Acid and Enzyme Content of Postoperative Emesis as Indication of Regurgitation from the Duodenum

Abstract

The lack of knowledge concerning the cause of the nausea and vomiting which follows surgical operation prompted these studies. We have examined 115 specimens of postoperative vomitus from 62 cases chosen at random to include anesthetics and operations of many types. Over half had had ether either alone or in combination with other anesthetics. These factors seemed to bear no relationship to the results tabulated below. Cushing has recently called attention to a possible nervous mechanism in the production of peptic ulcer. In this connection it is interesting to note that of 11 specimens with an acidity over 20, 7 were obtained following operations for brain tumors. This observation might be explained by Cushing's postulation of a center in the cerebrum which is capable of promoting gastric secretion. Not only the cases that actually vomit have this anacidity. Postoperative aspiration was done by nasal catheter in 15 patients, In these specimens there was no free acid. This lack of acid is not accompanied by a corresponding lack of enzymes. In all cases where free acid was present peptic activity was present, and in most of the cases (91 of 115) where the acid was absent peptic activity was detected after acidification with 0.4% hydrochloric acid. Rennin was present in 80 of 115 specimens. Evidence of duodenal regurgitation is present as witnessed by the fact that of 115 cases, only 57 had bile in the stomach, while a considerably greater number contained pepsin but were not acid. Specimens from 75 cases were found to contain trypsin. Twenty-five of these 75 samples contained no bile.