Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clin path test 4 > Chem lect 22: GI and Exocrine Pancreas > Flashcards

Chem lect 22: GI and Exocrine Pancreas Flashcards

1
Q

GI and Exocrine Pancreatic Dzs

A
  • May or may not be present
    • Anorexia
    • vomiting
    • diarrhea
    • weigh loss
  • Degree of dz is variable
  • abdominal pain and fever are highly variable
    • more likely in acute inflammatory dz
    • less likely in chronic inflammatory dz
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Comon Exocrine Pancreas (EP) disorders

A
  • Pancreatitis: inflammation
  • Chronic dysfunction of exocrine pancreas
    • EIP (exocrine pancreatic insufficiency)
      • maldigestion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

About exocrine pancreas

A
  • several digestive enzymes produced by acinar cells of pancreas
  • mechanism that prevent auto-digestion
    • digestive enzymes made as zymogens
    • zymogens stored with trypsin inhibitor
    • protease inhibitors in circulation
      • anti-trypsin, alpha2-macroglobulin
    • duodenal enteropeptidase activates trypsin
    • trypsin activates other enzymes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Pancreatitis

Cats vs Dogs

A
  • dogs and cats, (rarely horses)
  • dogs
    • pain, vx, diarrhea
    • more commonly have acute, fatal dz
  • cats
    • usually more subtle signs
    • chronic form more common in cats
  • Both species
    • may have subclinical dz, or acute fulminating fatal dz
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Pancreatitis

Chemistry changes

A
  • Can cause cholestasis and inc
    • ALP
    • GGP
    • bilirubin
    • cholesterol
  • CBC
    • inflammatory leukogram
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Pancreatitis

Possible CBC abnormalities

A
  • Neutrophilia w/ left shift +/- toxicity
  • Lymphopenia
  • Eosinopenia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Pancreatitis

Possible biochemical abnormalities

A
  • Hypercholesterolemia
  • inc ALT, liver leakage enzyme
  • inc ALP, cholestatic enzyme
  • hyperbilirubinemia due to cholestasis
  • hypocalcemia (we don’t know why)
  • hyperglycemia
    • hyperglucagonemia (made by alpha cells of pancreas)
    • diabetes
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Pancreatic enzymes we test for

A
  • trypsins
  • alpha-amylase
    • helps hydrolyze starches
  • lipase
    • helps hydrolyze lipids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Amylase

A
  • can test for in pancreatitis
  • made by pancreatic acinar cells
  • cleared by kindey
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Increased amylase

Decreased amylase

A
  • Pacreatic dz
    • inflammation
    • trauma
    • necrosis
    • neoplasia
  • GI dz
  • Hepatic dz
  • corticosteroids
  • renal failure
    • b/c that’s how it’s excreted
  • severe dehydration

​*decreased amylase insignificant

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Serum amylase interpretation

A
  • pancreatitis cause of increases greater than 3-fold
  • Inc serum amylase seen with
    • pancreatitis
    • enteritis
    • hepatitis
    • carcinomas of pancreas and liver
  • Renal failure/severe dehydration also causes increase
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Lipase

Sources

Cleared by

A
  • Produced by lots of sources
    • pancreatic acinar cells
    • gastric mucosal cells
    • small intestine
    • liver
    • adipocytes
    • myocytes
  • inc > 3-fold likely pancreatic dz
  • dec with EPI
  • Cleared by Kidney
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Interpreting Lipase and lipase activity

A
  • total lipase not specific
    • not run at UF
  • Older testing methods measure amylase and lipase enzyme activity
    • lipase activity
  • Protease inhibitors can bind to pancreatic lipase
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Spec cPL

Spec fPL

Snap test/vs Texas A&M

A
  • Immunoglobulins targeting pancreatic lipase
  • Pancreatic lipase immunoreactivity
    • send to Texas A&M GI lab or IDEXX
  • feline vs kidney for Texas A&M
    • probs will have to retest if in gray zone
  • snap test
    • if positive maybe send out for more bloodwork
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Maldigestion/malabsorption

A
  • Not digesting food = maldigestion
    • not enough enzye from pancrease (EPI)
  • Not absorbing food = malabsorption
    • GI tract dz
    • GI lymphatic dz
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Maldigestion / EPI

clinical signs

caused by

concurrent probs

tx

A
  • chronic severe weight loss
  • voluminous ‘cow patty’ stool
  • Caused by
    • pancreatic atrophy of aplasia-acinar cells
      • Dogs (german shepherds overrepresented)
    • chronic bouts inflammation and scarring
      • cats
    • genetics, GSD overrepresented with EPI
  • Can be associated with
    • concurrent DM
    • secondary SI bact overgrowth (SIBO)
    • secondary cobalamin (B12) deficiency
      • consumed by bacteria that have overgrown
      • deficiency of intrinsic factor
  • Is treatable, requires lifelong management
    • enzyme supplements
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

