The Digestive System [excerpt]

     Regressive Changes.—Care must be taken to distinguish between ante mortem and post mortem changes in this organ. If death occurs when the cells are in an active state, there is a marked tendency for the intracellular enzymes to diffuse out, and bring about a condition of post mortem self-digestion. In the early stages of this process the organ may be firm, opaque, and homogeneous, and on section the nuclei either stain feebly or fail to stain. This condition resembles somewhat coagulation necrosis; at a later stage softening takes place with disorganization. In discussing the so-called hemorrhagic pancreatitis we have already described the main features of the commoner forms of ante mortem or intravital necrosis and self-digestion. In general, this affects part and not the whole of the organ, and areas are preserved [596][597] in which the pancreatic acini still preserve their normal staining power. Occasionally, however, at operation or post mortem it is found that practically the whole of the organ has undergone ante mortem self-digestion. The appearance in such cases is very remarkable; in the region where the pancreas ought to be there is found a mass of completely degenerated softened “muck,” blood-stained, shreddy, greasy, with intense surrounding inflammation and tendency to generalized peritonitis. Throughout the peritoneal cavity in such cases there may be found foci of fat necrosis. This extensive necrosis may follow not merely the causes above mentioned, namely, stasis, vascular obliteration and infection, but may, as in the case of the late President McKinley, follow trauma, or, again, operative section with liberation of the pancreatic juice.