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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
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2
Q

Comon Exocrine Pancreas (EP) disorders

A
  • Pancreatitis: inflammation
  • Chronic dysfunction of exocrine pancreas
    • EIP (exocrine pancreatic insufficiency)
      • maldigestion
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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
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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
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5
Q

Pancreatitis

Chemistry changes

A
  • Can cause cholestasis and inc
    • ALP
    • GGP
    • bilirubin
    • cholesterol
  • CBC
    • inflammatory leukogram
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6
Q

Pancreatitis

Possible CBC abnormalities

A
  • Neutrophilia w/ left shift +/- toxicity
  • Lymphopenia
  • Eosinopenia
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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
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8
Q

Pancreatic enzymes we test for

A
  • trypsins
  • alpha-amylase
    • helps hydrolyze starches
  • lipase
    • helps hydrolyze lipids
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9
Q

Amylase

A
  • can test for in pancreatitis
  • made by pancreatic acinar cells
  • cleared by kindey
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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

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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
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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
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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
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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
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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
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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
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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
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18
Q

EPI

CBC

Chem

A
  • CBC
    • often normal
    • +/- NN anemia
  • Chem
    • often normal
    • +/- low cholesterol
    • +/- hyperglycemia
    • +/- mild to mod inc in ALT, ALP
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19
Q

Congenital cobalamine deficiency

A
  • can cause anemia
  • cobalamine required for every cell in body
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20
Q

Low amylase and lipase

A

Not really used to dx EPI

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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
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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
Malabsorption GI tract dz
* 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
Triaditis in cats
* pancreatic duct in cat enters common bile duct * this close association can cause more involved dz
27
GI change with dz ## Footnote 1) BUN: creat 2) TP 3) Albumin 4) Globulins 5) Cholesterol 6) Ca 7) Na 8) K 9) Cl 10) TCO2
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
Albumin and Globulins in dz ## Footnote 1) ext blood loss, PLE 2) Exudative lesion, severe PLN or hepatopathy 3) PLN, hepatopathies 4) inflammation, hepatopathies 5) dehydration
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
Hypocholesterolemia
* Dec hepatic synthesis * hepatic dz, PSS * hypoadrenocorticism * Dec intestinal absorption * PLE * Maldigestion * EPI (sometimes)
30
Effect of GI dz on blood glucose
* not common finding in * maldigestion * malabsorption * might see with * starvation * severe malnutrition
31
Hypoclycemia
* 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
Hypoclycemia real causes
* 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
Remember that cortisol is an _______ antagonist
insulin
34
Hyperglycemia
* common after meals * along with hypercholesterolemia and inc triglycerides * transient hyperglycemia * epinephrine induced in fractious cats * Cushings * DM * Drugs * Dextrose * Xylazine * Ketamine
35
Other testing for primary GI dz
When PLE suspected * Fecal alpha1-proteinase inhibitor * not degraded in feces * need a 3 day frozen fecal sample
36
SIBO | (small intestinal bacterial overgrowth)
* 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
Serum tests for GI Dz
* 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
Serum tests for EPI and GI Dz EPI
* Folate =\> inc or normal * Cobalamin =\> dec * TLI =\> dec
39
Serum tests for EPI and GI Dz Bacterial overgrowth
* Folate =\> inc * Cobalamin =\> dec * TLI =\> normal
40
Serum tests for EPI and GI Dz Proximal small intestinal dz
* Folate =\> dec * Cobalamin =\> normal * TLI =\> normal
41
Serum tests for EPI and GI Dz Distal small intestinal dz
* Folate =\> normal * Cobalamin =\> dec * TLI =\> normal
42
Serum tests for EPI and GI Dz Diffuse small intestinal dz
* Folate =\> dec * Cobalamin =\> dec * TLI =\> normal
43
EPI often has secondary
Intestinal bacterial overgrowth
44
TLI is a very specific marker for
Exocrin Pancreatic function
45
MMA
Marker for cobalamin deficiency on a cellular level
46
inflammatory leukogram
leukocytosis (inc WBCs)
47
azotemia caused by dehydration
Pre-renal azotemia
48
ALP inc depending on source
* Cholestasis can cause more of an inc than ALP originating from bone
49
Stress leukogram SMILED
Lymphopenia * Segs and Monos inc * Lymphs and Eos dec
50
Lymphopenia DDX
* **steroids/stress response** * **acute infection** * immunosuppressive drugs * **loss of lymph** * **​lymphangectasia** * lymphoma * hereditary dz
51
Panhypoproteinemia DDX
* hemorrhage * liver dz * malabsorption (PLE) * protein losing nephropathy (severe) * Fluid overload
52
Hypoglycemia DDX
* 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
Hypocalcemia DDX
* pancreatitis * hypoproteinemia * maldigestion * malabsorption
54
Normal serum trypsin-like imunoreactivity (TLI)
* normal pancreatic function * rules out maldigestion (EPI)

Clin path test 4 (9 decks)

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