534 THE DIGESTIVE SYSTEM. 



Cadaveric Changes. 



The mucous membrane of the stomach is liable to undergo considerable alterations 

 soon after death owing to changes in the distribution and composition of the blood and 

 to the action of the digestive fluids. The blood is apt to collect in the small veins, 

 especially at the fundus, while by diffusion of the coloring matter, red or brown or 

 black streaks and patches form in the mucous membrane. 



Those portions of the mucosa on which the food and digestive fluids collect, usually 

 at the fundus and on the posterior aspect of the stomach, frequently appear gray, tur- 

 bid, and are soft, and are easily rubbed off. The epithelium in these regions is unusu- 

 ally granular or disintegrated, and is often detached. Sometimes this post-mortem 

 softening involves the entire thickness of the stomach wall, which is converted into a 

 gray or yellow or brown gelatinous pulp. Thus large or small post-mortem perfora- 

 tions may occur. 



INJURIES. 



Perforating wounds of the stomach usually give rise to a fatal perito- 

 nitis. It is possible, however, for the wound to heal, or a gastric fistula 

 may be formed. 



Eupture of the stomach may be produced by severe blows or falls. 



HAEMORRHAGE. 



Small extravasations of blood in the wall of the stomach are fre- 

 quently found in persons who have died from one of the infectious dis- 



Hsernorrhage into the cavity of the stomach may occur in a variety 

 of ways. It may take place from injuries or poisons; from ulcers or 

 carcinoma ; from rupture of small aneurisms of the stomach, or from the 

 rupture into the stomach of aneurisms elsewhere. It may occur in in- 

 fectious diseases, especially in yellow fever, or in diseases of the blood. 

 It may be associated with passive congestion of the stomach in hepatic 

 cirrhosis of the liver, obstruction of the portal vein, chronic disease of 

 the heart and lung ; with an enlarged spleen and in chronic gastritis. In 

 the new-born and young infants haemorrhage into the stomach not infre- 

 quently occurs without apparent lesions which would account for it ; or 

 there may be ulcers of the mucous membranes, or cardiac disturbances, 

 or infection. While the source of haemorrhage into the stomach is often 

 evident, in many cases none can be discovered. Considerable bleeding 

 can evidently take place by diapedesis in congested vessels. 



Some cases of chronic gastritis are characterized by general bleeding 

 from the mucous membranes of the stomach. 



