1 - Pancreas Flashcards
1
Q
Does the dog or the cat have fused bile duct
A
Cat
2
Q
Acinar cells synthesize
A
Inactive enzymes and store them in zymogen granules
3
Q
Acute pancreatitis
A
Inflammatory disease characterized by inflammatory cell infiltration of the exocrine pancreas, edema, and necrosis
4
Q
What are some possible risk factors in dogs with AP
A
- hypovolemia
- nutrition
-hyperlipoproteinemia
-endocrine conditions
5
Q
How does pancreatitis cause hypovolemia
A
Plasma loss into peri pancreatic tissues and peritoneal cavity, pooling of fluid in lumen of gut due to ileus, dehydration from vomiting, diarrhea and lack of intake
6
Q
How does pancreatitis cause peritonitis
A
Leakage of pancreatic enzymes into peritoneal cavity cause local inflammation and increase vascular permeability
7
Q
What cells synthesize zygomens
A
Acinar cells
8
Q
Zygomen granules are segregated
A
In the lumen of the rough ER
9
Q
When are the zygomen granules activated
A
Duodenum - small intestines
10
Q
Plasma a - macroglobulins bind proteases to enable
A
Macrophage uptake
11
Q
What secretes juice into the duodenum
A
Exocrine pancreas
12
Q
The initial food response is
A
Initial phase rich in enzymes
13
Q
The second food response is
A
Rich in bicarbonate
14
Q
Food related secretion is due to what two things
A
Cephalic stimulation and gastric and intestinal stimulation
15
Q
What pancreatic enzymes are present at low concentration in teh plasma of normal animals
A
Amylase, lipase, and trypsin
16
Q
Acute pancreatitis is recognized more often in
A
Dogs
17
Q
Acute pancreatitis
A
An inflammatory disease characterized by inflammatory cell infiltration of the exocrin pancreas, edema, and necrosis associated with acute onset of a wide range of clinical signs
18
Q
Most commonly pancreatitis is caused by the auto digestion of the pancreas due to premature activation of digestive zyogmens where
A
Within the acinar cells
19
Q
Alpha cells secrete
A
Glucagon
20
Q
B cells secrete
A
Insulin
21
Q
D cells secrete
A
Somastatin
22
Q
What activates trypsinogen into trypsin
A
Enterokinase
23
Q
Trypsin becomes activated in what type of pH
A
Low
24
Q
What does the body do to keep the pH high to prevent activation of trypsin
A
NaHCO3
25
What does zygomen granules do if there is an apical block
Leak into the interstitial space causing inflammation of surrounding fat
26
Risk factors of pancreatitis in dogs
Ischemia, nutrition, hyperlipoproteinemia ( fat), endocrine conditions
27
What mediates protection against leakage of enzymes into the blood
Alpha macroglobulin, alpha protease inhibitors
28
Pancreatic inflammation and edema can lead to
Ischemia, infarction, hemorrhage, and necrosis
29
Inflammatory cytokines enter systemic circulation and cause
Systemic signs
30
What is the gold standard for DX pancreatitis
Histopathology
31
What is seen on Histopathology in acute pancreatitis
Neutrophilic inflammation , oedema, and necrosis
32
What is seen in chronic pancreatitis on histo
Fibrosis and acinar loss
33
Clinical signs of dogs with acute pancreatitis
Vomiting and abdominal pain
34
General pancreatitis clinical signs
Anorexia, vomiting, depression, prayer position, fever, shock, DIC
35
What can be found on Clin path for pancreatitis
Left shift , hyper lipid, azotemia, low calcium
36
Pancreatitis spec test is
Quantative
37
Pancreatitis snap test is
Qualitative
38
If there is a negative Lipase DGGR
Exclude pancreatitis
39
What could increase cPLI and DGGR
Renal, cardiac, diabetes, hyperadrenocorticim, GIT inflammation
40
Can spec CPLI rule out pancreatitis if negative
Yes
41
2 pancreatic test for feline
FPLI and lipase DGGR
42
What are some findings on radiographs with pancreatitis
Left displaced pylorus, R displaces duodenum, enlarged pancreas, duodenal lines, peritonitis
43
Is a CT good for pancreatitis
Poor choice in small animals
44
On ultrasounds, the pancreas is normally
Isoechoic to the fat
45
What does a pancreas on ultrasound look like with pancreatitis
Enlarger hypoechic pancreas with hyperechoic fat
46
What are the only times to do cytology in pancreatitis case
Neoplasia or abscess
47
What are the possible consequences of pancreatitis
Hypovolemia, peritonitis, hepatobiliary complications, pulmonary and or pleural disease, DIC, cardio, fat necrosis
48
Pancreatitis can cause hypovolemia due to
Plasma loss into peri pancreatic tissues and peritoneal cavity, pooling of fluid in lumen of gut due to ileus, dehydration from vomiting, diarrrhea or lack of intake
49
With hypovolemia you should monitor
BP, hydration, and calculate fluid needs
50
Peritonitis may be localized where
Right upper quadrant
51
Peritonitis
Leakage of pancreatic enzymes into peritoneal cavity which can cause inflammation and increased vascular permeability
52
What to monitor with peritonitis
Albumin, total solids, assess potion for edema or 3rd spacing of fluids
53
Peritonitis may cause
Hepatobiliary complications such as choleostasis
54
Describe hepatobiliary complications
Obstruction of bile duct due to edema or fibrosis leads to extrahepatic biliary obstruction or due to dysfunction of biliary duct lead to miminal gall bladder contraction and bile excretion
55
Why can you get pulmonary disease with pancreatitis
Damage to pulmonary capillary and alveoli and lad to edema, ARDS, or SIR
56
List reasons for pulmonary disease
Aspiration pneumonia from vomiting, pulmonary thromboembolism, pleural effusion due to vascular leakage of fluid
57
Cardiac arrhythmias may develop with pancreatitis due to
Myocarditis
58
Saponification
Free fatty acids and calcium combine to form insoluble soaps - white nodules in pancreas
59
Pancreatitis fluids treatment
Ringers preferred, collloids, electrolyte, Glucose, plasma transfusion
60
Which test is the most useful in ruling out pancreatitis
Snap CPL or FPL
61
Abdominal CT is useful in a identifying
Pancreatic necrosis
62
Cytology is associated with
Low complication rate
63
Histopathology for pancreatitis should be done via
Laparotomy, laparascopy or necropsy
64
First and only medication approved for management of acute pancreatitis in dogs
Panoquell - CA1
65
What is important about fluid therapy in pancreatitis management
Do not give excess
66
In dogs what should you feed for management of pancreatitis
Fat restricted foods
67
Butorphanol is good for pancreatitis?
