Volume 1
A Textbook of the theory and practice of medicine ... / edited by William Pepper.
- Date:
- 1893-94
Licence: Public Domain Mark
Credit: A Textbook of the theory and practice of medicine ... / edited by William Pepper. Source: Wellcome Collection.
Provider: This material has been provided by The University of Leeds Library. The original may be consulted at The University of Leeds Library.
1014/1082 page 988
![The color may not diifer from the normal, or may be more yellow or more white in individual instances. The consistency is increased, sometimes to such an extent that the density of the organ suggests that of cartilage. The sur- face is smooth or granular, and thickening and induration may be found at the root of the mesentery and in the vicinity of the suprarenal capsule and coelic plexus. On section the pancreas may present a more homogeneous appearance than normal, or granules of various size may be seen; the projecting acini may be distributed throughout. These acini may be opaque-gray or opaque-yellow, the latter in case of associated degeneration. The duct may show no altera- tion of structure or be indistinct, or it may be dilated, tortuous, and ribbed, with corresponding atrophy of the glandular structure. Klebs states that small white streaks or spots may be seen in the midst of the dense fibrous tissue, and that a sort of emulsion is to be squeezed from the spots, in which a granular, amorphous mass of molecules of lime may be pi-esent. He has also found clusters of radiating crystals of fatty acids, evidently from the atrophy of fat-tissue. The cheesy nodules, as large as peas, found by Drozda in the fibrous ])ancreas from a syphilitic patient, may have been gummata, Syraptomatology.—There are no characteristic symptoms of fibrous pan- creatitis. As a rule, digestive disturbances, deep epigastric pain and tender- ness, progressive emaciation, and debility are present. The digestive disturbances are those usually attributed to gastric catarrh— viz., loss of appetite, nausea, belching, pyrosis, a sense of epigastric fulness and weight. These symptoms may precede for a long time the .emaciation and debility which usually eventually occur. More rarely they may be wholly wanting. Vomiting is rare, and sometimes bloody, even in the absence of ulcer of the stomach. The bowels are irregular, diarrhoea being rather fre- quent. The stools may be colorless, are sometimes fatty even in the absence of jaundice. The latter symptom is occasionally present: it may be transitory or persistent, for the common bile-duct is sometimes compressed by the con- tracted head of the pancreas. Epigastric pain, deep-seated, dull, burning, or boring, is frequently com- plained of. The pain may be paroxysmal, and, when severe, associated with great anxiety, restlessness, and attacks of faintness. The epigastrium, especi- ally on the left, may be tender on deep pressure, and a sense of resistance, even a tumor, has been felt, either to the right of the median line or extending to the left and elongated. Slowly progressing and moderate ascites has been observed, and also a gradual enlargement of the spleen. A symptom which has attracted attention in a number of cases is glycosuria, and the disease has run the course of severe diabetes. The duration of chronic pancreatitis is uncertain. In some instances the above-mentioned symptoms precede death for a few months only, while in others the course may extend over a year or two. When glycosuria is con- spicuous, it may be present four years before death. The experiments on rab-](https://iiif.wellcomecollection.org/image/b21508677_0001_1014.jp2/full/800%2C/0/default.jpg)
