Part 30

The condition becomes pathological when associated with atony, and this may occur directly from over distension. It is especially common in the horse by reason of the difficulty of relieving the over distension by eructation or vomiting, and also by reason of the habit of swallowing air (cribbiting). The dog, which has great facility in vomiting, should be correspondingly protected from the condition, yet it is very common in old dogs, doubtless from their common vice of gourmandizing and lack of exercise. Cattle are rarely attacked, the fourth stomach being protected by the others which stand guardian over it and prevent the sudden access of excess of food even if that is rapidly swallowed.

Other causes are: chronic catarrh which renders the stomach atonic, lessens its peptic secretion and determines indigestions and over distensions: habitual overfeeding which results in chronic indigestions and fermentations; lesions of the brain, and tumors of the jugular furrow or mediastinum which interfere with the functions of the vagus nerve; obstructions of the intestines which force the contents back into the stomach or hinder their exit. Thus tumors on the duodenum, calculi in stomach or intestines, volvulus and invagination have been charged with producing overdistension. Chronic hepatic disorder has also been quoted as a cause.

Symptoms. The subject may eat naturally or excessively yet is unthrifty, the belly is habitually distended, the hair dry and rough, there is loss of flesh, there may be eructations or (in the horse) swallowing of air, lack of endurance, a disposition to perspire easily, a tendency to indigestion and colics after meals, and hurried breathing sometimes marked by a double lifting of the flank in expiration. In the dog which has the stomach more accessible to examination its outline may be followed by percussion, a tympanitic resonance being produced from the eighth rib back to the umbilicus or further. If there is any difficulty the organ may be emptied of water by a stomach tube and then pumped full of air by means of a Davidson’s syringe, and percussed in each condition. Or a half a teaspoonful of bicarbonate of soda may be given in a little water followed by an equal amount of tartaric acid, and the stomach percussed.

Lesions. The distension of the stomach may reach ten times its normal size in the horse (Leisering). Kitt found a stomach with a capacity of 84 quarts. Fitzroy Philipot took from a dilated equine stomach 140 lbs. of contents. The contents of the viscus are usually largely of solids which the weakened and attenuated walls failed to pass into the duodenum. On the contrary and as if by compensation, the pylorus and duodenum are constricted and the latter has liquid contents which pass from the stomach with very little of the solids.

Special dilatations are sometimes met with, thus an equine stomach has been found largely dilated at the greater curvature where concretions formed in the viscus or pebbles introduced with the food had habitually lodged. In other cases the cardia has been dilated like a funnel, so that the animal could eructate or vomit with great facility. This last dilatation is especially common in cribbiters.

Treatment. This must necessarily be prolonged as time must be allowed for a tonic contraction of the viscus. Food must be given often in small quantity, of easy digestion, and of aqueous composition. For dogs, milk, eggs and soups, or pulped raw meat furnish examples. For horses milk gruels, boiled flax seed, pulped roots may suffice. If the stomach is loaded as is usually the case, it should be washed out with the stomach tube, which when passed into the stomach should be raised at its free end and filled with tepid water; it is then suddenly lowered so as to act as a syphon in evacuating the liquid contents of the stomach. This may be repeated again and again, the stomach in the case of the dog being manipulated so as to mix and float the solids and favor their exit through the tube. Daily washing out of the stomach by the tube is of the greatest possible value.

Meanwhile we should seek to improve the tone of the stomach by strychnia (horse 2 grs., dog ¹⁄₆₀ gr. daily), by salts of iron, and by faradisation.

To counteract fermentation, antiseptics (salol, naphthol, freshly burned charcoal) may be given with each meal, along with pepsin and hydrochloric acid.

RUPTURE OF THE STOMACH IN SOLIPEDS.

