Phlegmonous Gastritis.
Synonym:—Acute suppurative gastritis.
Definition:—An inflammation of the tissues of the stomach, resulting in suppuration within the sub-mucous structures, ultimately extending to the muscular coat.
Etiology:—The disease appears at all ages of adult life, very rarely as a primary disorder. Usually it follows as a sequel to acute infectious fevers, notably those strictly designated as septic fevers. It is common to alcoholics, occuring more frequently in males than in females. It may occur in a circumscribed form, known as stomach abscess, in which the symptoms are not necessarily severe, or it may occur in a diffused form, involving the sub-mucous structures of perhaps the entire organ, in which case it produces profound constitutional disturbances, runs a rapid course and terminates in death. The disease is fortunately of rare occurrence.
Symptomatology:—Usually there is an initial chill, quickly followed by an abrupt rise of the temperature to 104° or 105° F. The evidences of severe illness are immediately apparent. There is severe pain in the stomach, radiating over the entire abdomen, which is distended, and which is often, especially in the diffused variety, quite tender. Over the stomach the tenderness may be exquisite. There is often severe vomiting, difficult of control. The vomitus is composed of bile mixed at first with the fluids of the stomach; ultimately the substance is brown or black in color, containing blood. Pus is found, if at all, in those cases which may be considerably prolonged. Quite quickly the symptoms assume the character of a low typhoid type. The patient becomes jaundiced, there is mental dulness, stupor and coma follow, and death results. The seriousness of the disease depends both upon the extreme septic infection and upon the involvement of so important an organ as the stomach.
Diagnosis:—The diagnosis is difficult, the presence of the disease being determined by the profound toxemia exhibited by the development of typhoid symptoms in conjunction with the other indications.
Prognosis:—The prognosis is always unfavorable. Usually death results within a few days. In an occasional case the symptoms may be milder, but there is chilliness, with erratic temperature, increasing prostration and ultimate death.
Treatment:—The treatment is very unsatisfactory. If the suppuration could be anticipated, favorable results could be obtained, but this being impossible, but little is accomplished by medicine. Remedies that exercise a soothing influence upon the stomach should be used in conjunction with echinacea, baptisia and calcium sulphid, to prevent or retard the development of pus and to antagonize pyemia. Echinacea has proven to be a most valuable remedy in this latter named condition. Later the soluble ferric iodid would be beneficial. Food should be administered per rectum at first, later easily digestible or pre-digested foods only should be given. At the onset, when pain is severe, hypodermic injections of morphin should be administered, as in the toxic form of this disease, and perhaps strychnin, to support the strength.
