Digestion & Metabolism 2: SA Exocrine & Pancreatic Dz Flashcards
BILE DUCTS in the PANCREAS IN….
dogs?
cats?
in DOGS, have PANCREATIC and ACCESSORY DUCT
–> ACCESSORY size > PANCREATIC
in CATS, RARELY have ACCESSORY DUCT, usually just PANCREATIC
the LEFT lobe of the pancreas sits at the…..
the RIGHT lobe of the pancreas sits…
LEFT lobe = sits on GREATER CURVATURE OF THE STOMACH
RIGHT lobe = next to DUODENUM
the ACCESSORY pancreatic duct opens on the ____ duodenal papilla
the PANCREATIC duct opens on the ___ duodenal papilla
the COMMON bile duct opens on the ____ duodenal papilla
ACCESSORY = MINOR
PANCREATIC = MAJOR
COMMON = MAJOR
what 2 cells in the PANCREAS are responsible for SECRETION? what do they secrete? (2 things for second one)
2 cells for SECRETION?
1. ACINAR cells = store DIGESTIVE ENZYMES as ZYMOGENS (inactive)
- DUCTULAR EPITHELIAL CELLS along PANCREATIC DUCTS…
–> make BICARBONATE to CARRY DIGESTIVE ENZYMES to DUODENUM
–> make INTRINSIC FACTOR to fight pathogens
what is a LIKELY cause of PANCREATITIS? (pathophys)
PREMATURE activation of DIGESTIVE ENZYMES that sit as ZYMOGENS in ACINAR CELLS
how does the pancreas defend against AUTODIGESTION? (three)
- zymogens can ONLY be activated in the DUODENUM by ENTEROKINASE (brush border enzyme)
- PANCREATIC SECRETORY TRYPSIN INHIBITOR is a LOCAL factor that can TURN OFF PREMATURELY ACTIVATED TRYPSINS
- CIRCULATING PROTEASE INHIBITORS for REGULATION of RELEASE of the enzymes
–> ALPHA-1 PROTEASE INHIBITOR
–> ALPHA-MACROGLOBULINS
other name for enterokinase?
what is the FUNCTION of enterokinase?
ENTEROPEPTIDASE
FUNCTION?
1. CONVERT TRYPSINOGEN –> TRYPSIN
2. TRYPSIN can then ACTIVATE MORE TRYPSINOGEN and MORE ZYMOGENS CAN BE ACTIVATED
PANCREATIC SECRETORY TRYPSIN INHIBITOR binds to trypsin REVERSIBLY/IRREVERSIBLY
ALPHA-1 PROTEASE INHIBITOR binds to trypsin REVERSIBLY/IRREVERSIBLY
ALPHA MACROGLOBULINS bind to trypsin & ____ REVERSIBLY/IRREVERSIBLY
PANCREATIC SECRETORY TRYPSIN INHIBITOR = binds REVERSIBLY
ALPHA-1 PROTEASE INHIBITOR = binds REVERSIBLY
ALPHA MACROGLOBULINS bind to trypsin & OTHER PANCREATIC PROTEASES IRREVERSIBLY
is ACUTE or CHRONIC pancreatitis IRREVERSIBLY CHANGED?
CHRONIC pancreatitis is more common in ___ > ____
CHRONIC = IRREVERSIBLE
CHRONIC pancreatitis MORE COMMON IN CATS > DOGS
pathogenesis of PANCREATITIS…
what 2 things occur in NORMAL animals?
what four things occur in PANCREATITIS animals?
NORMAL animals?
1. in a NORMAL animal, animals have INACTIVE TRYPSINOGEN sitting in ZYMOGEN GRANULES
- LYSOSOMAL ENZYMES are normally SEPARATED from ZYMOGENS & within THEIR OWN GRANULES –> fuse with DUCT EPITHELIAL CELLS & release CONTENTS into duct
PANCREATITIS
1. NOXIOUS STIMULUS causes APICAL BLOCK so that VACUOLES & DUCT EPITHELIUM CANNOT bind to release ZYMOGENS or LYSOSOMAL ENZYMES
- this causes a BUILD-UP of GRANULES
- this then causes FUSION & PREMATURE activation of ZYMOGENS by LYSOSOMAL ENZYMES
- when PSTI tries to INHIBIT TRYPSIN, INFLAMMATORY CASCADE
what 4 adjacent structures can be affected by PANCREATITIS?
what 2 SYSTEMIC effects can occur?
4 structures?
1. LIVER
2. STOMACH
3. DUODENUM
4. COLON
2 systemic effects?
1. SIRS
2. MULTIORGAN DYSFUNCTION
what is a COMMON CAUSE of PANCREATITIS in DOGS?
what are 2 ways we can get this?