EPI

develops when…

Maldigestion due to inadequate levels of digestive enzymes

A
  • secretory capacity reduced to less than 10-15% of normal
  • Maldigestion due to inadequate levels of digestive enzymes
    • congenital abnormality
    • chronic pancreatitis
    • pancreatic duct obstruction
    • ischemia
    • immune-mediated dz
    • toxic damage
    • infection
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

EPI

CBC

Chem

A
  • CBC
    • often normal
    • +/- NN anemia
  • Chem
    • often normal
    • +/- low cholesterol
    • +/- hyperglycemia
    • +/- mild to mod inc in ALT, ALP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Congenital cobalamine deficiency

A
  • can cause anemia
  • cobalamine required for every cell in body
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Low amylase and lipase

A

Not really used to dx EPI

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Trypsin

Dec

Inc

A

Decreased trypsin used as a marker, not so much increased

  • Dec
    • EPI
  • Inc
    • pancreatic necrosis
    • renal dz
    • inflammatory bowel dz
    • hepatic lipidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Trypsin test

A
  • TLI
    • trypsin like immunoreactivity
  • look for low values in dogs and cats
23
Q

GI dz

Initial fecal tests

A
  • Diarrhea very common presenting complaint
  • Initial fecal tests
    • fecal fload
    • fecal sedimentation
    • direct cytologic exam
    • rectal scraping cytology
    • fecal occult blood test
24
Q

Major causes of morphologic chronic intestinal dz

DDX

A
  • Inflammatory bowel dz (IBD)
  • Triaditis in cats
    • pancreatitis
    • hepatitis
    • enteritis
  • GI lymphoma
  • lymphangiectasia (dogs only)
  • pythiosis (dogs only)
  • GI histoplasmosis

Excludes: food allergies, intestinal parasitism, antibiotic response enteritis

  • these can cause malabsorption as well
25
Q

Malabsorption

GI tract dz

A
  • Thickened by abnormal cell infiltration
    • inflammation or cancer
  • Paracitism or infiltrative infection
  • GI lymphatic dz
    • lymphangectasia: dilated lacteals and other lymphatics don’t absorb fats and protein properly
  • GI tract dz can affect just 1 segment of SI
    • specific GI testing can help localize
    • Imaging (ultrasound) very useful
26
Q

Triaditis in cats

A
  • pancreatic duct in cat enters common bile duct
    • this close association can cause more involved dz
27
Q

GI change with dz

1) BUN: creat
2) TP
3) Albumin
4) Globulins
5) Cholesterol
6) Ca
7) Na
8) K
9) Cl
10) TCO2

A

1) BUN: creat => can be high with prerenal azotemia
2) TP => low with PLE
3) Albumin => low with PLE
4) Globulins => low with PLE
5) Cholesterol => low with PLE
6) Ca => low w/ intestinal malabsorption sec to hypoalbuminemia
7) Na => high if pure water loss by GI; low if isotonic fluid or NaCl rich fluid loss by GI
8) K => low if lost in GI tract +/- anorexia
9) Cl => high if pure water loss by GI; low if isotoic fluid or NaCl rich fluid loss by GI; disproportionately elevated relative to Na if bibcarb lost by GI
10) TCO2 => high with upper GI dz and selective loss of HCl; low if losing bicarb in diarrhea

28
Q

Albumin and Globulins in dz

1) ext blood loss, PLE
2) Exudative lesion, severe PLN or hepatopathy
3) PLN, hepatopathies
4) inflammation, hepatopathies
5) dehydration

A

1) ext blood loss, PLE, Exudative lesion, severe PLN or hepatopathy => dec A; dec G
3) PLN, hepatopathies => dec A; N
4) inflammation, hepatopathies => dec A; inc G
5) dehydration => inc A; inc G

29
Q

Hypocholesterolemia

A
  • Dec hepatic synthesis
    • hepatic dz, PSS
    • hypoadrenocorticism
  • Dec intestinal absorption
    • PLE
  • Maldigestion
    • EPI (sometimes)
30
Q

Effect of GI dz on blood glucose

A
  • not common finding in
    • maldigestion
    • malabsorption
  • might see with
    • starvation
    • severe malnutrition
31
Q

Hypoclycemia

A
  • exclude false results, esp in a patient with no clinical signs
  • glucose readily dec in the tube after collection
    • RBCs continue to consume glucose after sample has been collected
      • exaggerated with leukocytosis or thrombosis
    • separate serum/plasma w/in 30 minutes of collection
32
Q

