Prognosis. — Cases  of  chronic  gastritis  seen  early  and  systematically
treated  get  well.  Advanced  cases  are  comfortable  only  on  a  non-irritating
diet  and  require  continuous  therapeutic  management.
iii.  Dilatation  of  the  Stomach.
Castrcctasis.
Enlargement  of  the  stomach,  usually  attended  with  weakening  and
thinning  of  the  various  coats,  and  supersecretion.  Acute  and  chronic
dilatations  are  recognized.
irni;


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940  MEDICAL  DIAGNOSIS.
Acute  Dilatation* — The  etiology  is  not  well  understood.  The  condi*
tion  is  that  of  paralytic  distention  of  the  organ.  Among  the  assigned  causes
are  local  and  general  debilitating  conditions,  trauma,  general  aniesthesia
and  other  forms  of  narcotism,  and  dietetic  errors,  especially  excesses  in  beer.
Post-mortem  findings  point  to  acute  dilatation  as  a  terminal  condition  in
acute  illness,  especially  pneumonia  and  cardiac  disease.
Symptoms. — Sudden  collapse   symptoms,  the  vomiting  of  enormous
J.,  amounts  of  fluid,  moderate  pain,  and  pressure  symptoms  from  dist-ention,

I   I  as  dyspnoea   and   cardiac   oppression,   constitute  the  symptom-complex.
The  fluid  reaccumulates  as  fast  as  vomited,  the  pylorus  remaining  in  a
condition  of  spasmodic  closure.
Physical  Sis:n8. — The  physical  signs  of  enormous  distention  of  the
stomach  are  present.  The  enlargement  is  often  such  that  its  true  outline
is  lost.  Peristalsis  is  not  observed.  The  removal  of  large  amounts  of  fluid,
as  much  as  eight  or  nine  pints,  by  the  stomach-tube  and  subsidence  of  the
distention  are,  as  a  rule,  followed  by  only  transient  relief  of  symptoms.
This  fluid  is  dark  brown  or  clear  and  contains  traces  of  blood  and  bile.
Its  odor  is  foul  but  not  fecal.  HCl  is  present  in  diminished  but  variable
amounts,  and  there  are  in  some  cases  traces  of  lactic  acid.  Constipation,
oHguria,  and  torturing  thirst  not  easily  allayed  aie  among  the  symptoms.