Mainly in solipeds. Causes: overloading, fermentation, impossibility of eructation, violent concussions, falls, galop, concretions, dilatation, catarrh, ulcers, cicatrices, abscesses. Symptoms: Anamnesis, colic relieved, followed by prostration, sinking, complete anorexia, tender abdomen, vomiting, no abdominal rumbling. Lesions: tear in greater curvature, most extensive in outer coats, shreddy, bloody edges with clots, contents in omentum, other seats, partial ruptures. Treatment: in partial ruptures, stomach pump, diet. Prevention.

This is pre-eminently a disease of solipeds for the reason that they alone of domestic animals are especially liable to overload the comparatively small stomach and are mostly unable to relieve the overloaded viscus by eructation or vomiting.

Causes. These are in the main overloading of the stomach and overdistension, by the gases of indigestion. To this are usually added violent concussions when the animal throws itself down violently. The stomach distended to the fullest possible capacity, and lodged in a cavity which is not all equally tense, is comparable to a very tense bladder which is liable to burst when forcibly struck, or suddenly compressed.

Apart from such indigestion, cases are recorded in which the full stomach has been burst by a sudden fall in the shafts or elsewhere. Miles even records a case which occurred during a rapid galop after a full drink of water.

The presence of solid bodies (calculi, gravel) in the stomach or even in the intestines has appeared to cause rupture by blocking the outlet of ingesta and determining indigestion.

Certain conditions predispose to rupture, notably dilatation of the stomach with attenuation of its walls, cribbiting, old standing catarrh of the viscus, pre-existing ulcerations, cicatrices and abscesses.

Symptoms. There is usually the history of a full feed of grain, followed by violent colic, and indications of gastric overdistension, tense abdomen, dullness, then the rejection of the gastric contents by vomiting, the matters escaping by the nose, and then collapse. The violence of the colics may cease, but the pulse becomes rapid, small, and finally imperceptible, the breathing hurried, the head depressed, eyelids, ears and often the lower lips drooping, the face becomes heavy and expressionless, the belly distended and tender, the skin covered with cold sweat, and the temperature exalted above or depressed below the normal. There is never any disposition to eat nor drink. Death follows in a few hours.

In the vomiting which is independent of rupture, the symptoms are usually at once relieved, when the emesis occurs, since not only liquid and solid matters escape but also gaseous material. The pulse retains its fullness, the facial expression is that of intelligence and comfort, rumbling may be resumed in the bowels, fæces and urine may be passed, and colics are less acute. In favorable cases the animal may even desire to eat or drink.

Lesions. The usual seat of rupture is on the great curvature and may extend longitudinally for from six to ten inches. The laceration is usually most extensive in the outer coats, and the mucosa is carried outward with the escaping ingesta, which helps to efface the normal mucous folds at the cardia, and to render vomiting possible. The edges of the wound are more or less shreddy, and of a dark violet color from blood extravasation and clots. The escaping contents are rarely diffused in the cavity of the abdomen, but remain enclosed in the omentum through the thin meshes of which they can be easily seen, and which has sometimes been mistaken for the walls of the stomach reduced to this attenuated condition by disease. When the omentum gives way the contents are at once diffused through the abdominal cavity between the convolutions of the intestines. In exceptional cases the rupture has its seat in the lesser curvature, or even at the cardia. In still others the laceration implicates the muscular and peritoneal coats only, and the looser mucosa, filled with ingesta bulges outward as a hernia. In such a case a recovery seems possible if the viscus could be relieved of its contents.

Treatment is virtually hopeless. Yet a moderate laceration of the two outer coats only might be followed by recovery through the formation of a cicatrix. The first consideration would be the unloading of the stomach spontaneously or by the aid of the stomach pump, and thereafter the adoption of a rigidly restricted diet of easily digestible food (such as gruels) in small quantities at a time.

Prevention is much more available. In violent colics with overloading or tympany of the stomach, employ anodynes to keep the animal from throwing himself down violently, give a soft bed of litter where the shock on lying down will be lessened, employ antiferments to prevent gaseous distension, and whenever possible relieve the plenitude of the viscus by the stomach pump or tube.

