Exam 3 - Pancreatitis Flashcards
what is more common - acute or chronic pancreatitis?
chronic pancreatitis
what are some challenges for diagnosing pancreatitis on ultrasound in regards to sensitivity?
sensitivity is largely operator dependent!!!!!
sensitivity is lower with less severe disease & limited operator skill
what are some challenges for diagnosing pancreatitis on ultrasound in regards to specificity?
specificity is limited by other conditions being associated with similar changes - hyperplastic nodules on the pancreas, pancreatic edema, & peritoneal effusion
what are some possible ultrasound findings for a patient with pancreatitis?
enlargement of the organ
fluid around the pancreas
echogenicity changes of the pancreas - if decreased, necrosis & if increased, peripancreatic fat necrosis
dilation of the pancreatic duct
what are 4 components that make up the challenges encountered in using ultrasound to diagnose pancreatitis?
severity of disease
quality of the equipment used
level of suspicion
skill of the operator
T/F: MRI is used for routine diagnosis of pancreatitis
false
what is the best diagnostic imaging used in humans for diagnosing pancreatitis? is it the same in companion animals?
ct in humans
no - the organ is so small, CT isn’t too great
the CBC & chemistry on a pancreatitis patient will have a variety of changes observed & none of which are specific for pancreatitis - why is it still important to run?
you need to evaluate the patient for systemic complications!!!
is serum amylase activity useful in diagnosing pancreatitis in dogs & cats? why?
no - can be elevated in some dogs with pancreatitis but rarely in cats, can also be elevated in dogs with non-pancreatic conditions
low sensitivity & specificity
T/F: most point of care analyzers for lipase activity are based on dry chemistry
true
what is the most specific assay used for the measurement of pancreatic lipase?
spec cPL
is serum lipase activity useful for diagnosing a dog or cat with pancreatitis? why?
NO - none of the substrates are truly specific for pancreatic lipase/pancreatitis
depends on the substrate elevated in dogs/cats with spontaneous pancreatitis
limited diagnostic value in dogs & cats - sensitivity/specificity are dependent on the substrate & cut-off values
what is the most sensitive & specific test available for canine/feline pancreatitis?
canine pancreatic lipase immunoreactivity - cPLI, both spec & SNAP tests
feline pancreatic lipase immunoreactivity - fPLI, both spec & SNAP tests
what does a negative SNAP cPLI/fPLI tell you?
rules out pancreatitis
what does it mean if you have a patient that has a positive cPLI/fPLI SNAP test? what should you do next?
need to run a spec cPL/fPL to confirm your diagnosis & to get a baseline value for monitoring
which of these cPLI/fPLI tests suggests an abnormal result?
the one on the right is abnormal - dot on the right is darker than the control dot on the left
is the VetScan cPL test useful? why?
assay shows poor linearity - may be clinically relevant because the assays working range is only up to 600-700 ug/L
poor precision & poor reproducibility
what is a pancreatic cytology useful for confirming? what is it not useful for ruling out?
high specificity for confirming an inflammatory process
not very useful to rule out an inflammatory process - low sensitivity
what is the safest way to get cytology of the pancreas in dogs & cats?
FNA - safe
why are multiple biopsies needed of the pancreas when trying to diagnose pancreatitis?
pancreatitis is highly localized - need to biopsy for confirmation of diagnosis
what are the components of management for acute pancreatitis in dogs/cats?
treatment of identified risk factors - hypercalcemia, hypertriglyceridemia
treatment of hypovolemia - aggressive fluid therapy
limit exposure to unnecessary drugs - especially those associated in causing pancreatitis
nutritional support
rigorous monitoring & early intervention against complications
analgesia
antiemetics
what are some complications seen in cats & dogs with acute pancreatitis?
electrolyte & acid/base imbalances
DIC
myocarditis
acute renal failure, pulmonary failure, & multi-organ failure
T/F: routine NPO is no longer suggested for patients with acute pancreatitis
true
how is nutritional support used in patients with pancreatitis?
enteral nutrition is preferred to parenteral nutrition
pre-pancreatic nutrition
why is analgesia important for patients with pancreatitis?
abdominal discomfort is the key clinical sign in humans with pancreatitis but isn’t commonly noted in veterinary patients
becomes apparent after analgesic therapy has been started
why not use metoclopramide in patients with pancreatitis?
weak anti-emetic & is a dopamine inhibitor, so it may have negative effects on pancreatic perfusion
are antibiotics commonly used for patients with pancreatitis?
no - rare infectious causes
dogs & cats with severe acute pancreatitis usually don’t reach the late stage of disease
what is fuzapladib?
novel drug that acts as a LFA-1 inhibitor that is approved for canine pancreatitis in Japan that has shown promise
how is chronic pancreatitis managed?
treatment of the cause
treatment of the concurrent conditions - such as IBD, hepatitis, & diabetes mellitus
analgesia
nutritional support - very important in dogs, very low fat diet & only low-fat treats
anti-nausea drugs & appetite stimulants
what drug is a very effective choice for appetite stimulation in cats?
mirtazapine
what drug is a very effective choice for appetite stimulation that is licensed for use in dogs & cats?
capromorelin
how are patients with chronic pancreatitis monitored?
serum spec cPL in dogs/serum spec fPL in cats
every 2-3 weeks after resolution of pancreatitis with decreasing frequency
what is the pathogenesis of autoimmune pancreatitis?
associated with lymphoplasmacytic infiltrates that is mostly centered around the pancreatic ducts with inflammatory cells staining positive for IgG
associated with severe swelling of the pancreas - patients often suspected of having pancreatic neoplasia
how are patients with autoimmune pancreatitis treated?
corticosteroids
T/F: many dogs & cats with chronic pancreatitis have a lymphocytic-plasmacytic infiltration of the pancreas
true
why are dogs & cats with chronic pancreatitis treated with immunosuppressive doses of steroids or cyclosporine instead of azathioprine?
azathioprine is associated with pancreatitis
