

CHAPTER XXX 

 THE STOMACH AND DUODENAL CONTENTS 



FROM a microscopical standpoint there is comparatively little that 

 is of value in the examination of the gastric contents; there is nothing 

 very specific about the findings. 



A test meal is not a necessity as in the chemical examination, but 

 either vomitus or material withdrawn with a stomach-tube two or more 

 hours after an ordinary meal suffice. 



The most satisfactory specimen is one taken before the giving of 

 the test meal. 



The washings from the stomach are allowed to stand until the 

 sediment has fallen to the bottom and an examination of this is made. 



The microscopical diagnostic points in connection with distinguishing cancer of 

 the stomach from nonmalignant dilatation are : i . Fragments of cancer tissue. These 

 are very rarely found and are most difficult to diagnose. 2. The presence of flagell- 

 ates in the early stages of cancer (the so-called anacid stage preceding the develoy- 

 ment of lactic acid). As flagellates prefer an alkaline medium, they disappear 

 after the acidity due to lactic acid comes on. 3. The presence of the Boas-Oppler 

 bacillus. There are probably several organisms so designated. They are lactic acid 

 producers and are characterized by being very large bacilli (7XI/-0 and arranged in 

 long chains which stretch across the field of the microscope. They are Gram-posi- 

 tive and do not form spores. They can be cultivated on media rich in milk or blood 

 and are aerobic. They should only be reported when present in great abundance and 

 in long chains. Heinemann thinks it probable that the Boas-Oppler bacillus, Lepto- 

 thrix buccalis, and B. bifidus may be identical with B. bulgaricus (see under Milk). 



4. The absence of sarcinae and yeasts. The presence of these sarcinae and fungi in 

 vomitus is indicative of a simple dilatation. 



In the diagnosis of cancer, other than the finding of tumor, gastric 

 stasis, etc., much importance is attached to the absence of free HC1. 

 This is best determined by the Gluzinski test. In the Mayo clinic 

 total acidity of gastric contents averaged 63 (% free HC1) in ulcer, 

 while cancer averaged only 31 (% free HC1). Lactic acid was found 

 in 43% and blood, occult or otherwise, in 73% of cancer cases. 



In determining the pepsin activity of the gastric juice we usually 

 employ the Mett tube. 



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