4 Peritoneum . 13.1 3 Intestines . . 20.42 4Liver . 7.8 5Mouth and • 4Liver . . . 10.02 5 Peritoneum . . 2.75 pharynx . 11.3 5 Peritoneum . . 5.71 6 Pancreas 1.1 6 Pancreas 3.5 6 Pancreas 1.8o growth of members of the other. The specieswhich produce acids are more resistant to the action of acids. Thus, when the contents of the stomach possess a normal or excessive proportion of free hydrochloric acid, a much larger number of putrefactive and pathogenic organisms in the food are destroyed or inhibited than of the bacteria of acid fermentation. Diminished gastric acidity allows of the entry of a greater number of putrefactive (and pathogenic) types, with, as a consequence, increased facilities for their growth and activity, and the See also:appearance of intestinal derangements. In a healthy new-See also:born See also:infant the mouth is free from micro-organisms, and very few are found in a See also:breast-fed baby, but ulcers of greater or lesser curvature; the gastric cavity becomes " See also:hour-See also:glass " in shape. In addition, the stomach may be displaced downwards as a whole, a See also:condition known as gastroptosis: if the pyloric portion only be displaced, the See also:lesion is termed pyloroptosis. Ptoses of other abdominal organs are described; the liver, transverse colon, See also:spleen and kidneys may be involved. Displacements downwards of the stomach and transverse colon, along with a movable right See also:kidney and associated with See also:dyspepsia and See also:neurasthenia, form the malady termed by Glenard enteroptosis. A general visceroptosis often occurs in those patients who have some tuberculous lesion of the lungs or elsewhere, this disease causing a general weakening and subsequent stretching of all ligaments. Displacements of the abdominal viscera See also:ate almost invariably accompanied by symptoms of dyspepsia of a neurotic type. The rectum is liable to prolapse, consequent upon See also:constipation and straining at See also:stool, or following local injuries of the perineal See also:floor. Every pathological lesion shown by digestive organs is closely associated with the See also:state of the nervous See also:system, general or local; See also:Influence so stoppage of active gastric digestive processes after oftee profound nervous See also:shock, and occurrence of nervous nervous See also:diarrhoea from the same cause. Gastric dyspepsia system. of nervous origin presents most varied and contradictory symptoms: diminished acidity of the gastric juice, hyper-acidity, over-See also:production, See also:arrest of secretion, lessened or increased movements, greater sensitiveness to the presence of contents, dilatation or spasm. Often the nervous cause can be traced back farther,—in females, frequently to the pelvic organs; in both sexes, to the condition of the See also:blood, the See also:brain or the bowel. Unhealthy conditions related to evacuation of the bowel-contents commonly induce reflex nervous manifestations of abnormal See also:character referred to the stomach and liver. Gastric disturbances similarly react upon the proper conduct of intestinal functions. Local Diseases. The Mouth.—The lining membrane of the cheeks inside the mouth, of the gums and the under-See also:surface and edges of the tongue, is often the seat of small irritable ulcers, usually associated with some digestive derangement. A See also:crop of See also:minute vesicles known as Koplik's spots over these parts has been lately stated by Koplik to be an See also:early symptom of See also:measles. Xerostomia, or dry mouth, is a rare condition, connected with lack of salivary secretion. Gangrenous stomatitis, cancrum oris, or noma, occasionally attacks debilitated children, or patients convalescing from acute fevers, more especially after measles. It commences in the gums or cheeks, and causes widespread sloughing of the adjacent soft parts—it may be of the bones. The Stomach.—It were futile to See also:attempt to enumerate all the protean manifestations of disturbance which proceed from a disordered stomach. The possible permutations and combinations of the causes of gastric vagaries almost reach infinity. See also:Idiosyncrasy, past and present gastric See also:education, penury or plethora, actual digestive See also:power, motility, bodily requirements and conditions, environment, See also:mental influences, local or adjacent organic lesions, and, not least, reflex impressions from other organs, all contribute to the variance. See also:Ulcer of the stomach, however—the perforating gastric ulcer —occupies a unique position among diseases of this organ. Gastric ulcers are circumscribed, punched out, rarely larger than a sixpenny-See