Disturbances of Metabolism 



Accompanying Pancreatic Disease 1 



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BURR1LL B. CROHN 



NEW YORK 



Physiological Considerations 



The pancreas, the "salivary gland of the abdomen," is a compound 

 racemose gland that spans the face of the vertebral column in the upper 

 abdominal quadrants. It lies deeply buried in the depths of the ventral 

 cavity, in a position which had been almost inaccessible both to experi- 

 mental physiologists and to clinical surgeons. It is only in recent years 

 that more complete appreciation of its vital importance and protean 

 functions has come to realization, and this only as a result of the brilliant 

 physiological researches of Claude Bernard, Pawlow, Minkowski, and 

 others, and of clinical observations of Fles, Senn, Fitz(c), Opie(d), and 

 a host of subsequent workers. 



Generally speaking we recognize two independent secreting functions 

 of this gland, one an excretory or external secretion, an alkaline liquid con- 

 taining, among others, the vital digestive ferments trypsinogen, steapsin 

 and amylase ; and an internal secretion which we have learned has a close 

 relationship with the control of carbohydrate metabolism as well as a par- 

 ticipating function in the endocrin control of body processes and the vege- 

 tative nervous system. 



The pancreas secretes into the duodenum a fluid computed by Shumm 

 (a), and by Glaessner(a), to amount to 300-600 c.c. a day. This fluid 

 contains the inactive ferment trypsinogen which is activated into trypsin in 

 the intestinal tract by enterokinase. Trypsin is a powerful proteolytic 

 ferment which furthers the digestion of proteids begun in the stomach and 

 carries the process to the amino-acid stage. There are also to be found in 

 the external secretion of the acini of the pancreas an amylolytic ferment 

 which completes the hydrolysis of starches and the inversion of sugars ; and 



'It is proposed in this chapter to deal only with such disturbances of metabolism 

 as accompany diseases of the pancreas and affect its external secretion. The re- 

 sults of aberrations of the internal secretory functions of the pancreas are considered 

 elsewhere in this system. 



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