TORSION OF THE STOMACH IN THE DOG.

Causes: mobility of dog’s stomach when empty, leaping, running down stairs. Lesions: viscus doubled forward, pylorus in front of cardia, duodenum compresses cardia, liver, spleen and omentum displaced, stomach tympanitic, lungs and heart compressed, latter gorged with dark blood. Symptoms: tympanitic abdomen, and half thorax, no rumbling, murmur in front of thorax, abdomen tender, patient stands, dyspnœa, emesis impossible. Course: violent symptoms in twelve hours, death in thirty-six. Diagnosis: sudden, severe seizure, complete anorexia, tympany, tenderness, dyspnœa, no vomiting, arrest of peristalsis. Obstruction. Peritonitis. Choking. Treatment: tapping, laparotomy, replacing the viscus.

This has been demonstrated by Kitt and Cadeac who believe that it is quite a common occurrence.

Causes. The predisposing cause is the extreme mobility of the canine stomach which hangs from the œsophagus like a pear from its stalk, the remainder of the viscus being only attached to the loose omentum, spleen, and commencement of the duodenum all of which it can carry with it easily when it rolls on itself. Its mobility is, however, very restricted when full, the liver on the one side and the spleen and intestines on the other proving almost insuperable obstacles to rotation. But when empty it moves with great freedom and by a sudden shock in leaping, gamboling or running rapidly down stairs the pylorus is carried forward and to the left until it and the commencement of the duodenum are jammed in front of the cardia. The result is the obstruction of the cardia and duodenum by their mutual pressure in crossing each other, and the interruption of the gastric circulation and functions.

Lesions. As just stated the stomach which would normally extend from the cardia downward and to the right is bent forward and doubled upon itself, the pylorus lying in front of the cardia, the duodenum extending from before backward above the cardia and tightly compressing it, the liver drawn to the left by the hepato-duodenal peritoneum, and the spleen displaced to the right by the traction on the omentum. The stomach enveloped in its omentum is distended by gas to perhaps ten times its normal dimensions and appears to fill the entire abdominal cavity while the intestines are pushed aside and concealed. The chest is compressed by the strong pressure on the diaphragm, and the lungs are congested of a deep blue and the right heart distended with dark blood. The animal appears to have perished of apnœa.

Symptoms. In fully developed cases the abdomen is greatly distended and tympanitic. The drumlike resonance is met with in the anterior part of the abdomen including the umbilical region. It extends forward over one-half of the thorax, excepting only a space of 5 or 6 inches square in the right hypochondrium, which represents the situation of the liver, and spleen. Auscultation furnishes no sound in the abdomen, and only in the anterior portion of the thorax is there a distinct respiratory murmur. The heart may beat strongly and rapidly, or weakly and slow, and the pulse is small and thready. The abdomen is tender. The animal stands, dull, and breathes with great effort. If made to walk it is done slowly, stiffly and with head extended, mouth open and tongue protruding. There is no sign of vomiting and this cannot be brought about by tickling the fauces, or even by giving apomorphine subcutem, though retching may be induced.

Course. The disease may develop into dullness and anorexia in two hours after boisterous health; in twelve hours there may be considerable tympany and dyspnœa; and a fatal result is reached in about thirty-six hours.

Diagnosis. This is based on the transition from vigorous health to sudden illness, with complete anorexia, inability to swallow or to vomit, tympany of the stomach as shown by percussion, tenderness of the abdomen, dyspnœa, disturbed heart-functions, and inactivity of the bowels. With intestinal obstruction on the other hand there is free vomiting of bilious and feculent matters. With peritonitis there is much greater and more uniform abdominal tenderness, vomiting and higher fever, but less tympany in the anterior abdominal region, and no such complete suspension of defecation. With choking there is no such progressive tympany, appetite and defecation are not so completely suspended, and liquids may often pass the obstruction in small quantities in both deglutition and vomiting. Choking is by no means so speedily fatal.