Part 93

Lesions. The mucosa of the pancreatic ducts is reddened, congested and thickened and their lumen blocked by a white, granular matter, containing pus globules, fibrine filaments, and granular, ciliated epithelium. The blocked ducts become dilated, and their walls thickened, the epithelium is desquamated to a greater or less extent, and the raw exposed surface may present ulcers or granulations. The pancreatic cells undergo fatty degeneration and the connective tissue becomes steadily indurated (sclerosis). These lesions were especially noted by Megnin and Nocard in a case of pancreatitis in the horse.

In the horse, sheep and goat, which have a common outlet for the bile and pancreatic juice, the blocking of the latter and the arrest of the bile almost of necessity causes hepatitis, and infection in the one gland is directly transferred to the other so that pancreatitis and hepatitis are mutually causative of each other. In the ox, pig, dog and cat, in which the bile and pancreatic juice are poured into the duodenum through separate ducts and orifices, this mutual pathogenic action is not so certain.

When the liver is implicated, there is catarrh and dilatation of the bile ducts, fatty degeneration commencing in the centre of the acini, pigmentation appearing at their periphery, and sclerosis of the organ follows.

Symptoms. In Nocard’s equine case there was progressive loss of spirit, energy, and endurance; appetite was poor and eating listless; after two weeks jaundice set in, the visible mucosæ and skin showing a yellow tinge, and the scanty urine becoming brownish yellow; the bowels became costive the fæces being formed of small hard discolored balls, but no excess of fatty matter is recorded. Emaciation advanced rapidly, the most marked wasting being in the muscles of the back, loins and croup. Death ensued at the end of two months from the commencement of the illness. In man sudden, violent colic, with nausea, tympany and collapse are prominent symptoms.

Diagnosis is more satisfactory when with digestive disorder, tardily developing icterus, and rapid emaciation, there is an excess of fat in the ill-smelling fæces. Pain on percussion of the right hypochondrium would be an additional feature.

Treatment can rarely be adopted because of the uncertainty of the diagnosis. It would proceed on general principles, antithermics, eliminants, antiseptics, and counter-irritants being resorted to as the conditions seem to demand. Alkaline laxatives and diuretics, salicylates of soda or potash, and guarded doses of sulphuric ether to solicit the action of the pancreas, might be resorted to. The disorder of the liver would require attention along the lines indicated under catarrh of that organ.

INTERSTITIAL PANCREATITIS.

Causes: paresis, marasmus, septic infection, blood diseases. Lesions: connective tissue in excess—pancreas and liver; catarrhal complications; calcic points; congestion and petechiæ in septic infection. Areas of fat necrosis in the pancreas and abdominal adipose tissue. Stearates of lime. Calcic foci in animals. Symptoms: obscure. Treatment.

This is especially liable to accompany paretic and wasting diseases, septic infection, and diseases of the blood. Radionow examined the pancreas in animals that had suffered from chronic paralysis, gastro-intestinal catarrh, hepatic catarrh, chronic anæmia and marasmus, and found fatty degeneration of the epithelium, with atrophy and pigmentary degeneration of the glandular epithelium. The fibrous tissue of the gland was in excess in the pancreas and in the liver (sclerosis), and mucous cysts were found.

Siedamgrotzky found a chronic interstitial pancreatitis connected with alopecia, œdema and leucocythæmia. The pancreas was indurated, fibrous, resisting the edge of the knife and sprinkled with gritty particles. Much of the glandular tissue had been destroyed, and the ducts were filled with a dense, grayish, grumous mucus.

Kirilow and Stalnikow have found interstitial pancreatitis marked by congestion and ecchymosis, with intervening anæmic areas, in animals injected with septic matter. There was increased secretion in the early stages.

A marked feature of pancreatitis in man is the occurrence in the interlobular tissue of the gland, the omentum, mesentery and abdominal fatty tissue generally, of circumscribed areas of fat necrosis, each varying in size from a pin’s head upward even to a hen’s egg. On section these show a soft tallowy consistency and Langerhans has shown that they are composed of lime and fatty acids in combination. When lime is in excess they become gritty. According to Osler they may be dependent on some other primary affection (Bright’s disease). The partially calcified concretions found in the pancreatic ducts, and the yellowish white, gritty areas, which represent the degenerate lobules in animals (Seidamgrotzky) are suggestive of a similar morbid condition of the pancreas or it may be of some distant organ. Of late years a number of cases have been recorded in man and a very high mortality noted.

The symptoms in the lower animals are very obscure, and an accurate diagnosis is looked upon as almost impossible. They are essentially the same as given above under catarrhal pancreatitis.

Treatment too has the same narrow limitations.

PANCREATIC ABSCESS, SUPPURATIVE PANCREATITIS.

A complication of strangles or purulent infection. Symptoms: Colics, chill, tender right hypochondrium, emaciation, fatty stools. Treatment: Constitutional.

Reimers has reported several cases of pancreatic abscess, as a phase of irregular strangles (rhinoadenitis). In one case multiple abscesses with an aggregate capacity of 2½ quarts were found, and some of the pus had escaped by rupture into the peritoneum and produced infective inflammation. The abscesses had destroyed the greater portion of the gland, only a few isolated lobules being left.

Galland found an abscess as big as a walnut in the pancreas of a horse which had multiple tumors in the abdomen.

Symptoms. Colics occur from the local phlegmon, and it may be from its pressure on the duodenum so as to obstruct it, and this appearing in the course of strangles would indicate a forming abdominal abscess. Staring coat or shivering may coincide. Tenderness of the abdominal walls has been noticed by Reimers, together with a partial loss of appetite and a characteristically rapid emaciation. Fatty stools, if present, would be almost the only pathognomonic symptom.

Prognosis is that the abscess will open into the abdomen, and cause fatal infective peritonitis. It is only as an exceptional occurrence that its rupture into the duodenum or colon can be hoped for, yet in such a case recovery is possible.

Treatment. Little can be done. It would be well to treat the constitutional symptoms, and await results.

FOREIGN BODIES IN THE PANCREAS.

Brückmüller has noticed needles and other sharp objects in the pancreas of the dog, determining abscess and the formation of a thick, greenish pus in the adjacent glandular follicles. Goubaux once found a fragment of straw in the pancreatic duct of the horse. Such conditions are not likely to be diagnosed, but if this could be done laparotomy might be permissible in the dog for the removal of the foreign body.

PANCREATIC CALCULI.

Mostly in cattle from over feeding, dry feeding, inactivity. Small. Multiple. Round, angular, lobulated. Nucleus. Composition. Dilated ducts. Atrophied or sclerosed glandular tissue. Prevention: succulent food, water at will, open air life, correction of local catarrh.

Pancreatic like biliary calculi have been found especially in cattle. They appear to be predisposed by their stimulating, forcing feeding, by their quiet life apart from all causes of excitement and especially by the combined effect of dry feeding and prolonged confinement in the stall through the long winter.

The calculi are usually small but numerous, Jungers having found 36 weighing 38 grammes. Bär has found a mass with an aggregate weight of 23 grammes.

The form of the calculus varies; many are angular from mutual attrition in the large ducts; others from the smaller ducts are rounded; those from the glandular follicles may be even lobulated, in keeping with the divisions of the cavity. The color is white and each shows a distinct central nucleus of epithelial, mucus, or other origin. Their specific gravity is 2.397 (Fürstenberg), and their composition 92 per cent. calcium carbonate, 4 per cent. magnesia, and traces of calcium phosphate (Gurlt).