= HIGH CIRCULATING FATS (hyperlipidemia)
can get this from…
1. OVERWEIGHT ANIMALS
2. AFTER EATING a BIG FATTY MEAL
2 common etiologies of PANCREATITIS in CATS?
pancreatitis tends to be ____ in cats & ___ to diagnose
- IDIOPATHIC
- TRIADITIS
tends to be CHRONIC in cats & HARDER to diagnose
TRADITIS…
includes WHAT 3 inflammations?
more common in __ > ___
3 inflammations?
1. CHOLANGITIS
2. PANCREATITIS
3. INFLAMMATORY BOWEL DZ
CATS > DOGS
CANINE PANCREATITIS…
common clinical signs? (4, one is +/-)
SEVERE clinical signs? (5, one is a disease)
common clinical signs?
1. V+
2. ANOREXIA
3. CRANIAL ABDOMINAL PAIN
4. +/- LARGE BOWEL D+
SEVERE clinical signs?
1. PULMONARY EDEMA
2. PLEURAL EFFUSION
3. HYPOTENSION
4. ICTERUS
5. MULTIORGAN FAILURE
DIAGNOSIS for PANCREATITIS in small animals….
single definitive test?
often have NON-SPECIFIC findings in these 3 diagnostics…
PLI vs. TLI
THERE IS NO SINGLE DEFINITIVE TEST
NON-SPECIFIC findings in…
1. CBC
2. CHEM
3. UA
PLI > PANCREATITIS than TLI
PLI definition & best test for…
___ SENSITIVITY & ____ SENSITIVITY
PANCREATIC LIPASE IMMUNOREACTIVITY & best test for PANCREATITIS
HIGH SENSITIVITY & HIGH SPECIFICITY
cPLI vs. Snap cPL & PARAMETERS
cPLI = QUANTITATIVE PLI
<200 ug/L = NORMAL
200-400 ug/L = EQUIVOCAL
>400 ug/L = PANCREATITIS
Snap cPL = NORMAL OR ABNORMAL BINARY TEST
NORMAL reading = <200 ug/L
ABNORMAL reading = >400 ug/L
why do we usually NOT perform pancreatic biopsies?
if we did, this would probably give us the most ____ diagnosis
usually DON’T perform pancreatic biopsy because patients tend to be SICK and MANIPULATING PANCREAS THOUGH TO BE BAD
if we did, DEFINITIVE diagnosis likely
RADIOGRAPHIC findings of PANCREATITIS…
often…
2 common findings?
often DIFFICULT TO SEE
2 findings?
1. GROUND-GLASS appearance/DECREASED DETAIL in RIGHT CRANIAL QUADRANT OF ABDOMEN
- WIDENING of GASTRODUODENAL ANGLE
CIRCLE vs. ARROW?
what DISEASE is this?
CIRCLE = GROUND-GLASS/DECREASED DETAIL appearance of RIGHT CRANIAL QUADRANT of ABDOMEN
ARROW = WIDENED GASTRODUODENAL ANGLE
both from PANCREATITIS
= what is the IMAGING MODALITY OF CHOICE for PANCREATITIS?
what do we usually see? (2)
can ALSO see REGIONAL ____
if INFLAMMATION present, we might be able to see… (2)
____ sensitivity
= ABDOMINAL ULTRASOUND
usually see…
1. ENLARGED, HYPOECHOIC PANCREAS due to FLUID PRESENT INSIDE
2. HYPERECHOIC MESENTERY
can ALSO see REGIONAL LYMPHADENOPATHY (near pancreas)
if INFLAMMATION…
1. PERITONEAL EFFUSION
2. CORRUGATED DUODENUM
TOP circle?
BOTTOM line?
shows WHAT disease?
TOP circle = ENLARGED, HYPOECHOIC pancreas from FLUID
BOTTOM line = HYPERECHOIC SURROUNDING MESENTERY
shows PANCREATITIS
TREATMENT for pancreatitis? (6)
- REMOVE any INCITING CAUSE
- NUTRITION CHANGE
- AVOID DRUGS that can AGGRAVATE pancreatitis
- provide adequate PERFUSION
- ANALGESIA
- ANTI-EMETICS
2 nutritional directives for PANCREATITIS?
nutrition PREFERRED to be given via _____ via what 2 methods?
if ILEUS is present, what method should we use to deliver nutrition
2 nutritional directives?
