ULCERATION OF THE STOMACH.
Causes: peptic digestion, paresis, caustics, irritants, acids, alkalies, salts, mechanical irritants, hot food, parasites, thrombosis, embolism, specific disease poisons, aneurism, tumors, infective growths, nervous disorder, debility, toxins of diphtheria, staphylococcus, etc. Symptoms: slight colics, tympany, emaciation, vomiting blood, tender epigastrium, dark or bloody stools, irregular bowels; in carnivora abdominal decubitus, arched back, bloody, mucous, acid vomit, colics after meals. Lesions: in horse erosions, ulcers, parasites, neoplasms, discolorations, extravasations; in cattle and dogs on folds, nature of ulcer. Treatment: restricted, digestible diet, lavage, anodynes, bismuth, antacids, antiseptics, salol, naphthol, chloral, pure water.
Causes. Gastric ulcers may arise from quite a variety of causes which determine necrotic conditions of the mucosa and the gradual invasion of the resulting lesion by destructive microbes. One of the simplest factors is the peptic juice, the stomach, being struck with paresis (in inflammation, fever, nervous disorder), while containing a quantity of its secretion, undergoes an autodigestion which affects particularly the lowest (pyloric) portion, toward which the liquid gravitates, and the free edges of the folds which are the most exposed to its action.
The swallowing of irritant and caustic agents (the mineral acids or alkalies, mercuric chloride, tartar emetic, antimony chloride, Paris green, arsenious acid, etc.) by corroding or causing destructive inflammation of the exposed mucous membrane may similarly operate. This is especially the case with monogastric animals, (horse, pig, dog, cat), as in the ruminants such agents tend to be diluted in the first three stomachs and rendered more harmless.
Mechanical irritants may cause the lesion and infection atrium in any of the domestic animals, pins, needles, nails, pieces of wire and other sharp pointed bodies being swallowed by horse and ox, and small stones, pieces of bone, and all sorts of irritant objects picked up by the puppy or rabid dog.
Cooked food swallowed hurriedly at too high a temperature is especially liable to start necrotic changes in the single stomach of horse, pig or dog, the ruminant being in a measure protected by the food passing first into the rumen.
The wounds caused by gastric parasites may become the starting points of molecular degeneration and ulceration. In the horse the spiroptera megastoma, s. microstoma, and the larvæ of the various œstri; in cattle and sheep the strongylus contortus, s. convulutus, s. filicollis and s. vicarius; in swine the spiroptera strongylina, Simondsia paradoxa, and gnathostoma hispida; in dogs spiroptera sanguinolenta, and in cats the ollulanus tricuspis act in this way.
Gastric catarrh debilitates the affected mucosa and lays it open to necrotic microbian infection especially in the pyloric sac and on the summit of the folds.
Interruption of the local circulation in the deeper parts of the mucosa as in inflammation and capillary thrombosis, arterial embolism, venous thrombosis, may lead to local sloughing and ulcerous infection. This may be seen in the petechial fever of the horse, malignant catarrh, rinderpest, and anthrax in cattle and sheep, and in canine distemper in dogs. Vogel found ulcers resulting from a gastric aneurism in the dog.
Tumors and infective growths in the walls of the stomach may prove an occasion of ulceration. Thus sarcoma, epithelioma, actinomycosis and tubercle may be the primary morbid lesion in different cases.
Gastric ulcers have also been attributed to morbid nervous influences as in dogs they have been found associated with lesions of the dorsal myelon, and the corpora quadrigemini, and faradisation of the vagus has apparently led to their production.
General constitutional debility has been alleged as a factor, and experimentally in dogs, the hypodermic or intravenous injection of various microbes or their toxins (diphtheritic toxin, Enriquez and Hallion, staphylococci, Panum, Lebert, Letulle, and a bacillus of dysentery in man, Chantemesse and Widal), have produced gastric ulcers.
