METABOLISM IN THE STOMACH AND INTESTINES 629 



the direct cause of death. The interest lies more in the analysis of which 

 of the disturbed factors in the pathological intestines are responsible for 

 the effects on the metabolism of the body. 



The diseases of the intestines will be taken up largely in accordance 

 with the classification as given in Barker's "The Clinical Diagnosis of 

 Internal Medicine," Vol. III. This arrangement, groups the diseases very 

 conveniently for the consideration of metabolic complications. Where 

 such complications are the same for different diseases of a group, they 

 will be considered for the whole group and not for each subdivision sep- 

 arately. Thereby much needless repetition will be avoided. 



The Inflammatory Enteropathies 



(a) Acute enteritis. 



(b) Chronic enteritis. 



(c) Ulceration of the intestines. 



1. Chronic duodenal ulcer. 



(d) Appendicitis. 



This classification includes the diseases of the intestines associated 

 with diarrhea, other than the specific dysenteries (such as bacillary and 

 amebic dysentery), and inflammatory conditions of the appendix. It will 

 also be convenient to include acute colitis in this subdivision. 



Although it is possible, by means of stool examinations and x-ray, to 

 differentiate to some degree which part of the small intestine is especially 

 involved, the metabolic disturbances are practically the same and are de- 

 termined more by the intensity and extent of the inflammation than by 

 its exact localization as in the duodenum, jejunum or ileum or colon. In 

 the primary forms of the acute inflammatory enteropathies, besides the 

 inflammatory reaction in the intestines, there may be toxic effects due to 

 spoiled food or chemical irritants. 



In the mild acute enteropathies the metabolism of the body is not 

 much disturbed. There may be a slight loss of weight, which is rapidly 

 restored as soon as the diarrhea ceases. Secretion and absorption are only 

 temporarily deranged and the increased decomposition which accompanies 

 some of these enteropathies is of slight degree and produces no deleteri- 

 ous effect upon the body metabolism. 



In the very severe cases, particularly those caused by the ingestion 

 of spoiled food, there may be striking metabolic complications. Very 

 marked loss of weight and dehydration of the tissues occur when the 

 diarrhea is profuse. The absorption of ptomains from spoiled food may 

 produce severe prostration, often with collapse. In children especially, 

 there is rapid loss of strength and collapse, as familiar in the clinical 

 picture of cholera infantum. 



