Diseases of the stomach : including dietetic and medicinal treatment / by George Roe Lockwood ... ; illustrated with 126 engravings and plates.

Lockwood, George Roe

Date:: 1913

Credit: Diseases of the stomach : including dietetic and medicinal treatment / by George Roe Lockwood ... ; illustrated with 126 engravings and plates. Source: Wellcome Collection.

Provider: This material has been provided by the Augustus C. Long Health Sciences Library at Columbia University and Columbia University Libraries/Information Services, through the Medical Heritage Library. The original may be consulted at the the Augustus C. Long Health Sciences Library at Columbia University and Columbia University.

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$Pain Type. — Recurring epigastric pain due to arteriosclerosis is (leseril)e(l under the term of angina abdominalis. The pathogenesis of the })ain is often obscure. By some the pain is attributed to hyper- esthesia of the sympathetic plexus that overlies the abdominal aorta, while by others the pain is ascribed to a distal localization from painful distention of the aortic ring or ascending portion of the thoracic aorta. The generally accepted view is that epigastric pain is analogous to the pain of intermittent claudication and is due to a diminished blood supply from vascular colic (Gefass Koliken of Nothnagel) of the affected artery. For the analogy to be complete one must imagine an increased activity in the gastjric wall itself, during increased peristalsis following eating. This reason is probably sufficient to explain the occurrence of ])ain after hearty meals, but does not explain the connection between pain and exercise requisite to produce it, unless we surmise that exercise raises blood pressure, producing vasoconstriction in the splanchnic Fig. 122 Pain cliait of a patient witli angina abdominalis, showing the gradual onset of distress increasing toward the height of gastric digestion, then slowly subsiding even though the i)atieut rests quietly after eating. area, and narrows the already sclerotic bloodvessels to produce a com- parative ischemia of the stomach wall. PaP regards vascular crises to be due to arterial spasm producing cerebral cardiac or abdominal symptoms as well as the paroxysmal phenomenon known as internal claudication. According to Pal a rise of blood pressure precedes and accompanies the crisis of pain, and in a few of his cases spasm or con- traction of the retinal arteries could be demonstrated. The group of arteriosclerotic ])atients })resenting ei)igastric ])ain as a prominent feature may be subdi\ided into three clinical groups. 1. A dull aching or throb})ing pain may be experienced about one hour after eating, which is not due to gas. As a rule the heartier the meal the greater the distress. It is probable that in these cases the narrowed arteries are able to carry sufficient blood to the stomach for its require- ments in the quiescent state, l)ut are unable to meet the increased demands of j)hysiological congestion during the digesting state. 1 )uriiig active peristalsis the symptoms of ischemia become apparent and the (•()ii(htioii is tlierefore akin to that of intermittent claudication. ' Gefiisscrisen, Leip.sic, 1905.$