Basic Gastro-Enterology. Including Diseases of the Liver by J. M. Naish

By J. M. Naish

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Those with Group Ο blood and those unable to secrete A B substances into their saliva and gastric secretions have a greater liability to duodenal ulceration. Patients with chronic anoxia and infection (namely, chronic emphysema) seem more liable, as do patients with rheumatoid disease and polycythaemia. 52 BASIC GASTRO-ENTEROLOGY 4. —Patients with hyperparathyroidism and tumours of the pancreatic islets (cells) are unduly prone to duodenal ulcer, whereas those with pituitary or adrenal failure are immune.

Hyper-rugosity of the stomach, often diagnosed radiologically, but erroneously, as chronic hypertrophic gastritis, is seen in hypersecretory states, commonly duodenal ulcer, and also in the rare Zollinger-Ellison syndrome (see p. 51). Hyper-rugosity is also found in the protein-losing gastropathy, Ménétrier's disease. GASTRIC ULCER There are four clinical groups separated by differences in causation, symptoms, and management (Table I). A E T I O L O G Y (Fig. 10) T h e difference between the acute gastric ulcer and the chronic lesser curve ulcer is that the one heals without trace, and the other, if it heals at all, leaves a scar.

There is often difficulty even on the operating table in distinguishing the condition from carcinomatous infiltration. —This is a locally invasive tumour of the muscularis which easily ulcerates and bleeds. It is rare, and the first manifestation may be a haematemesis. Radiologists can distinguish the smooth oval filling defect of this type of tumour from that caused by a cancer. —May develop primarily or in a leiomyoma, and is very rare indeed. Bleeding is an early symptom. —Single or multiple adenomatous polyps in the stomach are not very unusual.

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