Functional Vomiting as Interpreted by Auscultation of the Abdomen

Abstract

THE two types of vomiting, postoperative and periodic, discussed in this article rest on a functional basis. Both are frequently the result of spasm of the pylorus, with simultaneous relaxation of the fundus and inhibition of the cardia. These factors may be produced by a number of different causes, the most important being certain drugs and the condition of the nervous system. Fatigue, alcohol and dietary excesses also play a leading part.Many physicians and surgeons fail to remember that spasm of the pylorus is the primary cause of vomiting in these functional conditions, and that acidosis and loss of fluids are the result and not the cause.Furthermore, the antispasmodic action of luminal sodium is not sufficiently appreciated, and one frequently overlooks the fact that this drug stops vomiting in the majority of such cases, usually within half an hour. No good results are obtained by giving it by mouth, since it either is vomited or fails to be absorbed. It must be given hypodermically and in fairly large doses, the first one being S or 6 gr. Usually one dose is enough.If one makes a practice of listening to the abdomen of patients with functional vomiting, one finds that they are uniformly silent before any medication is given. The spasm at the pylorus seems to effect the motility of the entire bowel. Twenty minutes to half an hour after the administration of luminal sodium peristalsis begins, and almost immediately the nausea and vomiting cease. Postoperative VomitingPostoperative vomiting is of frequent occurrence. It not only may be exceedingly distressing to the patient but at times results in disaster, so far as the operation is concerned. It is more frequent in nervous, high-strung persons than in others. Its occurrence depends to a large extent on the preoperative sedative and the kind of anesthetic used. Morphine is the sedative preferred by most surgeons and the one most conducive to vomiting by its central emetic action. Many surgeons still do not realize that morphine causes, on the one hand, pyloric spasm and, on the other, hypermotility of the small intestine. The net result is an irritable bowel, which together with the shock of the operation frequently produces postoperative vomiting. If luminal sodium were always used in large doses, both preoperatively and postoperatively, the incidence of vomiting and gas pains would be reduced to a minimum. Contrary to the prevailing belief, gas pains are due to a collection of gas not in a dilated, flaccid bowel but in a hypertonic and spastic small intestine. Morphine and other stimulants of the motor function of the bowel, although they may produce a temporary relief, in the end aggravate and prolong the trouble.Illustrative of the type of case under discussion is the following.A 50-year-old woman had a hysterectomy and vaginal repair and was given \4 gr. of morphine preoperatively. The anesthetic was ether. The operation was uneventful. After coming out of the anesthetic the patient vomited and continued to do so for the next 24 hours. During that time,...

Towards an Understanding of Public Property

“…Yet despite their revered status, access to wet sands can be perplexing. 168 In the United States piecemeal 169 public rights depend on the vagaries of jurisdiction, limited by the low tide in some states, extending to the mean high tide mark in others, and in Texas protected by public rolling easements to the first vegetation line. 170 Access is an underdeveloped discourse in the common law, 171 too often dependent on agency whim rather than espoused as a universal right qualified only on principle.…”