Otsuji, Sadao

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TitleA PHYSIOLOGICAL STUDY ON VOMITING INDUCEDBY THE STIMULATION OF THE PARIETALPERITONEUM OR BILIARY TRACTAuthor(s)Ot uji, SadaoCitation日本外科宝函 (1955), 24(4): 365-372Issue Date1955-07-01URL http://hdl.handle.net/2433/206196RightType Departmental Bulletin PaperTextversionpublisherKyoto UniversityA PHYSIOLOGICAL STUDY ON VOMITING INDUCED BY THE STIMULATION OF THE PARIETAL PERITONEUM OR BILIARY TRACT by SADAO 0TSUJI From the 2nd Surgical Division, Kyoto University :¥frdical School (Director: Prof. Dr. YAsDMASA AovAor) (Received for publications : June 20, 1955) INTRODUCTION 365 SCHRAGER and Ivy who produced nausea, vomiting and distress by distending the bile ducts and gall bladder in dogs maintained that the afferent paths were the vagi and the right splanchnic nerves. WALTON, MooRE and GRAHAM had to section both the vagi and the splanchnic nerves in order to prevent vomiting of experimental peritonitis. WANG and BoRISON who studied the afferent paths from the gstrointestinal tract in copper sulphate emesis claimed that the afferenet paths were the vagi and the sympathetic nerves. I studied the afferent paths for vomiting arising from the bile ducts and gall bladder. On the other hand, vomiting has been considered as a peritoneal symptom by many clinical physicians. Does vomiting occur by stimulation of the parietal peritoneum ? I attempted to solve this problem. Concerning the sensory innervaion of the parietal peritoneum, it will be described in the next report. EXPERIMENTAL MATERIALS AND METHODS. 8 young cats (below l.2kg.) and 18 adult cats (2.0kg-4.0kg) were used. 戸 Experimentswere made under following conditions. 1) Unanesthetised, no decerebration, no section of nerve trunks 8 cases 2) decerebration, no section of nerve trunks 5 cases 3) decerebration, section of intercostal nerves 2 cases 4) ~ bilateral splanchnectomy 3 cases 5）グ bilateralvagotomy in the neck 5 cases 6）グ bilateralvagotomy in the neck together with right splanchnectomy 3 cases Young cats were used only in the first experiments. Decerebration was performed by SHERINGTON’s method. As indications of noci-reflex I measured the blood pressure through a carotid artery or recorded the contraction of the abdominal rectus muscles by MILLER’s method. Pinching with a forceps was used as a mechanical stimulus on the parietal peritoneum, electric faradization by Du Bms RAYMOND as an electrical stimulus and 366 自主外科宝函第24巻第4号painting with tincture of iodine or carbolic acid as a chemical stimulus. Mechanical and electrical stimuli were given ~o the biliary tract. Y. WATANBE of our clinic proved that subcutaneous injection of adequate doses of acetylcholine produced vomiting in cats or it facilitated the emetic response to the mechanical stimulation of the digestive organs. But he did not succeed to produce vomiting after stimulation of the parietal perintoneum by this method. In my experiments various stimuli were given to the parietal peritoneum or biliary tract after subcutaneous injection of acetylcholine. Stimuli were given to the vagal branches of the stomach, vagal trunks in the neck and intestine etc. as controls. EXPERIMENT AL RESULTS I. Experiments on the unanesthetized and undecerebrated cats in which nerve trunks were left intact. 