also:bit, See also:funnel-shaped, the narrower end towards the peritoneal coat, and distributed in those regions of the stomach wall which are most exposed to the action of the gastric contents. They occur most frequently in females, especially if anaemic, and are usually accompanied by excess of acid, actual or relative to the state of the blood, in the stomach contents. Local See also:pain, dorsal pain, generally to the See also:left of the eighth or ninth dorsal spinous See also:process, and haematemesis and melaena, are symptomatic of it. The amount of blood lost varies with the rapidity of ulcer formation and the size of See also:vessel opened into. Fatal results arise from ulceration into large blood-vessels, followed by copious See also:haemorrhage, or by perforation of the ulcer into the peritonealcavity. Scars of such ulcers maybe found post mortem, although no symptoms of gastric disease have been exhibited during See also:life; gastric ulcers, therefore, may be latent. Irritation of the sensory See also:nerve-endings in the stomach wall from the presence of an increased proportion of acid, organic or See also:mineral, in the stomach contents is accountable for the well-known symptom heartburn. See also:Water-brash is a See also:term applied to eructation of a colourless, almost tasteless fluid, probably saliva, which has collected in the lower See also:part of the oesophagus from failure of the cardiac sphincter of the stomach to relax; reversed oesophageal peristalsis causing regurgitation. A similar reversed action serves in merycism, or rumination, occasionally found in See also:man, to raise part of the food, lately ingested, from the stomach to the mouth. Vomiting also is aided by reversed peristaltic action, both of the stomach and the oesophagus, with the help of the See also:diaphragm and the muscles of the anterior abdominal wall. Emesis may be caused both by local nervous influence, and through the central nervous mechanism either reflexly or from the See also:direct action of substances circulating in the blood. Further, the causal See also:agent acting on the central nervous apparatus may be organic or functional, as well as medicinal. Vomiting without any apparent cause suggests nervous lesions, organic or reflex. The obstinate vomiting of pregnancy is a See also:case in point. Here the See also:primary cause proceeds reflexly from the See also:pelvis. In females the pelvic organs are often the true source of emesis. Haematemesis accompanies gastric ulcer, cancer, chronic congestion with haemorrhagic erosion, congestion of the liver, or may follow violent acts of vomiting. In cases of ulcer the blood is usually See also:bright and in considerable amount; in cancer, darker, like See also:coffee-grounds; and in cases of erosion, in smaller quantity and of bright See also:colour. The reaction of the stomach contents, if the cause be doubtful, yields valuable aid towards a diagnosis. Of increased acidity in gastric ulcer, normal in hepatic congestion, it is diminished in cancer; but as the acid present in cancer is largely lactic, See also:analysis of the gastric contents must often be a sine qua non, because hyperacidity from lactic may obscure hypoacidity of hydrochloric acid. Flatulence usually results from fermentative processes in the stomach and bowel, as the outcome of bacterial activity. A. different form of flatulence is common in neurotic individuals; in such the gas evolved consists simply in carbonic acid liberated from the blood, and its See also:evolution is generally characterized by rapid development and by lack of all fermentative signs. The Liver.—The liver is an organ frequently libelled for the delinquencies of other organs, and regarded as a common source of See also:ill. In catarrhal See also:jaundice it is in most cases the bowel that is at See also:fault, the liver acting properly, but unable to get rid of all the bile produced. The liver suffers, however, from several diseases of its own. Its fibrous or connective tissue is very See also:apt to increase at the expense of the cellular elements, destroying their functions. This cirrhotic process usually follows See also:long-continued irritation, such as is produced by too much See also:alcohol absorbed from the bowel habitually, the organ gradually becoming harder in texture and smaller in bulk. Hypertrophic cirrhosis of the liver is not uncommonly met with, in which the liver is much increased in size, the " unilobular form, also of alcoholic origin. In still-born children and in some infants a form of hypertrophic cirrhosis is occasionally seen, probably of hereditary syphilitic origin. Acute congestion of the liver forms an important symptom of malarial