1. NO NEED FOR NPO
2. LOW-FAT diet or at least NO HIGH-FAT FOODS
nutrition PREFERRED to be given ENTERALLY via…
1. FEEDING TUBE
2. ORALLY if tolerated
if ILEUS present, use NG tube for NUTRITION
what 2 clinical signs could indicate ANTIBIOTIC USE in PANCREATITIS?
usually NOT indicated, but could be if…
1. BLOODY D+
2. BLOODY V+
FUZAPLADIB (PANOQUEL BRAND)
= what does this aim to do & in what species??
pathophys?
= aims to CONTROL CLINICAL SIGNS of PANCREATITIS in dogs
pathophys = BLOCKS NEUTROPHIL MIGRATION to PANCREAS
PROGNOSIS of pancreatitis in dogs?
MOST will…
GUARDED, WIDE range of severity!
MOST will RECOVER
FELINE pancreatitis…
often is these one of 3 descriptors?
often associated with WHAT 2 diseases?
often see ___-___ clinical signs, specifically… (2)
use ____ test and ____ ____ to diagnose, but compared to dogs…
often is one of 3….
1. CHRONIC
2. INSIDIOUS
3. and/or RECURRENT
often associated with…
1. CHOLANGITIS
2. IBD
often see NON-SPECIFIC clinical signs, specifically…
1. LETHARGY
2. ANOREXIA
use fPLI test and ABDOMINAL ULTRASOUND to diagnose, but compared to dogs US LESS SENSITIVE FOR FELINE PANCREATITIS
after the INDUCTION of pancreatitis, fPLI remains ____ for ____ ____
fPLI quantitative parameters? (3)
PROGNOSIS of FELINE PANCREATITIS?
ELEVATED, 10 DAYS
fPLI
≤3.5 ug/L = NORMAL
3.6-5.3 ug/L = EQUIVOCAL
≥5.4 ug/L = PANCREATITIS
PROGNOSIS is VARIABLE/GUARDED
what are the TWO differences in treatment for FELINE pancreatitis when compared to dogs?
- DO NOT WITHOLD FOOD bc DO NOT WANT TO CAUSE HEPATIC LIPIDOSIS
- more likely to give ANTIBIOTICS because HIGH POSSIBILITY of CONCURRENT CHOLANGITIS from ASCENDING BACTERIAL INFECTION
2 NEGATIVE prognostic indicators for FELINE PANCREATITIS?
- HYPOCALCEMIA
- fPLI >20 ug/L at HOSPITAL ADMISSION
EXOCRINE PANCREATIC INSUFFICIENCY…
what is the MOST COMMON cause in DOGS?
1. definition/pathophys
2. likely mediated by…
what is the MOST COMMON cause in CATS?
1. definition/pathophys
TREATMENT is often very…
DOGS = PANCREATIC ACINAR CELL ATROPHY
1. = CONGENITAL CONDITION where PANCREATIC ACINAR cells will ATROPHY over time
2. likely IMMUNE-MEDIATED
CATS = CHRONIC PANCREATITIS
1. = RECURRENT pancreatitis causes LOSS OF ACINAR CELL MASS, so if this happens enough they DON’T MAKE ENOUGH DIGESTIVE ENZYMES = EPI
TREATMENT often very EFFECTIVE
EXOCRINE PANCREATIC INSUFFICIENCY…
likely in WHAT age dogs?
what BREED of dog is most affected? + give 3 other breeds
likely in WHAT age cats?
likely in YOUNG ADULT dogs 1-5 YEARS
most COMMON BREED for EPI = GERMAN SHEPHERD
1. ROUGH-COATED COLLIE
2. CHOW
3. CAVALIER KING CHARLES
like in MIDDLE AGED to OLDER cats
EXOCRINE PANCREATIC INSUFFICIENCY…
3 clinical signs in DOGS?
1 clinical sign in CATS? what 2 things do we NOT see?
what is the CHOICE for DIAGNOSIS?
what is COMMONLY seen on CHEM & why?
in DOGS…
1. WEIGHT LOSS
2. D+ (not enough enzymes to absorb ingesta) –> VOLUMINOUS & STEATORRHEA
3. POLYPHAGIA (RAVENOUS hunger)
in CATS…
1. WEIGHT LOSS ONLY
2. NO APPETITE CHANGE or D+
do TLI!
can see COBALAMIN DEFICIENCY in dogs/cats from LACK OF INTRINSIC FACTOR
TREATMENT for EPI…
1 common worry for OWNERS?
usually give WHAT medication? if that doesn’t work, can try..?
2 traits of DIET we can put EPI pet on?
OWNERS = can be EXPENSIVE, especially for large dogs & LIFELONG
usually PANCREATIC ENZYME SUPPLEMENTATION via POWDER, but if that doesn’t work, can try ANTIBIOTICS (dysbiosis)
DIET can be…
1. HIGHLY DIGESTIBLE
2. LOW FAT
