Osteopathy Complete
Elmer D. Barber, D. O.
1898
DISEASES OF THE PANCREAS
THE PANCREAS
The pancreas is a long, narrow, compound racemose
gland of a cream color and soft texture, which lies across the posterior
wall of the abdomen, behind the stomach, and opposite the first lumbar
vertebra. It is about seven inches long; its structure resembles
that of the salivary glands.
The broader end, or head, lies in and is embraced by the curvature
of the duodenum; and the narrow end, or tall, is in contact with the spleen.
Capsule. - The gland has a thin connective-tissue
capsule, which sends a fine process and septa between its lobules, and
these septa carry into it the blood-vessels and nerves.
Ducts. - The duct of Wirsung runs along the
whole length of the gland, and in its course it receives nearly at right
angles contributory small ducts from the different lobules of the gland.
It opens with the common bile-duct, piercing the coat of the latter obliquely.
In man there is a small accessory duct opening independently into the duodenum.
The duct consists of connective tissue, and is lined
by a single layer of non-striated columnar or cylindrical cells.
When traced backward, the ducts open into intermediate or intercalary parts
lined by flattened epithelium, while the intercalary parts open into the
acini.
Condition of Blood-Vessels. - During secretion
the blood vessels behave like the blood vessels of the salivary glands
after stimulation of the chorda tympani. They dilate, and the venous
blood is bright red; thus it is probable that a similar nervous mechanism
exists.
Nerves. - The nerves arise from the hepatic,
splenic, and superior mesenteric plexuses, together with branches from
the vagus and sympathetic. The secretion is excited by stimulation
of the medulla oblongata, as well as by direct stimulation of the gland
itself. It is not arrested by section of the cervical spinal cord.
The secretion is suppressed by atropin (in the dog, but not in the rabbit),
by producing vomiting, by stimulation of the central end of the vagus,
as well as stimulation of other sensory nerves. Extirpation of the
nerves accompanying the blood vessels prevents the above named stimuli
from acting. Under these circumstances a thin paralytic secretion,
with feeble digestive powers, is formed, but its amount is not influenced
by the taking of food.
Secretion. - As in other glands, we distinguish
a quiescent stage, during which the gland is soft and pale, and a stage
of secretary activity, during which the organ swells up and appears a pale
red. The latter condition only occurs after a meal, and is caused,
probably, reflexly, owing to stimulation of the nerves of the stomach and
duodenum. The secretion begins to flow when food is introduced into
the stomach, and reaches its maximum in two or three hours thereafter.
The amount falls toward the fifth or seventh hour, and rises again, owing
to the entrance of the chyme into the duodenum, toward the ninth and eleventh
hour, gradually falling toward the seventeenth to the twenty-fourth hour,
until it ceases completely. When more food is taken, the same process
is repeated. As a general rule, a rapidly formed secretion contains
less solids than one formed slowly.
ACUTE PANCREATITIS
(Inflammation of the pancreas.)
SYMPTOMS
Pain and tenderness in the epigastric region; colicky,
in and shooting pains to the back of the shoulder; thirst; anorexia; and
other symptoms similar to Peritonitis.
TREATMENT
1. With the patient lying upon the side; operator
places his hands upon the upper cervicals, moving the muscles upward and
outward, gently but deeply, the entire length of the spinal column, being
very thorough in all regions which seem sensitive to the touch, or where
the temperature is abnormal. Treat the opposite side in a similar
manner.
2. Place one hand under the chin, the other
under the occipital; give strong extension, continued for one minute, using
sufficient strength to move the patient's body slightly; manipulate carefully
and thoroughly all the muscles of the neck.
3. Knead the bowels gently for a few moments,
thus starting the circulation.
In case of constipation, very thorough Constipation
Treatment should be given.
4. Place the hand lightly over the pancreas,
vibrating gently four or five minutes, thus freeing the circulation
of the pancreas, and thereby reducing the inflammation.
5. Draw the arms slowly but strongly above
the head, an assistant holding the patient's feet, giving rather strong
extension for one minute. This treatment, it will be observed, stretches
and moves the parts immediately over and around the pancreas, and very
often gives immediate relief.
6. Place the hands upon the sides of the
neck, fingers almost meeting over the upper cervicals; press gently
three or four minutes (cut 13).
This treatment should be given every other day,
and occupy about fifteen minutes. Immediate relief will be experienced,
and, if given correctly, a speedy cure may be expected.
SUPPURATIVE PANCREATITIS
(Inflammation of the pancreas, with suppuration.)
SYMPTOMS
Emaciation; exhaustion; constipation; irregular
fever; pain in the epigastrium; and evidence of tumor above the umbilicus.
TREATMENT
See Acute Pancreatitis.
PANCREATIC CYST
(Tumor in the pancreatic duct, due to impaction of calculi in the duct.)
SYMPTOMS
Appearance of a tumor in the upper abdomen.
May simulate ovarian tumor; sense of weight and fullness in the epigastrium;
complexion yellow; tumor smooth, soft, and fluctuating.
TREATMENT
See Acute Pancreatitis.
Treatment should be given every other day.
