Studies on Acholic Cachexia

Abstract

The occurrence of peptic ulcer of the duodenum after the exclusion of bile has been noted with a wide variation in frequency and the factors concerned are not clearly understood. Kapsinow and Harvey, 1 using a cholecystnephrostomy, produced ulcer in 17 out of 43 animals. Bollman and Mann 2 by simply ligating the common ducts produced ulceration in about 60%. In the experiments of Berg and Jobling 3 in which a Rous type of fistula was used, ulcers resulted in 13 of 23. Kim and Ivy report 10% ulcers in one series 4 in which the common duct was tied, but 60% in cases of Rous fistula.

Besides the obvious acid factor, there is considerable evidence that other influences are at work. Ivy has suggested that the mechanical irritation of the tubing near the duodenum may be important. On the other hand Elman has seen but few ulcers resulting from bile fistula alone. Our own experience has been that simple duct ligature alone caused ulceration in numbers about one-half the rate usually suggested (60%), but that a very high percentage resulted from the Rous fistula which has proven very difficult technically in our hands. Berg suggests that the general condition of the dog is very important and found that animals kept under poor hygienic conditions developed ulcer in 100% while those better cared for showed only 30%.

Using the Dragstedt cannula for making the biliary fistulas we have been surprised at the freedom from this complication. Twenty such experiments have been made and not a single ulcer has developed, as evidenced either by post-mortem examination or presence of blood in the stools. These animals have been fed on various diets, some with large amounts of meat and others with high carbohydrate content.