Irritant poisoning may be excluded by the history and the character of the vomit. Biliary colic is excluded by the , absence of collapse, a history of previ ous attacks, and jaundice is present, but its frequent absence must be kept in mind.
Intestinal obstruction is the condition most frequently suspected. The onset, however, is less sudden, the distension and tenderness are not confined to the epigastrium, and a tumor may be found at the seat of obstruction. Inflation of the colon may determine the seat of ob struction.
The symptoms of pancreatitis are as yet but vaguely distinguished from af fections of the gall-bladder; indeed, when complicated with jaundice one can not differentiate these conditions. It is. however, generally agreed that an ex tensive and rapid loss of weight is very significant, particularly in the presence of clay-colored stools. Glycosuria is a tolerably constant symptom, but it ap pears too late to be of any diagnostic value. Fat-necrosis is to be expected. although it is Sound only after opera tion; and, since it occurs in other con ditions, is not pathognomonic. Lipuria has been cited as an aid in diagnosis, but recent researches show that but little of the accumulating fat passes by means of the urine. If the urine in a case of pancreatitis be tested with phenylhydra zin, singularly arranged yellow crystals appear very constantly.
Ilmmorrhage, probably the direct re sult of the reduction of the calcium of the blood, may supervene at any mo ment, and cause death very suddenly. A. W. Mayo Robson (Med. News, May IS, 1901).
While as yet no diagnostic symptom of pancreatic disease is possessed, un less. indeed, further observation should confirm the possibility of the demonstra tion. in acute pancreatitis, of the fat splitting ferment in the urine, yet clin ical and pathological experience has taught certain combinations of symp toms which justify a diagnosis in various forms of pancreatic disease.
Acute panereatitis should be recog nized in many instances. The impor of all Carly recognition of those cases which go on to extensive necrosis and to suppurative parapa acre:160s is easily appreciable. Chronic interstitial
pancreatitis is to be suspected finder the following conditions: 1. Instances in which glycosuria develops in all indi vidual with chronic cholelithiasis. 2. ln cases of glyeosuria in association with cirrhosis of the liver. 3. In glycosuria in the course of Inemochromatosis. 4. In glycosuria following attacks suggestive of pancreatic colic.
Pancreatic lithiasis is recognizable only when calculi are found in the stools. Cysts of the pancreas are usually to be recognized on account of their location. Primary cancer of the pancreas is often latent. The presence of obstructive jaundice with distended gall-bladder and rapidly developing cachexia, in associa tion with little or no hepatic enlarge ment, is suggestive of this affection. Fatty stools—in the absence of diar rlicest or jaundice—together with indica tions of interference with the digestion of albuminoids. are valuable confirma tory evidence of deficiency or absence of the pancreatic secretion. W. S. Thayer (Amer. Medicine, March 1902).
Morbid Anatomy.—The gland is en larged throughout or in some part, and infiltrated with blood, the color of which varies with the duration of haemorrhage and the severity of inflammation. A section may show a variegated surface, with opaque white spots due to fat necrosis. Extensive haemorrhage may be found in the root of the mesentery in retroperitoneal tissue, and about the kidneys, especially the left. In these parts areas of necrosis of fatty tissue are often found. If gangrene results, the gland or part of it may be converted into a dark-gray mass, wholly or partly sepa rated from its attachments and lying in the lesser peritoneal cavity or in the cavity of a large abscess. The surround ing peritoneal surfaces become covered with a fibrinous exudate. The sac of the lesser peritoneum may contain a large quantity of dark, offensive fluid in which masses of necrotic fat may be found.
Perforation, with discharge of this ex udate, may take place into the stomach or duodenum, and recovery follow.