CATARRHAL PANCREATITIS.
Probable causation by parasites, calculi, irritants, microbes. Lesions: mucosa reddened, thickened, ducts dilated, epithelium fatty, granular, desquamating, pus, connective tissue indurated. Interdependence of pancreatitis and hepatitis in horse, sheep and goat. Liver lesions. Symptoms: loss of vigor, endurance, appetite, and condition. Icterus, costiveness, fœtid, fatty stools, percussion tenderness—right side. Treatment: antithermics, eliminants, antiseptics, derivatives, alkalies, salicylates, ether.
Causes. We know little of the causes of this affection, but it may be inferred that parasites, calculi and other irritants, will produce in this as in other mucosæ a mucopurulent inflammation. Then again the presence of pus suggests the coöperation of pus microbes as in the infective catarrhal icterus. The blocking of the common gall and pancreatic duct, by gall stones or biliary products, will entail arrest of the discharge of pancreatic juice, and a consequent pancreatitis, just as blocking with pancreatic products will cause hepatitis and icterus.
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.