. Diseases of the stomach : including dietetic and medicinal treatment . )ain is often obscure. By some the pain is attributed to hyper-esthesia of the sympathetic plexus that overlies the abdominal aorta,while by others the pain is ascribed to a distal localization from painfuldistention of the aortic ring or ascending portion of the thoracic aorta. The generally accepted view is that epigastric pain is analogous tothe pain of intermittent claudication and is due to a diminished bloodsupply from vascular colic (Gefass Koliken of Nothnagel) of the affectedartery. For the analogy to be complete
. Diseases of the stomach : including dietetic and medicinal treatment . )ain is often obscure. By some the pain is attributed to hyper-esthesia of the sympathetic plexus that overlies the abdominal aorta,while by others the pain is ascribed to a distal localization from painfuldistention of the aortic ring or ascending portion of the thoracic aorta. The generally accepted view is that epigastric pain is analogous tothe pain of intermittent claudication and is due to a diminished bloodsupply from vascular colic (Gefass Koliken of Nothnagel) of the affectedartery. For the analogy to be complete one must imagine an increasedactivity in the gastjric wall itself, during increased peristalsis followingeating. This reason is probably sufficient to explain the occurrenceof ])ain after hearty meals, but does not explain the connection betweenpain and exercise requisite to produce it, unless we surmise that exerciseraises blood pressure, producing vasoconstriction in the splanchnic Fig. 122. Pain cliait of a patient witli angina abdominalis, showing the gradual onset of distress increasingtoward the height of gastric digestion, then slowly subsiding even though the i)atieut rests quietlyafter eating. area, and narrows the already sclerotic bloodvessels to produce a com-parative ischemia of the stomach wall. PaP regards vascular crisesto be due to arterial spasm producing cerebral cardiac or abdominalsymptoms as well as the paroxysmal phenomenon known as internalclaudication. According to Pal a rise of blood pressure precedes andaccompanies the crisis of pain, and in a few of his cases spasm or con-traction of the retinal arteries could be demonstrated. The group of arteriosclerotic ])atients })resenting ei)igastric ])ain as aprominent feature may be subdi\ided into three clinical groups. 1. A dull aching or throb})ing pain may be experienced about one hourafter eating, which is not due to gas. As a rule the heartier the mealthe greater the distress. It is probable that in
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