19. Acute and chronic pancreatitis, exocrine pancreas insufficiency in dogs and cats Flashcards
classification of pancreatitis
Acute / chronic / recurrent
Mild / severe / fatal
Acute serous / acute haemorrhagic necrotising / purulent
Predisposed to Acute Pancreatitis
mini schnauzer
terriers
dachshund
poodle
middle / old ages
obese
pathogenesis of Acute Pancreatitis
initiation by oxidative stress, hypotension, acidosis
causing ineffective defence mechanism, circulatory failure, inflammatory failure
what happens after generalisation of Acute Pancreatitis
local effects - oedema, inflammation, haemorrhage, necrosis, acute fluid accumulation
regional effects - cholestasis, EHBO, duodenitis, colitis, local peritonitis
multisystemic effects
multisystemic effects of Acute Pancreatitis
SIRS
MODS
Acute kidney failure
ARDS, pleuritis
Cardiac arrhythmia
ischeamia, inflammation of git
DIC
high risk for developing Acute Pancreatitis
high fat diet
KBr, phenobarb, ttcs, furosemide
organophosphates
babesia, leishmainia
trauma
ischaemia
duodenal reflux
aetiology of Acute Pancreatitis
gall stones
hereditary
idiopahtic
clinical signs of Acute Pancreatitis
vomitting
anorexia
lethargy
abdominal pain
fever
diarrhoea
jaundice
dyspnoea
diagnostic imaging of Acute Pancreatitis
Abdo US - decreased echogenicity = pancreatic necrosis. increased echogenicity = peritonitis
XRAY
lab d
Biochem of Acute Pancreatitis
azotaemia = hypovolemia, dehydration
increased; cholesterol, lipid, liver enzymes, bilirubin = hepatocellular injury
specific lab test for Acute Pancreatitis
Pancreatic lipase immunoreactivity. PLI
cPL, fPL
ELISA
Haematology of Acute Pancreatitis
increased ; PCV, WBC, CRP,
Decreased ; thrombocytes
other non specific lab indicators of Acute Pancreatitis
increased ; blood glucose
decreased ; calcium, potassium, sodium,
metabolic acidosis
differential of Acute Pancreatitis
gastritis
gastroenteritis
peritonitis
acute renal insufficiency
ileua
pyometra
prostatitis
pyelonephritis
Treatment of Acute Pancreatitis
Fluid therapy
analgesia
antiemetics
managment of complications
special diet
what special diet is given for Acute Pancreatitis
aim to prevent malnutrition
feed enterocytes and rest pancreas
high digestibility, low fat
management of complications of Acute Pancreatitis
omeprazole
AB
corticostroids
when to give antiemetics in case of Acute Pancreatitis
intially even if no vomiting
maropitant, ondansetron, metoclopramide
what analgesiacs to give in case of Acute Pancreatitis
opioids
fentanyl ketamine lidocaine
fentanyl patch
avoid NSAIDS *ulcerogenic, nephrotoxic)
fluid therapy in Acute Pancreatitis
pancreas susceptible to hypovolemia
give colloids or crystalloids or plasma transfusion
Predisposed Chronic Pancreatitis
cats > dog
middle/ old aged
more common than acute
types of Chronic Pancreatitis
idiopathic - toy breeds, terriers, collie, boxer
autoimmune - cocker
Clinical signs of Chronic Pancreatitis
recurrent postprandial pain
no appetite
vomitting
haematochezia / colitis
severe acute peritonitis
extrahepatic bile duct obstruction
end stage DM, EPI
diagnosis of Chronic Pancreatitis
cPLI is preferred
histology
treatment of Chronic Pancreatitis
low fat
analgesia
treat acute, EPI, DM
cause of Feline Pancreatitis
trauma
ischaemia
concurrent disorders
Aetiology of Feline Pancreatitis
Bacterial translocation
haematogenous spread
Clinical signs of Feline Pancreatitis
acute - vomit, abdo pain, anorexia, lethargy, hypothermia
chronic - weight loss, signs of concurrent disorders
diagnosis of Feline Pancreatitis
fPL test
blood work
Treatment of Feline Pancreatitis
same as dog
additional AB
Aetiology of EPI exocrine pancreas insufficiency
2 main pathomechanisms
Pancreatic Acinar Atrophy
Chronic Pancreatitis
Pancreatic acinar atrophy
60% of cases are g. shepherd
young > old
AID cause
Symptoms of EPI
acute - polyphagia, weight loss, cachexia, claylike faeces
chronic - alert, good general state
diagnosis of EPI
decreased TLI
treatment of EPI
pancreativ=c enzyme substitution
high digestiblity
no fibre
cobalamin supplementation
