PANCREAS, DISEASES OF THE. Pancreatic Haemorrhage and Acute Pancreatitis.
H X,MORRHAGE.—IImmorrhage into the pancreas occurs occasionally from a crushing injury, or a blow on the abdo men, lacerating the gland. It may oc cur also from rupture of a diseased ves sel. Chronic venous congestion caused by heart disease may lead to small, dis seminated bleedings. A more interest ing class, however, are rare, grave cases in which hmmorrhage occurs from un known causes. Zenker in 1874 first brought this condition prominently into notice as a cause of sudden death, and later Draper and his Boston confreres directed the attention of the American profession to it. It may occur with or without inflammation of the gland, or there may be necrotic changes in it. In absence of inflammation the digestive action of the pancreatic juice has been attributed as a cause. A nervous origin has been assigned to some eases in which foci of limorrhage in the lungs were also found.
The haemorrhage may he limited to a part of the gland or it may infiltrate the whole gland and the retroperitoneal sues, even rupturing into the lesser peri toneal cavity and filling it with blood. ACUTE PANCREATITIS. — With pan creatic .limorrhage there may be flammation which not infrequently minates in necrosis. Inflammation may, however, occur without luemorrhage; it then tends rather to suppuration than gangrene. It occurs most frequently in males from 25 to 60 years of age; in 41 cases only 4 were females (Korta). have reported a case in a male infant aged 9 months. Painful denal disturbances have preceded in many cases, the inflammation evidently extending back along the duct. It is thus probable that indulgence in alco hol plays a part in its production.
Case of sudden death from haemorrhage into the pancreas. At the autopsy there was no evidence of any inflammation of the pancreas, which tends to show that, while there are many cases of humor rhagic pancreatitis, the inflammatory theory will not account for all pancreatic hemorrhages. In this case it resembled a cerebral haemorrhage, and was related to atheroma of the splenic artery.
Duquy (Jour. des Praticiens, Sept. 16, '99).
Of 40 eases found in literature, 25 oc curred in males and 9 in females; the sex of rest is not mentioned. Death in most instances occurred in a few hours. In some of these the loss of blood did not amount to more than eight ounces, and such deaths were apparently due to shock. Antlers (Jour. Amer. Med. Assoc.. Dec. '99).
Symptoms.—In both pancreatic hmm and pancreatitis the onset is usually sudden, but may be preceded by some uneasiness in the abdomen. Usu ally there is intense diffuse pain in the epigastrium; it may be constant or parox ysmal. Nausea and vomiting are early symptoms, increasing in severity, but without relief. The vomit consists of food and mucus chiefly, but may con thin blood in various stages of disinte gration. Marked prostration, or even collapse, soon follows, probably from in jury to the solar plexus. The tempera ture is normal or subnormal in cases of hemorrhage without inflammation, and may not be high in the inflammatory cases in which the fever may be preceded by chills. The abdomen usually becomes distended in the upper zone and there is tenderness in the epigastrium. A mass may be palpable in the situation of the pancreas. The bowels are usually con stipated, but there may be diarrhoea.
of the pancreas is indicated by the sudden onset of violent pain in the epigastrium, with vomiting, and soon followed by collapse. In the course of some hours there is usually tenderness and swelling in the epigas trium, and, in the inflammatory cases, some fever. Perforating ulcer of the stomach or duodenum may be suspected, but can generally be excluded by a pre vious history of pain after food, and hfemorrhages, and the more general peri tonitis that usually follows. Duodenal cases may present much difficulty, as perforation may occur without any pre vious history of pain or disturbed di gestion. The symptoms develop sud denly and the pain and collapse may be as marked. Moreover, duodenal ulcer ation occurs chiefly in the same class as pancreatic disease; that is, in males over forty years old.