METABOLISM IN THE STOMACH AND INTESTINES 633 



not represent a specific product of pathological processes in the intestines. 

 It has been shown in a number of diseases of the intestines as enteritis, 

 carcinoma, that the acetone bodies are decreased when carbohydrates can 

 be taken and utilized in sufficient quantities by the body. 



(2) The circulatory disturbances of the intestines are not associated 

 with metabolic complications of any particular importance. The slight 

 disturbances of the metabolism which do occur are too vague to permit 

 of any special discussion. 



Enteropathies due to Alterations of the Lumen or the 

 Position of the Intestines 



(a) Acute intestinal obstruction. 



(b) Chronic intestinal obstruction. 



(c) Dilatations of the intestine. 



1. Dilatation of the ileum and Heal stasis. 



2. Acquired diverticula of the colon. 



(d) Abdominal hernias. 



(e) Enteroptosis (mechanical ileus). 



Acute obstruction of the intestines may arise from a mechanical occlusion 

 or from a sudden loss of motor power of the intestinal wall (adynamic 

 and paralytic ileus). When the obstruction is in the small intestine, 

 the serious symptoms of abdominal pain, fecal vomiting and collapse 

 appear early and death is rapid, unless the obstruction can be relieved, 

 whereas, if the obstruction is in the colon, serious symptoms appear more 

 gradually and a fatal outcome occurs more slowly. The higher up in 

 the intestinal tract that the obstruction occurs the more serious is the dis- 

 turbance to the body nutrition, since, when the site is lower down in the 

 intestines, a greater area is left above for absorption. 



To produce severe symptoms an obstruction 'must be fairly complete, 

 because otherwise the fluid condition of the intestinal chyme allows a 

 great deal of material to pass the site of obstruction. Many causes pro- 

 duce mechanical ileus, such as twists, kinks, strangulations, and intus- 

 susceptions. The effect on the metabolism depends upon the extent and 

 position of the ileus and not upon the character of the cause. ^ In paralytic 

 ileus, the causes may be inflammatory, as in acute peritonitis, Atoxic as m 

 sepsis, typhoid, pneumonia or uremia, or reflex, as in renal or biliary colic. 

 Here the causative factor may modify the effect of the obstruction on 

 the metabolism. 



The means through which the serious symptoms of intestinal ob- 

 struction are brought about is still a matter of doubt. A brief discussion 

 of this phase of the subject seems advisable, before considering the meta- 

 bolic complications of this disease. 