Hypoclycemia

real causes

A
  • Inc insulin secretion
    • insulinoma (pancreatic beta-cell neoplasm)
    • xylitol tox
  • Dec insulin antagonists
    • hypocortisolemia/addison’s
  • dec gluconeogenesis
    • hepatic insufficiency/failure
    • hypocortisolemia
    • neonatal hypoglycemia
  • inc glucose utilization
    • lactaional hypoglycemia
    • hunting dogs
  • uncertain pathogenesis
    • sepsis
    • pregnancy
    • other neoplasms
  • pharmacologic
    • admin of insulin
33
Q

Remember that cortisol is an _______ antagonist

A

insulin

34
Q

Hyperglycemia

A
  • common after meals
    • along with hypercholesterolemia and inc triglycerides
  • transient hyperglycemia
    • epinephrine induced in fractious cats
  • Cushings
  • DM
  • Drugs
    • Dextrose
    • Xylazine
    • Ketamine
35
Q

Other testing for primary GI dz

A

When PLE suspected

  • Fecal alpha1-proteinase inhibitor
    • not degraded in feces
    • need a 3 day frozen fecal sample
36
Q

SIBO

(small intestinal bacterial overgrowth)

A
  • AKA ARE (antibiotic responsive enteropathy)
  • overgrowth of bact in intestine comprising fewer than normal diff species
  • empiric abx trial is often used
  • causes
    • secondary to EPI
    • secondary to numerous other intestinal dzs
    • idiopathic
37
Q

Serum tests for GI Dz

A
  • Folate / Vitamin B9
    • in food
    • produced by bact
      • ‘fart folate’
      • inc with ARE
    • absorbed in proximal SI
  • Cobalamin/Vitamin B12
    • In food
    • absorption dec by bacteria
      • consume cobalamin
      • dec with ARE
    • absorbed
      • some absorbed in duodenum
      • most absorbed in ileum
        • absorption aided by intrinsic facter (made mostly in pancreas)
38
Q

Serum tests for EPI and GI Dz

EPI

A
  • Folate => inc or normal
  • Cobalamin => dec
  • TLI => dec
39
Q

Serum tests for EPI and GI Dz

Bacterial overgrowth

A
  • Folate => inc
  • Cobalamin => dec
  • TLI => normal
40
Q

Serum tests for EPI and GI Dz

Proximal small intestinal dz

A
  • Folate => dec
  • Cobalamin => normal
  • TLI => normal
41
Q

Serum tests for EPI and GI Dz

Distal small intestinal dz

A
  • Folate => normal
  • Cobalamin => dec
  • TLI => normal
42
Q

Serum tests for EPI and GI Dz

Diffuse small intestinal dz

A
  • Folate => dec
  • Cobalamin => dec
  • TLI => normal
43
Q

EPI often has secondary

A

Intestinal bacterial overgrowth

44
Q

TLI is a very specific marker for

A

Exocrin Pancreatic function

45
Q

MMA

A

Marker for cobalamin deficiency on a cellular level

46
Q

inflammatory leukogram

A

leukocytosis (inc WBCs)

47
Q

azotemia caused by dehydration

A

Pre-renal azotemia

48
Q

ALP inc depending on source

A
  • Cholestasis can cause more of an inc than ALP originating from bone
49
Q

Stress leukogram

SMILED

A

Lymphopenia

  • Segs and Monos inc
  • Lymphs and Eos dec
50
Q

Lymphopenia

DDX

A
  • steroids/stress response
  • acute infection
  • immunosuppressive drugs
  • loss of lymph
    • ​lymphangectasia
  • lymphoma
  • hereditary dz
51
Q

Panhypoproteinemia

DDX

A
  • hemorrhage
  • liver dz
  • malabsorption (PLE)
  • protein losing nephropathy (severe)
  • Fluid overload
52
Q

Hypoglycemia

DDX

A
  • preanalytic (delalyed separation)
  • excess insulin
  • hypoadrenocorticism
  • liver dz
  • sepsis
  • neoplasia
  • maldigestion
    • possible but don’t usually have hypoglycemia
  • malabsorption
    • possible but don’t usually have hypoglycemia
  • starvation
53
Q

Hypocalcemia

DDX

A
  • pancreatitis
  • hypoproteinemia
  • maldigestion
  • malabsorption
54
Q

Normal serum trypsin-like imunoreactivity (TLI)

A
  • normal pancreatic function
  • rules out maldigestion (EPI)

Clin path test 4 (9 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions