METABOLISM IN THE STOMACH AND INTESTINES 621 



metabolic complication of cancer of the stomach while associated with 

 it may be an acidosis varying in degree from a very mild to a very severe 

 grade. The acidosis depends upon starvation for its production and is 

 not a specific effect of the cancer itself. 



In gastric lues, we may have a picture almost exactly simulating can- 

 cer, or less often ulcer, with obstructive phenomena, palpable tumor, usu- 

 ally gumma, bleeding and the usual nutritional disturbances of pyloric 

 obstruction. It is essential to rule out gumma before we may definitely 

 diagnose cancer, as the gastric secretory findings, motor disturbances and 

 x-ray pictures may be practically identical in the two conditions. 



In gastric polyposis, also, the repeated hemorrhages, obstructive phe- 

 nomena, anemia and loss of weight and strength may again present prac- 

 tically the same local and general picture as cancer. While in certain 

 cases the radiographs furnish suggestive evidence in favor of polyposis, 

 sometimes only an exploratory laparotomy can make the diagnosis certain. 



Gastroptosis Atony Dilatation 



Ptosis of the stomach per se has no influence on metabolism. Never- 

 theless, the individual with downward displacement of the stomach, 

 whether congenital or acquired, is unquestionably far more prone to 

 develop atony and motor insufficiency than the person with horizontal 

 stomach. This is especially true of those cases of ptosis associated with 

 a congenitally high, relatively fixed pylorus and duodenum, as the traction 

 on the pylorus, obviously increased by overloading the stomach, leads to 

 constriction, partly due to spasm, partly to hypertrophy of musculature, 

 partly to peripyloric adhesions. In certain of these cases, in which the 

 tone has been further reduced by pregnancy and diseases associated with 

 loss of weight, fever and inanition, the combination of lack of gastric 

 tone with partial obstruction may lead to marked dilatation with a degree 

 of malnutrition often as marked as that seen in the late stage of gastric 

 cancer, and yet when a return to normal weight and strength may be 

 brought about by persistent rest, posture, massage, careful diet with hyper- 

 alimentation as soon as that is possible, measures designed to improve 

 nutrition, combined in some cases, if the pyloric obstruction is more organic 

 than functional, by pyloroplasty. These cases of ptosis complicated by 

 atony, motor" insufficiency and dilatation show the same picture of chronic 

 starvation as previously described under other forms of pyloric obstruction, 

 and the ptosis is but a contributory factor in this picture. Simple atony 

 has but little influence upon metabolism, but with the development of 

 motor insufficiency of a more marked grade, nutrition is bound to be af- 

 fected, the degree of this depending on the extent of the obstruction and 

 of the loss of gastric tone and not upon the specific cause with the possible 



