Synonym.—Acute Hemorrhagic Pancreatitis.
Etiology.—The disease occurs far more frequently in men than in women, possibly owing to greater dissipation among the male sex, since alcoholism figures as a prominent factor in producing the disease. The most frequent cause, however, is an extension of inflammation from the duodenum to the pancreas, through Wirsung's duct. Glycosuria, gall-stones, trauma, acute tuberculosis, the infectious fevers, and hemorrhage, have each been credited as giving rise to pancreatitis.
Pathology.—The organ is enlarged, hyperemic, and deeply-stained with blood, being of a reddish-brown or chocolate color. The gland may be firm and dense, or soft, pulpy, and friable. A cut section reveals a hemorrhagic infiltration of the interstitial tissue, the color being modified by fat tissues, which gives it a mottled appearance. "The infiltration may involve the peripancreatic tissue, the mesentery, mesocolon, omentum, and the sub-peritoneal fat tissue, as low as the brim of the pelvis." (Fitz.) '"The fat necrosis of Balser may also be seen as opaque white specks, spots, or streaks."
Symptoms.—Although there may have been a history of aggravated dyspepsia preceding the disease, the onset is usually sudden, unexpected, and violent. The intense, agonizing pain is located in the epigastrium or beneath the left breast, and radiates to the back and shoulder, or downwards, involving the entire abdomen.
Accompanying the pain, there is retching, or more frequently persistent vomiting, which consists of bile, mucus, or dark blood, or all combined. Great prostration, with symptoms of collapse, are early features of the disease. Constipation is the rule. Tympanites is not uncommon, with marked tenderness in the epigastrium.
There is usually but little fever, and at times the temperature is subnormal. The pulse is small, feeble, and rapid, dyspnea is marked, and occasionally delirium is present. Hiccough is often an unpleasant symptom. In fatal cases, death usually takes place within forty-eight or seventy-two hours.
Diagnosis.—This is made with difficulty, and may be mistaken for intestinal obstruction or acute perforating peritonitis. The sudden seizure of excruciating pain in the epigastric region, of one in good health, which is attended by persistent vomiting, circumscribed swelling, and tenderness in the region of the pancreas, and tender spots over the abdomen, with symptoms of collapse, would suggest pancreatitis.
The previous history would throw some light on the case, especially in differentiating between peritonitis and pancreatitis, and the vomit would be different if clue to obstruction of the bowel.
Prognosis.—The disease generally terminates fatally, though recovery has taken place.
Treatment.—Our first effort will be made to relieve the pain. This will be accomplished by the hypodermic injection of morphia, and the local application of heat, or a cloth dampened with chloroform. Hypodermic injections of strychnia, camphor, and ether, or normal salt solution, will be used to prevent or overcome the symptoms of collapse. The subsequent treatment will be symptomatic, meeting the indications as they arise.