Pancreatic Calculi.—Concretions are sometimes met with in the pancreatic duct similar to those occurring in the salivary glands. They are usually small, like grains of sand, but may be as large as a walnut. They are usually multiple. They are generally round, and grayish white in color, and composed chiefly of carbonate of lime with some phosphate. Cholesterin is reported present in some cases. They occur in dilated ducts or may the cause of obstruction and dila tation of the ducts. They may excite chronic interstitial inflammation of the gland or acute suppurative inflamma tion.
Efficient cause of pancreatic calculus believed to be chemical alteration of pan creatic secretion, due, in most cases, to the action of microbes. Mere retention of secretion, although a predisposing condition, is not an efficient cause, for CaCo, predominates in pancreatic calculi, whereas it is not present in the normal secretion. Calculus appears not uncom monly in connection with diabetes (22 times in 225 cases). It is more common in men than women (19 men, 7 women), and chiefly attacks people of late middle life. Giudiceandra (II Policlinico, Mar.
15, '96).
The symptoms at best are very in definite. There is usually a preceding history of gastro-duodenal indigestion. The stone in its passage or incarceration may cause symptoms identical with those of gall-stone colic even to the jaundice, which, however, may be absent in both. Following the paroxysms of pain, cal culi may be found in the stools, while, sometimes, transient glycosuria follows the attacks of colic. There may be symptoms of acute or chronic pancreati tis and cyst of the pancreas may form. There may be much muscle-fibre in the stools, which may also be fatty. The patient may lose flesh and strength.
The diagnosis can only be surmised, unless calculi are found in the stools.
The treatment is similar to that for biliary colic. Good results are reported from the hypodermic injection of I cubic centimetre of a 1-per-cent. solu tion of pilocarpine, three times a week.