THE STOMACH AND DUODENAL CONTENTS 417 



In chronic gastritis the picture of mucus entangling large numbers of cells is 

 characteristic. It must be remembered, however, that strands of mucus entangling 

 polymorphonuclear cells may be found in normal gastric contents. The pus cells 

 which are free are the ones of significance. An occasional cylindrical gastric epithe- 

 lial cell may be found. The recognition of carcinoma cells, especially those showing 

 mitoses, is of value only when done by one who has made a special study of the 

 findings. 



In examining the sediment from the filter-paper after filtering off the stomach 

 contents always use a dilute Gram solution (about i to 4) for mounting the sediment. 

 Muscle fibers, yeast cells, red blood-cells, and epithelial cells are stained a golden 

 yellow. Starch granules are stained blue while fats are unstained and show as 

 globules of varying sizes. 



The Duodenal Fluid. This is best obtained with the Jutte modi- 

 fication of the Einhorn duodenal tube. There is little difficulty 

 in the passage of the tube when the stomach is not dilated. One can 

 aspirate from 5 to 20 c.c. in about five minutes, the amount varying with 

 the individual case. The normal fluid is clear, bile stained, sero- 

 mucous and contains few cells and living bacteria. Dead bacteria may 

 be found in considerable numbers. 



Of the greatest importance is the chemical examination of duodenal fluid for 

 pancreatic ferments. It is well recognized that the examination of the faeces for 

 such ferments is absolutely unreliable while with duodenal fluid it is most satisfac- 

 tory. The normal ferment value of duodenal fluid is best indicated by the tryptic 

 power, this being very constant. The lipase findings are very variable. 



Normally 10 c.c. of 0.1% casein solution is digested in twenty-four hours by 

 duodenal fluid in dilutions of i to 3000 to i to 10,000 or even higher. 



Turbidity of the fluid is thought to be suggestive of cholelithiasis. 

 Bile-stained pus cells are also of significance in cholecystitis. Hence 

 examine sediment unstained before adding Gram's iodine solution. 

 The presence of bile in the duodenal fluid is a far more certain index 

 of the patency of the bile duct than the test of faeces for bile as bile 

 may be absent in a fasces test when present in duodenal fluid. The 

 color of the fluid is about as satisfactory an indication of the presence 

 of bile as that given by the various tests for bile. Einhorn states that 

 with turbid bile cholecystitis with gall-stones is almost always present 

 if with fasting condition. Gall-stones without cholecystitis may give 

 a clear fluid Liver conditions, as neoplasms or high grade cirrhosis 

 may give rise to turbid duodenal fluid. 



McNeil attaches importance to the Wolff- Junghan's test of the duodenal fluid 

 which he states gives turbidity up to the third or fourth tube, but never in the fifth 

 or sixth one, normally. An increase would indicate some pancreatic, biliary or 

 duodenal inflammation, provided we checked up the test on the gastric contents. 

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