580 THE DIGESTIVE SYSTEM. 



the gland and the tissue about it. The haemorrhage may be moderate 

 arid limited to the pancreas, or it may extend into the subperitoueal tis- 

 sue for a considerable distance. 



Haemorrhage of the pancreas may be associated with acute inflamma- 

 tory changes and with more or less extensive gangrene of the organ. 



INFLAMMATION. (Pancreatitis.) 



Hsemorrhagic Pancreatitis. In this form of disease haemorrhage simi- 

 lar to that above described is associated with suppurative inflammation 

 or gangrene or both. The gangrenous pancreas may be more or less en- 

 capsulated ; it may be surrounded by pus ; it has by an opening through 

 the intestinal wall entered the gut and been discharged. Haemorrhagic 

 pancreatitis is often associated with fat necrosis. 



The conditions leading to pancreatic haemorrhage and hsemorrhagic 

 pancreatitis are not yet fully clear, but experimental studies of Flexuer 

 and Opie indicate that in some cases at least the presence of gastric juice 

 or of bile or other substances in the pancreatic duct may be of impor- 

 tance. The frequent association of gall-stones with haemorrhagic pan- 

 creatitis is significant. ' 



Suppurative Pancreatitis is not very common, and may be primary or 

 due to the extension of a suppurative inflammation from adjacent or dis- 

 tant parts of the body. There may be a diffuse infiltration of the organ 

 with pus cells or larger and smaller abscesses. The abscesses may open 

 into the gastro-intestinal canal or into the peritoneal cavity. The causes 

 of primary suppurative pancreatitis are often most obscure. It may be 

 associated with fat necrosis and with haemorrhage and gangrene of the 

 pancreas. 



Various forms of bacteria have been found in the uecrotic, haemor- 

 rhagic, and inflammatory lesions of the pancreas, but in most cases the 

 significance of their presence is not clear, since necrotic and haemorrhagic 

 foci may afford regions favorable to the lodgment and proliferation of 

 micro-organisms which are secondary invaders and whose lesions, if such 

 be induced, are complicating and not primary. 3 



Chronic Interstitial Pancreatitis. This lesion consists in an increase of 

 interstitial connective tissue, which may be general or confined to some 

 particular portion of the gland. The new-formed tissue may be inter- 

 lobular or interacinar in distribution. 



The organ is sometimes enlarged, sometimes smaller than normal. It 



1 For a study of the relationships between cholelithiasis and diseases of the pancreas 

 see Opie, " Diseases of the Pancreas. " 



For a study of experimental pancreatitis see Flexner, University Medical Magazine, 

 vol. xiii., p. 780, 1901; also Flexner and Pearce, Trans. Assn. Am. Phys., vol. xvi., 

 p. 349; also Opie, loc. cit. 



2 For a detailed consideration of acute inflammation, haemorrhage, gangrene, and 

 fat necrosis of the pancreas, with bibliography, consult Fitz, Middleton Goldsmith lec- 

 ture on "Acute Pancreatitis," Trans. New York Path. Soc., 1889. For later bibli- 

 ography see Warthin, Philadelphia Medical Journal, November 19th, 1898. and Opie, 

 " Diseases of the Pancreas. " 



