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.
1015/1082 page 989
![bits by Arnozan and Vaillard show that a fibrous pancreatitis from ligature of i Wirsung's duct may be well advanced within fourteen days after the ligature has been applied. Prognosis.—The prognosis of chronic pancreatitis is necessarily grave. But little evidence can be obtained of a favorable result, since the diagnosis is always doubtful. Recovery, however, is not impossible or unlikely, since it is well recognized that patients may live for a Jong time after being deprived of a large part of the pancreas by opei'ation, sequestration, and evacuation, by cystic degeneration or atrophy. Friedreich mentions the case of a patient in whom symptoms which might be attributed to chi'onic pancreatitis were recovered from. Treatment.—The treatment would be that for diabetes in the glycosuria cases. The digestive disturbances would demand a diet largely farinaceous, and minced pancreas or pancreatin might be used. The latter are indicated in all cases of diminished pancreatic secretion, since Abelmann's experiments showed that the digestion of fat was promoted by their use when the pancreas was extirpated. Pancbeatic Calculi. The discovery of calculi in the pancreas is usually regarded as an anatomi- cal curiosity. At the same time, they are not infrequently associated with such distressing symptoms and serious lesions that they must be considered as pos- sessing a high degree of importance in pancreatic pathology. Etiology.—The only recognized factors of etiological importance in the production of pancreatic calculi are chronic inflammation of the duct and its obstruction. The existence of the former is inferred from the resemblance of the contents of the dilated duct to those frequently found in retained inflam- matory products in mucous canals. The frequent association of obstruction ■ of the duct and calculi admits of a two-fold explanation. The calculus is always found in a dilated duct, but a dilated duct does not always contain a calculus. Although the obstruction to the escape of the pancreatic secretion may be the result of an impacted or incarcerated calculus, it may be dependent on causes outside the duct, as a fibrous pancreatitis, a pancreatic or other tumor, or a pathological process producing compression or traction. In the secretion thus retained in the cavity salts may be precipitated. Morbid Anatomy.—The calculi are composed cliiefly of carbonate of lime, usually with more or less phosphate of lime, and may be found in any part of the pancreas, more frequently lying in the main duct alone or in it and its branches. There may be but one, or upward of a hundred may be present. ■ The lime-salts may be present as a mortar-like material, or concretions may exist, varying in size from grains of sand up to masses as large as walnuts. The s]iape of the smaller calculi is often round; the larger calculi are elongated, perhaps oval. They are not infrequently branched, and the surface, though perhaps smooth, is not rarely rough, even spinous. They have been compared to a piece of coral in virtue of the shape and character of the surface.](https://iiif.wellcomecollection.org/image/b21508677_0001_1015.jp2/full/800%2C/0/default.jpg)
