244 III. DIGESTIBILITY OF FATS 



in which 1000 to 2650 g. of oily feces were excreted per day. A high fat 

 excretion has likewise been reported in acute pancreatitis. The fat may 

 amount to over 50% of the weight of the dried feces ; neutral fat makes up 

 40 to 70% of the total fat. 



Walker 134 reported the case of a man who was subjectively in good 

 health, in spite of the fact that he presented a persistent steatorrhea for 

 twenty-seven years before his death at the age of ninety. Throughout 

 this entire period he passed "butter stools." Autopsy revealed that the 

 pancreatic duct had been blocked by calculi, and that the pancreas had 

 been largely replaced by fat. 



Cameron and Gilmour, 135 who accept the Lipolytic Theory for fat ab- 

 sorption, attribute the failure in fat utilization in pancreatic insufficiency 

 entirely to the absence of lipolysis. On the other hand, if one accepts 

 the Partition Theory, the lack of absorption can also be explained as due 

 to the failure of partial lipolysis. Under such conditions, none of the di- 

 or monoglycerides are formed which are essential in the formation of the 

 fine emulsion required for absorption. 



Further evidence in support of the Partition Hypothesis is afforded by 

 the radiographic findings. A feathery pattern is noted in the radiogram 

 formed with barium sulfate in the case of pancreatic fibrosis. However, 

 Lowe et al. 136 showed that a flocculation pattern develops if pancreatin is 

 added which is similar to that observed in normal patients. 137 Frazer 

 et al. m reported that a flocculation pattern occurs after the administration 

 of fatty acids. 



(4-) Steatorrhea Related to Deficiency of Bile 



In normal feces, the fat content makes up a maximum of only 25 to 

 30% of the dried weight of the feces, and the neutral fat constitutes only 

 about one-fourth of this total. When a bile deficiency occurs, the total 

 fat may comprise as much as 70% of the total dried feces, but it consists 

 almost entirely of fatty acids and soaps. Such a deficient fat utilization 

 results not from a failure in lipolysis, although this is slowed up, but 



134 T. J. Walker, Med.-Chir. Trans., Roy. Med. Chir. Soc, London, 72, 2b7-27Z (1889); 

 cited by A. E. Garrod, Inborn Errors of Metabolism, 2nd ed., Chap. IX, Oxford Univ. 

 Press, 1923, p. 170. 



135 A. T. Cameron and C. R. Gilmour, The Biochemistry of Medicine, Wood, Baltimore, 

 1933. 



136 C. U. Lowe, C. D. May, H. M. Stauffer, and E. D. Neuhauser, Am. J. Diseases 

 Children, 70, 91-98 (1950). 



137 E. P. Pendergrasa, I. S. Ravdin, C. G. Johnston, and P. J. Hodes, Radiology, 26, 

 651-662 (1936). 