8 young cats were used. The animals were kept in spine position, the abdomen was opened and various stimuli were giv巴noロtheparietal peritoneum. The animal cried or struggled to avoid, but did not vomit. Immediately after stimulation of a vagal branch of the stomach it vomited. Soon after vomiting the stimulation were given to the parietal peritoneum but the cat did not vomit. The abdomen of the animal was opened, a wide area of the parietal peritoneum was painted with tincture of iodine or carbolic acid protecting the abdominal viscera from the chemicals with gauze, and then the abdominal wall was closed. Vomiting did not occur in any case. The following experiments were made in order to decide the sufficient doses of acetylcholine to cause vomiting. 0.2cc, 0.3cc, and 0.4cc of acetylcholine solution (O.lgm/20cc) was subcutaneously injected to each cat 800gm, 860gm, and 760gm in weight respectively. Only the third cat vomited. The third cat was us吋 onthe next day as a experimental material. 760gm o unanesthetised cat was tied in spine position, the abdomen was opened and electrical stimuli were given to the parietal peritoneum, but vomiting did not occur. It vomited soon after electrical stimulation on the vagal branches of the stomach or the bile ducts. Immediately after vomiting el巴ctricfaradization of the parietal peritoneum were made but the animal did not vomit. Subcutaneous injection of 0.3cc of acetylcholine solution was done to this cat on the day. In 5 minutes after the administration the animal vomited several times. In 2 minutes after recovering from vomiting electric faradization was given on the parietal peritoneum (in the ileocecal region) Vomiting recurred immediately. 2. Experiments on the decerebrated cats. VOMITING INDUCED BY THE STIMULATION OF THE PARIETAL PEEITONEUM 367 One of five cats vomited immediately after pinching of the parietal peritoneum (at the navel or in the ileocecal region) with a forceps(Fig. 1). The other four cats vomited easily by stimulating the vagal branches of the stomach or the bile ducts but did not vomit by stimulation of the parietal peritoneum. Among them, however, the below mentioned 2 cats vomited by electric stimula-tion of the parietal peritoneum after subcutaneous injection of acetilcholine. 2.8kg. 9 (Fig. 2) Electric faradization on a vagal branch of the stomach produced vomiting easily but stimulation of the parietal peritoneum failed to cause vomiting. In 6 minutes after subcutaneous injection of 0.6cc of acetylcholine solution the animal vomited. In two minutes after the recovery from vomiting electric faradization were given on the parietal peritoneum at the height of the navel and in the ileocecal region. (2 volt 8cm.) The animal vomited. 2.2kg o (Fig. 3) In 5 minutes after subcutaneous injection of O.Scc of acetylcholine electric faradi-zation was given on the parietal peritoneum in the ileocecal region (2 volt. 8cm) The animal vomited immediately. 3. Experiments on the decerebrated cats in which intercostal nerv巴swere sect-ioned distal to the white communicant rami. 2.0kg 0 Right 8th-12th intercostal nerves were sectioned distal to the white communicant rami in the decerebrated cat. In two minutes after subcutaneous injection of acetylcholine electric faradization was given on the parietal peritoneum in the right upper abdomen. But vomiting did not occur. On the other hand, immediately after electric faradization of the stomach and jejunum the animal vomited. Electric faradization of the parietal peri-toneum in the right lower abdomen caused vomiting. This result suggests that intercostal nerves are the main afferent paths for vomi-ting arising from the parietal peritoneum in the upper abdomen. 4. Experiments on the decerebrated cats in which bilateral splanchnectomy was done. The greater and lesser splanchnic nerves were bilaterally sectioned and decerebra-tion was done on the next day. 2.Skg. o (Fig. 4) Stimulation of vagal braches of the stomach and the bile ducts caused vomiting easily. Stimulation of the parietal peritoneum did not cause vomiting. In three minutes after subcutaneous injection of O.Scc of acetylcholine solution, stimuli were given to the parietal peritoneum in the upper abdomen. But the cat did not vomit. 