Symptoms. In horses and cattle these are very obscure, being mainly in the nature of chronic gastritis. In both there are recurrent attacks of slight colicy pains, with tympany in cattle, and gradual emaciation. Vomiting has been exceptionally seen in both class of animal and if the rejected matters are very acid and above all if mixed with blood it is more suggestive of ulcer. In the horse the attacks of colic are mostly in connection with eating. or (in case the ulcer is duodenal) an hour or two after a meal. In this animal it is possible to withdraw liquids from the viscus by the stomach pump, and any hyperacidity or blood may be almost diagnostic. Tenderness to pressure on the epigastrium or hypochondrium is often present, yet the colics of ulceration are often relieved by pressure and friction. Blood is sometimes present as such in the excrements, but more commonly these are simply blackened by the exuded blood as acted on by the gastric acid and intestinal liquids. The bowels may be alternately constipated and relaxed. A gradually increasing feebleness is a characteristic feature and in cattle paraplegia may precede death.
In the carnivora the symptoms are less obscure. The animal is dull, prostrate, weak, lies on its belly, but rarely long in one place, and when up has arched back, stiff movements, and tucked up abdomen. The epigastrium is painful to touch, which tends to arouse vomiting of food or bloody mucus. As in the horse the rejected matters are very acid. Constipation may alternate with diarrhœa, the fæces being blackened (melæna) or even streaked with blood. The occurrence of suffering after meals, the constancy and persistency of the symptoms and the steadily advancing emaciation and weakness are very characteristic. If the tenderness is referable to a given point, it is even more distinctive.
Lesions. In the horse ulcers and erosions occur in the cardiac sack in connection with œstrus larva and spiroptera which destroy and remove the cuticular covering, or with sarcoma or epithelioma growing in the gastric walls. In the right sac there may also be round ulcers from the hooklets of the œstrus, or irregular excavations on the summits of the folds in connection with catarrhal inflammation. Ulcers from autodigestion are usually in the right sac, in the most dependent part of the viscus, between the folds, and of a more or less circular outline. The raw surface is black, brown, slaty gray or white. The ulcers which result from petechial fever are irregularly notched and marked by a mass of dark blood coagulated in their depth.
In cattle and dogs the ulcers are most frequent near the pylorus, and when of catarrhal origin may be round or irregular, and on the summit of the fold, or if peptic, may be round and between the folds. In malignant catarrh and rinderpest, they are mostly formed on the summits of the folds. They may vary in size from a pea to a quarter of a dollar. The surrounding mucosa is usually congested, swollen, and projecting, and the surface of the ulcer itself of a dark red, black, yellowish, slaty or gray.
The round ulcer is usually marked by surrounding infiltration and by a tendency to become deeper and to perforate the gastric walls, with the result of inducing an infective peritonitis. This is more common in cattle and carnivora than in solipeds.
Treatment. If a reasonably certain diagnosis can be made the patient should be put on a restricted diet of easily digested materials, given at regular intervals. For the carnivora scraped or pulped raw meat, and milk, and for the herbivora milk and well boiled flax seed or other farina are appropriate.
Violent emesis in carnivora may demand washing out of the stomach with tepid water with or without the aid of a stomach tube. This may be seconded by anodynes, chloral, cyanide of potassium, or even morphia.
Bismuth trisintrate or oxide is appropriate in all animals, also sodium bicarbonate, chalk or magnesia to neutralize the muriatic acid.
As antiseptics calculated to obviate the formation of irritant products from the gastric contents and to check the progress of the microbian infection in the wound such agents as the following may be used: Salol (horse or ox 1 dr., dog 5 grs.), naphthol or naphthalin (same doses), chloral (horse 2 drs., dog 5 grs.).
Sometimes it is well to relax the bowels by small doses of Glauber salts, and in all cases an abundance of fresh water, butter milk, or other bland drink.
Cases of the kind are slow in their progress and unless the animal is specially valuable, treatment may be a source of loss.