174 CORTEX 



face. The gastric lesions develop, as Mann 423 showed, in the 

 absence of pancreatic secretion and bile and hence are not due 

 to regurgitation of these fluids. 



Although at times the entire gastro-intestinal may be con- 

 gested, the chief sites of congestion are the stomach, duodenum, 

 and rectum. Hemorrhages from the inflamed rectal mucosa 

 give rise to the bloody diarrhea observed in insufficiency, par- 

 ticularly in the dog. 



At autopsy one often finds bile in the stomach. The intes- 

 tines are sometimes filled with a brownish watery fluid which 

 may contain blood. 528 



LIVER 



Banting and Gairns 31 found much degeneration in the liver 

 cords of dogs dying of adrenal insufficiency. This degenera- 

 tion varied in degree from slight changes to actual necrosis of 

 the cells. There was also great vascular congestion and hemor- 

 rhage which was more marked in areas about the central vein 

 with pressure changes in the liver cords and fatty degeneration. 

 This degeneration had proceeded in the longer surviving ani- 

 mals to a point where little normal tissue remained. 



The above described changes in the liver would explain the 

 results of the liver function tests observed in adrenal insuffi- 

 ciency and account in part perhaps for the observed abnormali- 

 ties in carbohydrate metabolism (Chapter XII). 



KIDNEY 



Although many authors have failed to note any obvious 

 pathology of the kidneys in animals dying of acute adrenal in- 

 sufficiency, some have described definite changes — particu- 

 larly an increased lipid content of the renal cortex. Such an 

 increase in the lipoidal content of the cortex of the kidney with 

 congestion of the pyramids was found by Hartman and his 

 collaborators. 280 There was a high-grade, general hyperemia 

 involving chiefly the cortex with swelling and vacuolization of 

 the epithelium of the tubuli cortorti. In frozen sections stained 



