METABOLISM IN THE STOMACH AND INTESTINES 



stomach and secondary vomiting, very little nutriment reaches the cir- 

 culation, since the absorption of foodstuft's in the stomach is very slight. 

 Malnutrition bordering upon emaciation may result, associated with 

 varying degrees of acidosis. The mechanical position of the ulcer and 

 not its pathological nature determines how much the metabolism of 

 the body is injured. Of course, if the bile and pancreatic juices are 

 blocked off from entrance into the intestines, marked disturbances in 

 the absorption of fats and proteins result, which further intensifies the 

 malnutrition. There is no specific effect, as far as is known, upon the 

 metabolism, resulting from a damming back into the circulation of bile or 

 pancreatic juice. 



Perforation of a duodenal ulcer may lead to fatal general peritonitis, 

 which is usually so rapid that it does not produce any special added 

 effect upon the body metabolism. The same may be said in case of fatal 

 hemorrhage. Perforation into adjacent viscera as the gall-bladder, the 

 intestines, large blood vessels, or the thorax, while they produce very 

 diverse and often fatal symptoms, do so without modifying the metabolic 

 complications to any considerable extent. The obstruction resulting from 

 cicatrization occurs so high up in the intestines that no considerable degree 

 of auto-intoxication takes place, as does when the obstruction is situated 

 in the ileum or colon. 



Jejunal and ileal ulcers occur most commonly after gastro-enterostomy 

 performed generally for a gastric or duodenal ulcer. When associated 

 with much pain they may greatly interfere with the patient's taking 

 a sufficient diet to maintain the body equilibrium, consequently a state 

 of malnutrition develops, often necessitating secondary operations for 

 removal of the offending cause. 



When malignant degeneration of the ulcer takes place the features 

 of emaciation and cachexia are added to the picture. The effects of can- 

 cerous degeneration on the body metabolism will be discussed at length 

 when cancer of the intestines is taken up for consideration. 



Appendicitis. Acute appendicitis occurs too rapidly to have defi- 

 nite metabolic complications. Its deleterious effects are exerted upon 

 the blood vascular and nervous systems rather than upon the factors which 

 control the metabolism of the body. Only the chronic variety of ap- 

 pendicitis need be considered here. In this disease some complications 

 may occur which have an influence on the body metabolism. 



(1) Hyperacidity associated with pylorospasm can occur, producing 

 sufficient discomfort to interfere greatly with the intake of food. Where 

 these features are very marked the patient's revulsion to food may be as 

 great as in gastric or duodenal ulcers, and as marked a disturbance of 

 nutrition result. 



(2) Cecal stasis, from adhesions, producing constipation often of 

 a very obstinate degree with intestinal stasis, decomposition and auto- 



