Dx - malabsorption/maldigestion (Strandberg)

Question 1

Amylase

Answer 1

Amylase
- main source = pancreas
- additional sources = intestines +/- liver
- excretion from bloodstream = via kidneys

Acute pancreatitis:
- Dogs: AMS is wnl to >10x upper reference interval (URI)
- Cats: not very sensitive -> look for decreased GFR

Question 2

Lipase

Answer 2

• source = pancreas, gastric, hepatic
• excretion = kidney

Acute pancreatitis
- Dogs: LPS WNL to >10x URI
- Cats: LPS WNL to < 5x URI (not as sensitive as in dogs) -> look at decreased GFR (increaseds are < 4x URI)

Question 3

Pancreatic Lipase Immunoreactivity (PLI)

Answer 3

• is a referral diagnostic test for PANCREATITIS
• specific for pancreatic lipase enzyme
• in-house rapid tests (SNAP cPL and fPL): not as reliable, but if negative, acute pancreatitis = unlikely. If postiive, confirm with PLI test

PLI within the RI does not r/o pancreatitis

Question 4

Chronic pancreatitis

Answer 4

Continued inflammation can lead to Acinar necrosis
- decreased pancreatic mass -> amylase and lipase are going to be lower -> even more diffucult to diagnose with clinpath tests

Question 5

Etiologies of EPI

Exocrine Pancreatic Insufficiency

Answer 5

• Idiopathic pancreatic acinar atrophy (dogs)
• Chronic pancreatitis with destruction of acinar cells
• Typically presents chronically

Young adult german shepherds

Question 6

Trypsin-Like Immunoreactivity (TLI)
- uses
- interpretation of increased and decreased levels

Answer 6

• used to detect/rule out EPI
• test TLI before testing for malabsorption
• causes of increased levels: similar to those for AMS, LPS, PLI
• Decreased fasting TLI levels = diagnostic for EPI!!!

Question 7

Malabsorptive diseases

Answer 7

Chronic small-bowel enteropathies

Question 8

Malabsorptive diseases: Folate (vitamin B9)
- function/source
- interpreting decreased folate and increase folate levels

Answer 8

Folate (vitamin B9)
- is absorbed by proximal SI, sourced via diet & intestinal bacteria
- Decreased folate = proximal SI dz; dietary deficiency
- Increased folate = SI bacterial overgrowth, EPI, excess supplementation, excess gastric acid secretion, cobalamin deficiency in cats

Question 9

Malabsorptive diseases: Cobalamin (vitamin B12)

Answer 9

Cobalamin (vitamin B12)
- absorbed by distal SI and ileum
- requires low gastric pH & presence of pancreatic enzymes for absoprtion
- decreased cobalamin: EPI, SI bacterial overgrowth, ileus dz, Cobalt definciency in cattle

Cobalt (Co), in ruminants, is an essential component for the microbial synthesis of vitamin B12, a water-soluble vitamin belonging to group B, commonly known as cobalamin

Question 10

When are folate and cobalamin results significant?

Answer 10

ONLY if pancreatic function is normal and the patient’s condition is sufficiently chronic for the body’s reserves to beomce depleted-> Testing for issues with ABSORPTION (NOT digestion)