5. Experiments on the decerebrated cats in which bilateral vagotomy was donぞ368 日本外科宝函第24巻第4号in the neck. 5 cases. Electric faradization of the bile ducts (the hepatic duct, cystic duct and common bile duct) caused the contraction of the abdominal rectus muscles but did not cause vomiting. (Fig. 5) Electric faradization of the bile ducts after subcutaneous injection of O.Scc of acetylcholine solution caused vomiting. One of the five cats vomited immediately after electric faradization of the pari-etal peritoneum. (Fig. 6) 6. Experiments on the decerebrated cats in which bilateral vagotomy in the neck and right splanchnectomy were done, 3 cases. After subcutaneous injection of acetylcholine stimulation of the bile ducts and gall bladder was done. Vomiting did not occur in any case. (Fig. 7) DISCUSSION Most parts of the parietal p巴ritoneumare afferently innervated by the intercostal and lumbar nerv巴sand a part of the retroperitoneum by the phrenic nerves. Vagal and splanchn;c nerves are not considered to contain afferent nerve fibers from the parietal peritoneum. The emetic reflex arising from the parietal peritoneum was demonstrated in my experiments. How can we consider the mechanism of this reflex ? 1. The animal vomited by stimulation of the parietal peritoneum under the ad-equate administration of acetylcholine. 2. A region of the parietal peritoneum which lost the innervation of intercostal nerves gave no emetic response to the stimulations. 3. Bilateral vagotomy did not always inhibit to cause vomiting at the stimulation of the parietal peritoneum. 4. 3 cats in which bilateral splanchnic nerves were sectioned did not vomit by stimulating the parietal peritoneum. From these results we must consider that the main afferent pathways of emetic reflex from the parietal peritoneum are intercostal nerves and the splanchnic nerves seem to play a role in this reflex as efferent paths as well as the vagal nerves. The vagus, splanchnic and phrenic nerves are considered to be visceral affer官itsof the bile ducts or gall bladder. According to my experiments I) Stimulation of the bile ducts and gall bladder caused vomiting easily. 2) Stimulation of the bile ducts or gall bladder in bilaterally vagotomized cats couldn’t induce vomiting, but the same stimulus given after subcutaneous injection of acetylcholine solution made it possible. 3) Cats in which splanchnic nerves were bilaterally sectioned easily vomited by stimulation on the bile ducts or gall bladder. CONCLUSION 1) Cats rarely vomit by stimulation of the parietal peritoneum without precee-VOMITING INDUCED BY THE STIMULATION OF THE PARIETAL PERITONEUM 369 ding injection ’of acetylcholine. Vomiting has been considered as a peritoneal sympt-om by many clinical physicians, but we can not recognize it unless patients are in such a special condition as ( acetylcholine) shock. The afferent paths of this reflex are intercostal nerves and splanchnic nerves seem to play a role in this reflex as efferent paths as well as the vagal nerves. 2) The afferent pathways of emetic reflex from the biliary tract are considered the vagi and the right splanchnic nerves. I am much indebted to Assist. Prof. Ch. KIMURA, M. D. of our clinic for his constant help throughout my study. Explanation of Fig・ures Fig・. 1 Pinching the parietal peritoneum with a forceps caused vomiting. Kymogram shows the cont-raction of abd. rectus muscles on both sides. Fig・. 