Go to chapter: 1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | 12 | 13 | 14 | 15 | 16 | 17 | 18 | 19 | 20 | 21 | 22 | 23 | 24 | 25 | 26 | 27 | 28 | 29 | 30 | 31 | 32 | 33 | 34 | 35 | 36 | 37 | 38 | 39
Chapter 26 (page 124)
Lang et al. (l986) examined the gastrointestinal motor correlates of vomiting in canines
by means of implanted extramural strain gauge transducers. One of the motor responses
was a retrograde peristaltic contraction commencing in the middle of the small intestine
and moving in an orad direction through the small intestine to the gastric "antrum".
Ejection did not occur after a consistent delay following the "antral retrograde peristaltic
contraction", i.e. there was no evidence that the antral contraction correlated with vomitus
ejection. This was consistent with previous findings that the stomach did not provide the
propulsive force for vomitus ejection; it was more likely that the propulsive force was
provided by contractions of the abdominal or respiratory muscles. The small intestinal
retrograde peristaltic contraction, leading to gastric "antral" contractions, was probably
mediated peripherally by muscarinic cholinergic receptors as it was selectively blocked
by atropine (which does not readily cross the blood-brain barrier).
During routine barium studies we observed the act of ejection in 5 or 6 patients. Because
of violent movements it was usually not possible to obtain satisfactory radiographs. The
following is a representative case:
Case 26.4. S.S., female aged 42 years. After swallowing two mouthfuls of barium, it
accummulated in the pyloric region. Incomplete contractions of the pyloric sphincteric
cylinder, not propagating the barium into the duodenum, soon started. Almost
immediately the patient felt nauseous and retching commenced. At this stage the pyloric
sphincteric cylinder contracted maximally, giving rise to an appearance sometimes called
"amputation of the antrum". Immediately afterwards a long spastic contraction occurred
in the body of the stomach, associated with ejection. Two contracted areas were then
present in the stomach, namely the contracted sphincteric cylinder, and a larger region of
contraction of the body of the stomach. At that stage most of the remaining barium was
in the upper part of the stomach, above the contracted regions. Subsequent clinical
examination revealed no obvious cause for the vomiting.
With the exception of Torgersen (l942), none of the authors quoted above based their
descriptions of nausea, retching and vomiting on the muscular anatomy of the stomach as
previously determined by Cunningham (l906), Forssell (l913) and Torgersen himself.
Our radiographic observations show that nausea is characterized by loss of gastric tone,
absence of peristalsis and cyclical contractions of the pyloric sphincteric cylinder, and
lack of emptying of fluid barium in the erect position. A number of authors described the
electromyographic phenomena recorded during nausea (Monges et al. l974; You et al.
l980, l984; Hamilton et al. l986; Geldof et al. l986). It is probable that some of the
electrical arrhythmias may be associated with the appearances seen at radiography.
Pressure studies of Kerlin (l989) confirmed that postprandial "antral" hypomotility was a
major factor in unexplained nausea.
The representative cases described here show that retching is associated with contraction
of the pyloric sphincteric cylinder; this is well seen during radiographic studies.
Although Lumsden and Holden (l969) did not base the morphology in their cases on the
anatomy as described by Torgersen (l942), accompanying illustrations leave little doubt
that the pyloric sphincteric cylinder was contracted in all. Wood and Astley (l952) and
others (Chap. 20) described a temporary narrowing in the pyloric region closely
resembling infantile hypertrophic pyloric stenosis, in vomiting infants. Judging by the
descriptions it involved the pyloric sphincteric cylinder. The endoscopic appearances
described by Schindler (l937) also tally with contraction of the sphincteric cylinder.
Radiography shows that the cylinder is contracted during ejection. By means of strain
gauge transducers in canines Lang et al. (l986) demonstrated an "antral retrograde
peristaltic contraction", which appears to tally with contraction of the cylinder; this
contraction, however, did not provide the propulsive force for ejection. Radiographically
a second, longer area of contraction was seen in the upper part of the stomach during
ejection, in addition to the contraction of the cylinder in one of our cases (Case 26.4).
- Barclay AE. The Digestive Tract. Cambridge University Press,
London l936, p 268.
- Cunningham DJ. The varying form of the stomach in man and the anthropoid
ape. Trans Roy Soc Edin l906, 45, 9-47.
- Forssell G, Über die Beziehung der Röntgenbilder des menschlichen
Magens zu seinem anatomischen Bau. Fortschr Geb
Röntgenstr l913, Suppl 30, l-265.
- Geldof H, Van der Schee EJ, Van Blankenstein M, et al. Electrogastrographic
study of gastric myoelectrical activity in patients with unexplained nausea and
vomiting. Gut 1986, 27, 799-808.
- Hamilton JW, Ballahsene BE, Reichelderfer M, et al. Human electrogastrograms:
comparison of surface and mucosal recordings. Dig Dis Sci l986, 31,
- Kerlin P. Postprandial antral hypomotility in patients with idopathic nausea and
vomiting. Gut l989, 30, 54-58.
- Lang IM, Sarna SK, Condon RE. Gastrointestinal motor correlates of vomiting in
the dog: quantification and characterization as an independent phenomenon.
Gastroenterology l986, 90, 40-47.
- Lumsden K, Holden WS. The act of vomiting in man. Gut l969, l0,
- Monges H, Salducci J, Naudy B. Electrical activity of the gastrointestinal tract in
dog during vomiting. In: Gastrointestinal Motility, edit Daniel EE.
Mitchell Press, Vancouver l974, pp 479-488.
- Schindler R. Gastroscopy. University of Chicago Press, Chicago
l937, p 145.
- Stoddard CJ, Smallwood RH, Duthie HL. Electrical arrhythmias in the human
stomach. Gut 1981, 22, 705-712.
- Telander RL, Morgan KG, Kreulen DL, et al. Human gastric atony with
tachygastria and gastric retention. Gastroenterology l978, 75, 497-
- Torgersen J. The muscular build and movements of the stomach and duodenal
bulb. Acta Rad l942, Suppl 45, pp 38, 39.
- Wood BSB, Astley R. Vomiting of uncertain origin in young infants. Arch
Dis Child l952, 27, 562-568.
- You CH, Lee KY, Chey WY, et al. Electrogastrographic study of patients with
unexplained nausea, bloating and vomiting. Gastroenterology l980,
- You CH, Chey WY. Study of electromechanical activity of the stomach in
humans and dogs with particular attention to tachygastria.
Gastroenterology l984, 86, 1460-1468.
Previous Page | Table of Contents | Next Page
© Copyright PLiG 1998