The operation of gastro-jejunostomy and its physiologic effects / Herbert J. Paterson.

  • Paterson, Herbert John, (1867-1940)
Date:
1907
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Licence: In copyright

Credit: The operation of gastro-jejunostomy and its physiologic effects / Herbert J. Paterson. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    had performed gastro-jejunostomy for gastric ulcer. The pa- tient was placed on a milk diet and the observation lasted seven days. During this period the man absorbed 93.5 per cent, of the nitrogen and 94.1 per cent, of the fat taken in the food. In this case the nitrogen absorption was 0.9 per cent, and the fat absorption 0.9 per cent, below the average. Observation 9.—This, too, was made on a patient on a milk diet twenty-tour days after gastro-jejunostomy for gas- tric ulcer. In this patient 92.4 per cent, of the nitrogen and 90.8 per cent, of the fat taken in the food were absorbed, a diminution of 1.8 per cent, in the case of the nitrogen, and in the case of the fat an increase of 0.7 per cent, above the av- erage. Taking the whole series of nine observations, the aver- age diminution of nitrogen absorption is 1.7 per cent, and the average diminution of fat absorption 1.9 per cent., while in every instance the variation is within the limits found in individuals who are in good health. It may be urged that in those cases of this series in which there was no pyloric stenosis the food passed out through the pylorus rather than through the anastomotic opening. If this be true, although I am not prepared to admit it, it does not affect the conclusions to be drawn from the observations. We know clinically that gastro- jejunostomy has a very beneficial effect on gastric nicer. This effect is probably due to the diminution of the acid- ity of the gastric contents which the operation brings about. Which route is taken by the food is a matter of academic interest, as it does not affect the therapeutic value of the operation. The important point is that the short circuit does not appreciably affect the metabolism whether the pylorus he patent or not, for you will ob- serve that in those patients who have marked p}doric stenosis the absorption after operation is as good as in those in whom the pylorus is patent. It is interesting to look back and observe how incom- plete knowledge leads to the formation of erroneous hypotheses, and how as knowledge progresses facts ap- parently irreconcilable become reconcilable. Pawdow showed that the injection of acid into the duodenum causes a flow of pancreatic juice and that the acid chyme passing through the pylorus acts in the duodenum as the normal stimulus of the pancreatic gland. Herein apparently lay the cause of the loss of fat absorption which was supposed to follow gastro-jejunostomy.
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