2 Electric faradization of pari巴talperitoneum (at the navel) after subcutaneous injection of A. C. H. caused vomiting. Kymogram shows the change of the blood pressur巴．Fig・. 3 Electric faradization of the parietal peritoneum aft巴rsubcutaneous injectioon caused vomiting. Kymogram shows the contraction of abd. rectus muscle. Fig・. 4 Bilateral splanchnectomy. Electric faradization of th巴 pari~tal peritoneum did not cause vomiting even after subcutaneous injection of A. C. H. Kymogram shows blood pressure dming the expe-riment. Fig. 5 Bilateral vagotomy in the neck. Stimulation of the biliary tract did not cause vomiting. The contraction of the abdominal rectus muscles. Figl 6 Bilateral vagotomy in the neck. Stimulation of the parietal peritoneum after subcutaneous inje-ction of /¥. C. H. caused vomitng. Kymogram shows the contraction of abd. rectus muscle. Fig-. 7 Bilateral vagotomy in the neck, Right splanchnectomy. Electric faradization of the biliary tract caused the rise in tne blood pressure but no vomiting even after subcutaneous injection of A.C. H. References 1) Asai,$., and Masuyama, M., Kyoto Igaku Zassi 25, 31. 1928 2) Cannon, B., Am. J. Ph-ysiol. 105, 366, 1933 3) Derbyshire A., and Ferguson, J., Am. ]. Physiol. 123, 52, 1937 4) Goldberg, S. L., Am. ]. Physiol. 99, 156, 1931 5) Hatcher, R. A., Physiological Reviews 4, 4 79, 1924 6) Hacheτ，R. A., and Weiss. ]. Pharm. Exp. Therap. 22, 139, 1924 7) Kimura. Ch., Ni-hon Gekagakukai Zassi 52, 450, 1951 8)Kimura, Ch., Rinsho no Shinpo 7 9) Kushizaki, K. Nihon Yakurigaku Zassi 42, 148, 10) Kunz, A., The Autonomic Nervous Systom 239, 256, 1947 11) Kure. K., and Okinaka S., Jiritsu Shin-和文抄録keik巴i1941 12) Miller, F. R., ]. Physiol. 41, 409, 1910 13) Miller, F. R., Am. J. Physiol. 71, 84, 1924 14) Miller, F. R., and Simpson H. M吋Am. J. Physiol. 72, 231, 1925 15) Openshowski, T., Zentral. f. Phys. 3, l, 1889-1890 16) Schrager, R. L., and Ivy, A. C., Surg, Gynec, and Obst. 54, 133, 1932 17) Sherrington, C. S., J. Physiol. 38, 375, 1909 18) Wangs. C., and Borison, H. L., Am. J. Physiol, 164, 520, 1951 19) Watanabe, Y., Archiv fir japanische Ch-irurgie 23, 38 1954 20) White, J. C., and Smithwick, R. H., The Autonomic Nervous System 1941. 体壁腹膜或は胆道の刺戟により惹起されるn1副士に関する生理学的研究京都大学医学部外rl第2f.11~応（青柳安誠教授指導）尾辻貞夫多くの臨床家により腹膜刺戟症状と考えられてい る1¥l[吐！＇.·~＇ Lて体壁腹膜の刺市長に依って起り得るもの370 日：本外科宝函 第24巻 第4号respiration Fig. 1 」！吋州川A~Wv~＼w~w，~ ·川A blood pressure Fig・. 2 一一／＼（｛』一Yト－－－ム・ 白白目性＇＇’ l ' ・a・・，，， _-LI.凶 ιιι山 ............... ιμ A B Fig. 3 一＼〆common bile due七f↓ ＿ _ f Iい←樋叫』品.. 剖A・......＿.，.，叫司、“ －con主ロonbile du c七2.6 kg. Th.3-Th.4 Fig・. 4 ー～鴨川似，A州、川~~Yi.…一川崎川～t宇．。n官non 『v ’．bile hep a七ic cys七iC'du・c七 due七 due七VOMITING INDUCED BY THE. STIMULATION OF THE PARIETAL PERITONEUM 371 bila七eralcervical vago七omyts ~ー｛ーレ 」ーI-rectus 岨ぷ刷吋悌蜘刷…酬R‘H阿申叫伺.f. comm。nbi工ie' dtλc七 hepa七ic c-ys七i~ due七dueむFig・. 5 J士i山／vom1t1喝ω札反町ム"' fl~ . ~＜？.rmnon bile due七 faradiza七ion巾 M・・h‘・6・h白 日”・ － ・ー ’. －~・・”・・副嗣同・・・・・・圃・・掴匹2・P.P. Fig. 6 2.5 kg＇.合bi la七eralcervical vago七omyrigh七 splanchnec七。my？』faradiza七ioncon加10nbile du c七Fig-. 7 372 日本外科宝函第24巻第4号であるか， Z苗を使用して，此の問題に実験的吟味を加 症状と考えられているが，患者がシヨヲグのような特え，叉胆道の刺戟により惹起されるilM[吐の求心路を研 殊の条件に置かれなければ，この様な症状は発現し難究した． いと考えられら．!) 予めアセチ－Iレコリンを注射して帳吐を誘発せ この反射の求jし路（土肋間神経で，内臓神経はこの反しめF その快復後2～3分後体躍腹膜を刺戟すれば， H医 射に於いて迷走神経と同様にp 遠心路としてある役割吐を再発せしめ得る． を果すものの如くである．予めアセチ－Iレコ Hンの注射をしない場合， f仁川.j辺 2) 胆道からの恒吐反射の求心路は，迷走神経と右l震の刺戟により司猫に暇吐を誘起することは出うたな 内臓神経と考えられる．い．これによれ 晦吐は多くい｝日！ポ家により腹膜刺戟

体壁腹膜或は胆道の刺戟により惹起される嘔吐に関する生理学的研究

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体壁腹膜或は胆道の刺戟により惹起される嘔吐に関する生理学的研究

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