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By Hugh Devine (Auth.)

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Extra info for The Surgery of the Alimentary Tract

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Therefore no pain receptors are required ; it is only necessary for the stomach to have sensation which will indicate when it is full. Thus receptors sensitive to tension are the main ones provided in 30 THE DIAGNOSIS OF SURGICAL DYSPEPSIA the stomach. Stimulation of these tension receptors may cause a sensation of fullness, discomfort, or pain. —With a view to affording physiological and anatomical explanations of epigastric tenderness and rigidity and of the * deep tender spot '— manifestations which are found in most dyspeptic syndromes—it is of value to discuss the path of the tension impulses : that is, the path of the afferent sensory fibres from the stomach {Fig.

15) which produced almost complete obstruction of the pylorus in four months. In this case, severe cramp-like pains were present four hours after every meal, and they coincided with the development of deep, powerful, visible peristaltic waves which set in about this time. 32 THE DIAGNOSIS OF SURGICAL DYSPEPSIA Where obstruction in a hollow organ develops slowly, the same degree of spasm and therefore pain does not occur. For example, in the case of slowly growing pyloric carcinoma, tetanic-like spasm of the gastric muscle, which has hypertrophied slowly, does not occur ; and in this case no definite pain results.

In other cases where the malignancy is more of a tumefaction than an infiltration, an unusual type of pain may occur as the stomach empties. The emptying stomach contracts on the carcinomatous lump (only if it is in the prepyloric portion of the stomach), and appears to go into a state of painful spasm round it. It seeks, as it were, to expel this lump in its wall as if it were a lump of food. This painful spasm occurs in other hollow organs and is analogous to that which sometimes occurs in carcinoma of the lower end of the sigmoid {see pp.

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