PATHOLOGIC FACTORS ALTERING DIGESTIBILITY OF FATS 



243 



Table 20 summarizes the variations in these general changes in fat ab- 

 sorption which have been found in pancreatic insufficiency and sprue. 



Table 20 



The Effect of Pancreatic Insufficiency and Sprue on the Physiological Indices 



of Fat Absorption 



Glucose and urea absorption 



(intraduodenal) 

 Chylomicrographs in standard 

 field after use of: 



(a) Unemulsified oil 



(b) Pre-emulsified oil 



(No excess mucus) 

 Normal absorption 



Flat: maximum < 10 par- 

 ticles 

 Normal: > 120 particles 



cess mucus) 

 Depressed and delayed 



Flattened: maximum < 

 50 particles 



° Adapted from J. M. French, Defective Fat Absorption in Man, in R. T. Williams, 

 Lipid Metabolism, Biochem. Soc. Symposia No. 9, Cambridge Univ. Press, 30-36 (1952), 

 p. 34. 



(3) Steatorrhea Related to Deficiency of Pancreatic Juice 



In cases in which the pancreatic duct is occluded, the steapsin cannot 

 be excreted into the intestine; this results in an almost complete cessation 

 of lipolysis. When the acinar tissue of the pancreas is incapacitated, 

 with a resultant decrease in the production of pancreatic juice, the de- 

 crease in fat digestibility is proportional to the extent to which the organ 

 is affected. Chronic pancreatic disease is characterized by the production 

 of large, soft, oleaginous stools which may amount to as much as 1000 g. 

 daily. They are pale in color, due to the presence of excess fat. A con- 

 siderable proportion of undigested protein is also present; this condition 

 is known as a creatorrhea. 



Crohn 132 reported that the coefficients of digestibility of fat may vary 

 between 15 and 50 in cases of chronic pancreatitis with occluded ducts or 

 in patients having malignant tumors of the pancreas. Spriggs and 

 Leigh 133 cited a case in which 50 to 99% of the ingested fat was lost, and 



132 B. B. Crohn, "Disturbances of Metabolism Accompanying Pancreatic Disease," 

 in L. F. Barker, Endocrinology and Metabolism, Vol. IV, Appleton, New York-London, 

 1922, pp. 657-691. 



133 E. I. Spriggs and A. J. Leigh, Quart. J. Med., 9, 11-43 (1915-1916). 