See also:fever, and often leads in time to See also:establishment of cirrhotic changes; here the liver is generally enlarged, but not invariably so, and the part played by alcohol in its See also:causation has still to be investigated. Acute yellow See also:atrophy of the liver is a disease sui generic. Of rare occurrence, possibly of toxic origin, it is marked by jaundice, at first of usual type, later becoming most intense; by vomiting; haemorrhages widely distributed; rapid diminution in the size of the liver; the appearance of leucin and tyrosin in the urine, with lessened See also:urea; and in two or three days, death. The liver after death is soft, of a reddish colour dotted with yellow patches, and weighs only about a third part of the normal—about r~ lb in See also:place of 3; lb. A closely analogous See also:affection of the liver, known as Weil's disease, is of infectious type, and has been noted in epidemic form. In this the spleen and liver are commonly but not always swollen, and the liver is often See also:tender on pressure. As a large proportion of the sufferers from this disease have been butchers, and the epidemics have occurred in the hot See also:season of the See also:year, it probably arises from contact with decomposing See also:animal See also:matter. Hepatic See also:abscess may follow on an attack of amoebic See also:dysentery, and is produced either by infection through the portal vein, or by direct infection from the adjacent colon. In general pyaemia multiple small abscesses may occur in the liver. The See also:Gall-See also:Bladder.--The formation of biliary calculi in the gall-bladder is the See also:chief point of See also:interest here. At least 75% of such cases occur in See also:women, especially in those who have See also:borne children. Tight-lacing has been stated to act as an exciting cause, owing to the consequent retardation of the flow of bile. Gall-stones may number from one to many thousands. They are largely composed of cholesterin, combined with small amounts of bile-See also:pigments and acids, See also:lime and See also:magnesium salts. Their presence may give rise to no symptoms, or may cause violent biliary See also:colic, and, if the bile-stream be obstructed, to jaundice. Inflammatory processes may be initiated in the gall-bladder or the bile-ducts, catarrhal or suppurative in character. The Pancreas.—Haemorrhages into the See also:body of the pancreas, acute and chronic inflammation, calculi, cysts and tumours, among which cancer is by far the most common, are recognized as occurring in this organ; the point of greatest interest regarding them lies in the relations established between pancreatic disease and See also:diabetes See also:mellitus, affections of the gland frequently being complicated by, and probably causing, the appearance of See also:sugar in the urine. The Small Intestine.—Little remains to be added to the See also:account of inflammatory lesions in connexion with the small intestine. It offers but few conditions peculiar to itself, See also:save in typhoid fever, and the ease with which it contrives to become kinked, or intussuscepted, producing obstruction, or to take part in hernial protrusions. The first section, the duodenum, is subject to development of ulcers very similar to those of the gastric mucous membrane. For long duodenal ulceration has been regarded as a complication of extensive See also:burns of the skin, but the relationship between them has not yet been quite satisfactorily explained. The condition of colic in the bowel usually arises from over distension of some part of the small gut with gas, the frequent See also:sharp turns of the gut facilitating temporary closure of its lumen by pressure of the dilated gut near a See also:curve against the part beyond. In the large bowel accumulations of gas seldom cause such acute symptoms, having a readier exit. The Large Intestine.—The colon, especially the ascending portion, may become immensely dilated, usually after prolonged constipation and See also:paralysis of the gut; occasionally the condition is congenital. Straining efforts made in defaecation may often account for prolapse of the lower end of the rectum through the anus. Haemorrhage from the bowel is usually a sign of disease situated in the large intestine: if bright in colour, the source is probably See also:low down; if dark, from the caecum or from above the ileo-caecal See also:valve. Blood after a short stay in any section of the alimentary canal darkens, and eventually becomes almost See also:black in colour. (A. L. G.; M. Additional information and CommentsThere are no comments yet for this article.
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