. Diseases of the stomach : including dietetic and medicinal treatment . )oth, may be seen between the tubules of the adjacent otherwisehealthy mucous membrane, and the base of the ulcer is similarly PATHOLOGY 105 infiltrated and necrotic. In the acute ulceration, adhesions to theneighboring part are not ordinarily found, even though the ulcer extendto the serous coat, or even perforate. Lymphangitis is often present,radiating from the base of the ulcer. The exulceratio simplex, described by Dieulafoy, is practically anacute mucous ulcer, broad and shallow, extending partially or com-pletely t
. Diseases of the stomach : including dietetic and medicinal treatment . )oth, may be seen between the tubules of the adjacent otherwisehealthy mucous membrane, and the base of the ulcer is similarly PATHOLOGY 105 infiltrated and necrotic. In the acute ulceration, adhesions to theneighboring part are not ordinarily found, even though the ulcer extendto the serous coat, or even perforate. Lymphangitis is often present,radiating from the base of the ulcer. The exulceratio simplex, described by Dieulafoy, is practically anacute mucous ulcer, broad and shallow, extending partially or com-pletely through the mucous coat of the stomach. It is often the causefor sudden hematemesis, but the bleeding point is often with greatdifficulty discovered, even after the stomach has been opened. Beingonly a type of acute ulcer, it will require no further description. Fig. 20. Pyloric sphincter seen from the duodenal side, showing duodenal ulcer infolded, resemblingfissure in ano. (Codman.) Codman^ has made an interesting comparison between ulcer of theduodenum and fissure of the anus. Ulcer of the duodenum usuallyoccurs outside the pyloric ring, so that when the pylorus is contractedthe ulcer lies in the mucous folds just as a fissure of the anus lies inthe folds of the anal sphincter, and about its periphery there is oftena certain degree of inflammatory induration. This infolding of theulcer, by the mucous puckering during pyloric closure, explains thefreedom from pain that occurs when the stomach is full and the pyloricorifice is closed, and also gives us an explanation of the pylorospasm,and of the acute exacerbations which are characteristic of its clinicalcourse. The relation of the ulcer to the pyloric sphincter may explainthe difficultv of healing, which is so characteristic of duodenal ulcera- 1 Boston Medical and Surgical Journal, September 2, 19
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