DISTUKBAXCES OF PANCREATIC METABOLISM G69 



TABLE I 

 FAT AND NITROGEN EXCRETION WITH CLOSED PANCREATIC DUCT 



* Represents per cent of ingested fat and nitrogen which was excreted. 



nite interference of absorption dependent upon pancreatic duct blockage. 

 In the case of Harley wherein the block resulted from an inflammatory 

 stricture due to a cicatrized duodenal ulcer the loss was high and absorp- 

 tion from the intestine relatively very poor. As there was no autopsy upon 

 his case, the condition of the pancreas remains uncertain, a factor which 

 should be known before a conclusion is drawn. This factor is better 

 furnished in the report of Brugsch (d) who found in a carcinomatous ob- 

 struction of the duct a loss of 70 per cent fat and 25.4 per cent nitrogen; 

 upon autopsy the entire gland was diseased, atrophic and replaced by car- 

 cinoma. Again, in the case of Delfino where the obstruction was due to 

 a simple peripancreatic cyst with preserved gland parenchyma, the loss 

 of fat is less than 20 per cent. 



Evidently, simple obstruction is not the main factor in metabolism 

 disturbance ; a destruction of the secreting 1 tubules is a necessary con- 

 comitant. 



In acute pancreatitis (Table II) we see in the case of Brugsch and 



TABLE II 

 FAT AND NITROGEN EXCRETION IN ACUTE PANCREATITIS 



Koenig a loss of 59.7 per cent of the ingested fat during the critical 

 part of the disease; this loss increases to 72.2 per cent before recovery, 

 after clinical improvement and recovery the absorptive power is regained, 

 up to 73.9 per cent for fat. As the intake of fat was scanty (only 49 

 grams per diem) the losses encountered are very considerable and indicate 

 extensive damage to the gland (as was confirmed by finding a large ab- 

 scess of the pancreas). The ability of the pancreas to recover its normal 

 properties is shown by the improvement following the return to health. 



In the case of Crohn (c), a case of severe pancreatitis with profound 

 shock, fever, vomiting and prostration, fat absorptive tests at the height of 



