Obscure. Shown only by digestion or hepatic disorder. Excess of fat in
stools suggests suppression of secretion. Intestinal fermentations.
Suspension of glycogenesis and consequent emaciation, stunting or
poisoning. Pancreatic calculus and icterus.
Diseases of the pancreas are even more obscure than those of the liver.
Situated on the course of the duodenum, beneath the lumbar vertebræ and
their right transverse processes, and separated from the lateral walls
and floor of the abdomen by the great mass of the intestines, it is not
open to manipulation or satisfactory percussion, and its secretions
being used up in the function of digestion, so that they cannot be
perceived and tested externally like the secretions of the kidneys.
Beside the general constitutional disorder therefore, we must look
rather to the derangements of the digestive functions, to the abnormal
condition of the fæces, and to the alterations in subordinate functions
like the glycogenic action of the liver, for indications of an unhealthy
state of the pancreas. The suppression of the pancreatic secretion has
long been associated with the occurrence of fat in the stools, yet this
may result from the lack of bile which has important functions to
fulfill in emulsionizing fat, and in securing its endosmosis. On the
other hand the lack of pancreatic juice may hinder the complete
digestion of the albuminoids, and favor their fermentation and the
occurrence of tympanies, congestions, abnormal secretions, etc., which
may be easily attributed to another origin. Then again the dependence of
the liver on the pancreas for its stimulus to glycogenesis, would
suggest a series of disturbances from the abundance of the unused food
principles, from the hindrance to nutrition and growth, and perhaps from
the toxic action of the hepatic products. Once more, through the common
excretory duct, infection of the pancreas may extend to and involve the
liver, and blocking of the common duct by pancreatic parasites, or
calculi, may stop the flow of bile and cause jaundice or other icteric
disorder. And yet, it is rarely the case that pancreatic disorder is
successfully diagnosed, and it is too often only at the post mortem
examination that the actual lesions are revealed.