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Changes in the Pancreas - Complications of Diabetes

symptoms, observed and noted


Concerning the etiological significance of pancreatic changes enough has been said above (cf. pp. 51 and 71). We have here to see whether pancreatic diabetes betrays itself by any special signs and can be diagnosed. Not much use can be made at the bedside of such general data as Lancereaux has given, viz., specially malignant course, rapid emaciation, and tendency to pulmonary tuberculosis. This complex of symptoms is often enough observed in cases in which the pancreas is found healthy post mortem, or shows only such a reduction in size and softness in texture as could be easily accounted for by the generally lowered state of nutrition. Of more importance are the following symptoms : (a) Existence of a tumor of the pancreas (carcinoma, cysts, echinococcus) ; (1) severe colic which cannot be referred to the kidneys or the liver, but which by its location raises a suspicion of a calculus in the duct of Wirsung (Fleiner, Lichtheim, Holzmann); (c) excretion of maltose in the urine. This symptom has up to the present time been observed only twice (le Nobel, van Ackeren), and its significance is not yet clear; (d) steatorrhcea with out jaundice; (e) azotorrhcea, that is to say, the passage of large quantities of nitrogenous substances in the feces. This symptom

was noted in the cases of Hirschfeld referred to on page 84, as also in experimental extirpation of the pancreas in animals (Minkowski, Abelmanu, Sandmeyer).

These symptoms are individually seldom seen in diabetes, and all of them together are still more rarely encountered. The occur rence of the symptoms and a diagnosis of the condition presuppose not only that the internal secretion of the pancreas is interfered with, but also that there are at the same time certain gross anatomical changes present.

As regards the character of the lesions of the pancreas which have been noted, they were most frequently chronic interstitial inflamma tion (sclerosis), atrophy, fatty degeneration and necrosis of the cells; more rarely cysts, calculi, carcinoma, and echinococcus of the pan creas have been observed.