No
68
Why is morphine not great for pancreatitis
Induce vomiting
69
Antiemetics for pancreatitis
Maroptiant, ondansetron , metoclopramide
70
What is appetite stimulant
Entice, Miratazpine , gapabentin in cats
71
Panoquell CA 1
Blocks inflammation pathway associated with acute pancreatitis by blocking neutrophil extra as ion
72
Are antibiotics indicative for pancreatitis
If they are septic and that is it
73
Why should u avoid NSAIDS in pancreatitis
Decrease perfusion of splanchnic organs and pancreatic hypoexmia can worsen pancreatitis
74
What is the tria in cats
Pancreatitis, hepatitis, and IBD
75
What are potiental risk factors for pancreatitis in cats
Biliary and chronic inflammatory enteropathy
76
Is obesity, fat meals and dietary indiscretion associate with acute pancreatitis in cats
No
77
Clinical manifestation of acute pancreatitis in cats
Anorexia and lethargy
78
What is the most sensitive and specific blood test for pancreatitis n cats
FPLI
79
Radiographs and ultrasound in cats versus dogs for pancreatitis is
Lower sensitivity
80
With Chronic pancreatitis what may occur due to destruction of the endocrine and exocrine pancreas
Diabetes Mellitus and EPI
81
EPI
Syndrome of nutrient meal digestion resulting from deficiency of pancreatic acinar functions
82
What is the most common cause of EPI in dogs
Pancreatic acinar atrophy
83
Recurrent/ chronic pancreatitis can lead to
EPI
84
Pathophysiology of EPI
Lack enzymes to break down nutrients, leads to osmotic diarrhea from SI, malnutrition, weight lost, and polyphasic
85
EPI causing an increase substrate matter often causes
Dysbosis
86
What definicency is common with EPI
Cobalamin
87
Clinical signs of EPI are not seen until
90% of exocrine function is lost
88
What breed is at an increased risk of EPI
German shepherds
89
C/S of EPI
Weight loss, polyphasic, coprophagia, undigested food, Pica
90
Gold standard for diagnosing EPI
Serum trypsin like immunoreactivity
91
What value should u measure for EPI
Cobalamin - it will be deficient if positive
92
How do you treat EPI
Digestive enzymes and vitamin B12
93
What type of food trial can be done with a dog you suspect has EPI
Highly digestible, moderate fat, low fiber
94
What is prognosis of EPI
Life long
95
Clinical mainfestion of EPI is seen in
150 cats
96
What fraction of cats have the trifecta of EPI
1/3
97
With EPI you have impaired
Mucosal and brush border enzymes and transporters
98
Cobalamin is produced by what in dogs
Pancreas and stomach
99
Coblamanin is produced by what in cats
Pancreas
100
Chronic pancreatitis is more common in
Cats
101
What are 3 causes of EPI
Acinar atrophy, chronic pancreatitis, and adenocarinoma of pancreas
102
Is a biopsy indicative of EPI
No
103
What TLI is diagnostic for EPI
< 2.5
104
What is sign of too much supplement enzymes
Red gums
105
What can u feed for EPI treatment
Frozen pork pancreas
106
What are typical signs in cat with EPI
Weight loss and greasy coat
107
How much powdered enzymes is given to dog with EPI
2 teaspoons per 20 kg
108
How often do u feed raw pork pancreas to dog with EPI
2x a day
109
How much enzymes do u give to cat with EPI
1/2 - 1 teaspoon per meal
110
How much raw pancreases do u feed cat
25 - 50 gram raw pancreas per meal
111
What percent has weight loss in cats with EPI
5
112
What TLI is didagnost in cat
Less than 8
113
What to do if you get 8 - 12 in TLI in cats
Repeat in 1 month
114
TLI is higher in what type of cat
Azotemic
115
Cats should be fasted for how long before TLI
6 hours
116
What is 100% specific in cats for TLI
85
117
What is grey zone for TLI in dogs
2.5 - 5
118
What is greater than 5 in TLi in dogs mean
Not EPI
119
2 types of pancreatic neoplasia to consider
Adenocarcinma and insulinoma
